Diabetes Matters Summer 2017/18 by Diabetes WA

Summer 2017/18 $6.95

Partners in Health

THE HEALTH SPECTRUM

World Diabetes Day NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS

Eating the

Rainbow

From the Editor tern Australia can only be Supporting people affected by diabetes in Wes y individuals and organisations. man of ts effor joint the achieved through how important it is for health at look In this issue of Diabetes Matters we help people living with chronic care organisations to work together to conditions. trum, recognising that there We have called this issue The Health Spec So often, people are living . eing are many facets to health and wellb or otherwise, that is having an nic chro , issue h healt with more than one impact on their lives. lth Hub’ model of care that looks Diabetes WA is working towards a ‘Hea rated health care services. The at the provision of coordinated and integ illness prevention, capacity and otion prom h healt World Diabe model encompasses tes Day ciplinary care for people with i-dis building within the health system, mult selfand ation educ to oach appr d entre on-c pers a chronic conditions, and management programs (see page 8). egic vision, in November we While we continued to focus on our strat Living Well Day, as we celebrated etes were also super-powered for World Diab ted by, affec or , with g livin en wom – lives our the real super heroes in See what we, and our generous diabetes. It was all about the SHEroes! find out your ‘SHEro’ name can (you 6 page From the President.........................................................3 supporters, got up to on too!). Perspective .....................................................................4 coming up remember, shops may And finally, with the Christmas break your tact Con ay. holid on off Diabetes News be closed or perhaps you are heading make sure you have the diabetes preferred Access Point or pharmacy to Telehealth Award............................................................5 the festive season. supplies you need to get you through CGM Transmitters ..........................................................5 etes WA. Merry Christmas from the team at Diab World Diabetes Day........................................................6 Enjoy,

Contents

Natasha

page (AKA: Rainbow-Pump-Injector – see

SUMMER 2017/18 Editor Natasha Simmons Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA, 6904 Phone 1300 001 880 Email media@diabeteswa.com.au Editorial submissions should be sent to Diabetes WA, care of the above address. All care will be taken with contributions however no liability for loss or damage to unsolicited materials will be accepted. Disclaimer The opinions expressed in articles and the claims made in advertising materials presented in Diabetes Matters are those of the authors and the advertisers respectively, and do not necessarily reflect the view of Diabetes WA, unless stated. The information provided is for the purposes of general information and is not meant to substitute the independent medical judgment of a health professional regarding specific and individualised treatment options for a specific medical condition. No responsibility is accepted by Diabetes WA or their agents for the accuracy of information contained in the text or advertisements and readers should rely on their own enquiries prior to making any decisions regarding their own health.

The Health Spectrum The Shape of the Health System .................................8 Leading through Collaboration...................................12 Primary Care .................................................................14 Focus on Prevention ....................................................16

Education Planner Plan your sessions........................................................18

Research News Research Round-up......................................................20 Diabetes Research WA Update...................................21

In the Community A Family’s Story ...........................................................22 Disability and Diabetes ...............................................24 Q&A................................................................................25

Living Well Twinkle Toes...................................................................26

Thanks to Jim Dodds, Christopher Van Aurich, Sue Van Aurich, Identitywa, Michelle Ebbs, Sherl Westlund, Tony Ganzer, Murdoch Books, Podiatrists Perth, Josh Cheng, The Cobby Family

Moving Well

Photography DWA staff, ambassadors and contributors, Shutterstock, Murdoch Books

Eating Well

Foot Gymnastics...........................................................27

Design key2creative

Full Spectrum Eating ...................................................28 Recipes...........................................................................30

Print Quality Press

Members’ Area

Diabetes WA www.diabeteswa.com.au

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

Diabetes Information and Advice Line: 1300 001 880

Postal Address: PO Box 1699, Subiaco WA 6904

Email: info@diabeteswa.com.au

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

Members’ Competition and Puzzle ...........................33 Member Partners .........................................................34

What’s on....................................................................34 Dates for Your Diary .....................................................35

From the

Meet Our Team

President

hat a year 2017 has been for Diabetes WA. In this, our members’ magazine, we have encouraged you to change the way you think about diabetes, as we also changed to suit the environment in which we operate. We looked at the impact that technology is having on diabetes management, and reminded you about your rights in the workplace, as a person living with diabetes.

Dr Moira Watson Diabetes WA President and Board Chair

Amongst many operational highlights and challenges undertaken this year, our new constitution was introduced which is more capable of guiding and supporting our organisation’s growth and development into the future. This constitution promises opportunity, but only the continued commitment and hard work from your Diabetes WA team can help us achieve our goals. In this edition of Diabetes Matters we therefore examine the Health Spectrum and, in particular, we take a look at the Diabetes WA vision of creating a Health Hub. In our planning we recognise that the WA health system, of which we are a part, is going to need to change and reform if it is going to meet the challenge of balancing the supply and demand for services in a financial environment that is likely to remain constrained for the medium term at least. The WA Health Minister, Roger Cook has launched the WA Sustainable Health Review project which will examine specific opportunities for improvement and efficiency within the WA health system. Having regard for the State and Commonwealth duality of health system funding this, of course, immediately also sweeps up the Commonwealth Government’s health reform agendas. Diabetes WA is engaged in both, participating in the stakeholder consultations for the WA Sustainable Health review and the Commonwealth NDSS Enhancement Project. In the following pages we explore some of these conversations in more detail as we examine: discussion of inter-related chronic conditions; condition co-morbidity; prevention options and new initiatives; and the importance to Diabetes WA of working in partnership with primary health care providers and other health organisations. We also showcase our World Diabetes Day activities, an important event on the diabetes calendar and, this year, the opportunity to celebrate the women dedicated to their own or their loved ones journey with diabetes. As this year draws to a close and you embark on a new one, may you enjoy time with family and friends, celebrating and reflecting on the things that you are thankful for. Until next time…

Dr Moira Watson President and Board Chair

•

he articles in Diabetes Matters are informed by the wealth of knowledge contained within our organisation. Below are some of the talented DWA individuals who have contributed to this edition. Amanda Lee Accredited Practising Dietitian and Credentialled Diabetes Educator. Bachelor of Science in Nutrition with a Postgraduate Diploma in Nutrition and Dietetics and Graduate Certificate in Diabetes Education. (see page 29) Deborah Schofield General Manager Health Services. Accredited Practicing Dietitian and Diabetes Educator with a Graduate Diploma in Dietetics and a Graduate Diploma in Diabetes Education. Deb has wide experience in the field of nutrition and diabetes education, having held community and regional roles in Australia and the UK. (see page 8) Sophie McGough Health Services Operations Manager. Accredited Practising Dietitian and Credentialled Diabetes Educator with Diabetes WA for 20 years, Sophie has had a varied career working in diabetes within community, population health, research and primary care settings. (see page 15)

Want to know what we got up to in the 2016/17 financial year? Visit our website to read our 16/17 Annual Review. The accompanying audited financial statements are also available. diabeteswa.com.au – It’s hiding under the About Us/ Our Organisation tab.

perspective

Perspective D

iabetes WA Board member since 2011, Jim Dodds has been active in the health field for over 30 years. He is currently Director of Environmental Health in the Public Health Division within our state’s Department of Health, and says that prevention is key to creating positive change in community health. He gives us his perspective below. Working across the Pacific region in environmental health, in a team that also had a focus on obesity and lifestyle change, I have observed that as these countries become more developed, the impact on the economy and community is phenomenal. It demonstrates how lifestyle factors have such an effect on the health of a population. It is vital that we educate people about the impact lifestyle factors, such as diet and exercise, can have on health, and we need to approach it from all angles. Health partnerships in the future will be crucial for chronic disease prevention and management to ensure we make the best use of resources on the ground. It is important to collaborate so as not to duplicate and to ensure that the individual looking for support is receiving consistent advice from difference sources. At times, in health, consumers receive conflicting advice which can be confusing and can cause them to lose faith in the system and providers. Collaborating across telehealth services, in particular, is vital for remote communities to receive high level advice and assistance. It is great to hear that Diabetes WA has recently won the WA Health Excellence Awards for the Diabetes Telehealth for Country WA program. This is testament to how well this service is working and having an impact. Diabetes WA provides a great suite of programs and services, including DESMOND, and manages a whole range of risk factors for diabetes and chronic conditions to help people to gain control of their health. DWA has also worked particularly well in the NDSS space, acting as an important bridge in the community to ensure pharmacies and medical clinics provide the right product. The organisation’s partnerships with the WA Country Health Service and the WA Primary Health Alliance also add value and extend resources to create an even bigger impact.

So how do we achieve change? Prevention is very important. There are many stages to work on in order to prevent the burden on the health system. New programs such as Let’s Prevent is a great investment by the Government in regards to prevention. While working with local governments in community health planning in Australia, in regards to healthy activities, I have seen that getting city infrastructure and transport right helps to create a healthier environment and community. It has been important to me in my career to try to get communities looked after in city decision-making to create healthier neighbourhoods. The ‘Health Hub’ concept, as this edition of Diabetes Matters outlines, should be embraced and DWA is being very proactive in this space, willing to reach out to others to partner, which should be encouraged and embraced. This is our future and our strength. Partnerships with primary care are integral and allow for greater resourcing to deliver more programs and services particularly in rural and remote areas. There are so many facets to creating healthy people living in healthy environments, but it is important to recognise that what doesn’t work well in the health space, is being driven by ambition not evidence. Evaluation of programs is critical in order to provide outcomes for those living with diabetes and other chronic conditions, and to develop appropriate and relevant programs and services that will provide them with the support they need.

Jim Dodds In his role as Director of Environmental Health in the Public and Aboriginal Health Division of the WA Department of Health, Jim is currently working with local governments and committees to develop policies for food management and regulation – trying to take a holistic approach. He has worked in various Australian State and Federal governments and has held international roles with development and aid organisations.

Telehealth wins top award at the WA Health Excellence Awards T

he hard work and dedication of the team behind the Diabetes Telehealth for Country WA service was formally recognised and celebrated at the WA Health Excellence Awards 2017. On 8 November the Diabetes Telehealth service was named the winner of the highly prestigious Director General’s Award. This award is chosen personally by the Director General of the WA Department of Health, Dr D J Russell-Weisz, and is an over-arching award selected from a field of eight category winners. The Diabetes Telehealth service also won the WA Health Excellence Award in the category of Overcoming Inequities. “We are absolutely thrilled to receive these awards,” says Gill Denny, Manager of Teleservices at Diabetes WA. “To win our category is wonderful, but to have the Director General also recognise the

The Diabetes Telehealth team with Carole Rainsford (far left) and Kate Hawkings (far right) of the WA Cou ntry Health Service

work we do is just amazing. We are very proud and grateful for the support of the WA Country Health Service and WA Primary Health Alliance.” Established in 2015, Diabetes Telehealth is the first service of its kind in Australia. It uses video-conferencing technology to link credentialled diabetes educators with Western Australians living in rural and remote areas of the State. The team of four diabetes educators see up to six adults a day via video-conferencing, providing them with much-needed advice on living with and managing diabetes. The rest of the day is spent offering ongoing client support via phone and email.

“We know this service is making an impact,” says Gill. “In its first two years, the team has provided nearly 1900 consultations.” Importantly the service is also greatly reducing the need for clients to travel, as educators can conduct the consultations by linking with local hospitals, GP practices or even the client’s own home laptop. It is estimated that the service has saved more than 350,000kms of travel for clients. Congratulations to the dedicated Telehealth team!

Wild Wild Kids

west’ themed camp, etes had a wild time at our ‘wild, wild diab 1 type with g livin s year 9-10 Twenty-eight children aged n Camp in Hillarys. Along with learning garet Hospital, at Ern Halliday Recreatio Mar cess Prin with tion unc conj in ed host ding beach games, boot scooting, in a range of fun, physical activities inclu part took they , time ction refle and sessions petition. gumboot throwing and a quick draw com nes,” camp participant, Imogen said. camp, like how to help get rid of keto “I learned lots of different things on the I wasn’t alone.” type 1 diabetes was good because I felt “Spending time with other kids who have

Diabetes Day

We celebrated World Diabetes Day on 14 November

he theme for this year’s World Diabetes Day (WDD) was ‘Women and Diabetes’. According to International Diabetes Federation statistics, one in every 10 women is living with diabetes and, globally, over 199 million women live with the condition, a number which is projected to increase to 313 million by 2040. Here in Australia we channelled female empowerment with the ‘Super SHEro” campaign – recognising the women and girls who never give up, using their super inner strength to ride the rollercoaster of living with diabetes. We celebrated researchers super-charging the way to find new treatments and a cure; and super-amazing doctors and nurses dedicated to making life better for people with diabetes; as well as supercaring mums, sisters and daughters who help their loved ones with the highs, lows and all the other tricky parts of life with diabetes. We asked… Who is your Diabetes Super SHEro?

Thanks to some of our generous fund- and awareness-raisers Glengarry Primary School Glengarry Primary School in Duncraig hosted a dress in blue day to raise money for Diabetes WA. They raised $538.50 and also helped students to better understand diabetes by teaching them about the condition and gave the kids tips on healthy food choices and physical activity.

Mirvac Spin Cycle

Dept of Social Services Morning Tea

What did Diabetes WA get up to on WDD 2017?

The Department of Social Services in Perth CBD held a morning tea for staff serving healthy fruit and vegetables to create awareness about the condition. They raised $130.

Presentation with Lions Eye Institute

Hand Massages On the weekend following WDD Aromatherapist, Rebecca Tichbon raised money at the Bunbury markets. Visitors stopped by Rebecca’s stall to receive a relaxing hand massage with part proceeds going to Diabetes WA. Rebecca then continued to raise money during the following weeks.

Mirvac Spin Cycle On 30th November Mirvac, in conjunction with VAULT Fitness, hosted a spin bike challenge in the lobby of their Allendale Square building in Perth City. Staff and tenants created teams, clocking their kilometres on a spin bike. The owner of VAULT Fitness managed to cycle the entire day – 8 hours non-stop – even eating his lunch on his bike. More than $3,300 was raised for Diabetes WA.

Ophthalmologist, Dr Hessom Razavi of the Lions Eye Institute, joined Diabetes WA diabetes educator and dietitian, Rebecca Flavel for a free lunchtime presentation at the Harry Perkins Institute of Medical Research. Dr Ravazi offered attendees insights into diabetic eye disease while Rebecca told the local story of diabetes in WA.

Social Media Our Facebook page ran hot in November, promoting the Diabetes Australia Super SHEro characters and celebrating our super-strong women. See if you can create your Super SHEro name using the table on the following page.

Rebecca at the Bunbury Markets

Diabetes Day World Diabetes Day began in 1991, created by the International Diabetes Federation and the World Health Organisation. The day strives to raise awareness of diabetes and its health complications and, this year, aimed to enhance the wellbeing of present and future generations of women and those around them, breaking down the barriers that prevent access to cost-effective diabetes prevention.

WA’s Super SHEro Family T

o acknowledge World Diabetes Day, Channel Ten News interviewed local ‘Super SHEroes’, Karen, Hollymaree and Chelsealee Cobby. Diabetes WA coordinated the interview for the network, as the women of the Cobby family are all living with type 1 diabetes and were happy to share their story. Despite battling nerves on the day, the ladies spoke of their experience with diabetes and the challenges they face emphasising that, although diabetes is a serious condition, it doesn’t stop you achieving your dreams. Oldest sister Hollymaree, a lawyer, was diagnosed at aged 13, while her younger sister Chelsealee was diagnosed a few years later. Mum, Karen was the last to be diagnosed. The following is an excerpt from Hollymaree’s Facebook page after completing the interview; “Today is World Diabetes Day. I had the most wonderful day with Diabetes WA, and Channel 10, filming a piece on my experience with diabetes, and the support services available to everyone. I was 13 years old when I was diagnosed with type 1 diabetes….I had no idea what diabetes was, or what would happen to me. The confronting thing that I did know was that I would have to live the rest of my life having four injections of insulin a day, and have to manage the constant battle that was my sugar levels.

Now, almost 15 years and 8 months later I am acutely aware of what it’s like living with diabetes. It’s a condition that affects me every single minute of every single day, and is difficult at the best of times and unbearable at its worst. It’s an invisible illness and only those who are affected by diabetes know how relentless it can be. Thankfully, I now manage my diabetes with the assistance of an insulin pump, which…has given me a lot of flexibility with my treatment, and has allowed me to live a relatively normal life.

As a family, we are so lucky to have also had the support of a team of medical professionals, and the wonderful people at Diabetes WA. They have provided us with so many resources over the years, and have always kept us up to date with all of the diabetes news. Diabetes WA supports people affected by all types of diabetes, and provides a wealth of resources for anyone caring for someone with diabetes.”

Despite my diabetes battles, I am not defined by the disease. I don’t ever let it define who I am, or the goals I set out to achieve. I am so lucky to be surrounded by so much support. The support of my mum and sister has been unconditional, and I will eternally be grateful for everything that they have done for me.

The Cobby Family

THE HEALTH

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Shaping the future of WA’s health system

early 40% of people aged 45 years and over suffer from two or more chronic conditions, with an additional 30% of the population at risk of developing chronic disease. Though diabetes is not always one of these chronic conditions (though in a high percentage of cases it is) these statistics show that it is naïve of us to think we can throw one health solution at an individual and expect it to “fix” them. It is important to look at the whole spectrum of health and understand that many factors come into play.

Specific to diabetes, multiple morbidities are also common. To throw some more statistics around, 67% of people aged under 60 and 91% of people over 60 with diabetes are living with another chronic condition. Supporting people affected by diabetes in WA can only be achieved through the joint efforts of many individuals and organisations. There are numerous organisations that are working in this space, in both prevention and disease management, who are supporting individuals to lead long productive lives and to take the burden off the health system and the health dollar.

“To achieve effective change in health outcomes, we need to cut through the complexity and make everything revolve around patient need,” Diabetes WA’s General Manager of Health Services, Deb Schofield says. “If we bring our expertise together and share it, along with our resources and those that are being offered to us, we can do far more in collaboration than we can as individual organisations. “Innovative partnerships and continually searching for evidence-based solutions that create effective strategies work well.”

THE HEALTH

Innovative partnerships for chronic conditions The partnership between the Western Australian Country Health Service (WACHS) and Diabetes WA to commence the Diabetes Telehealth Service is an example of a successful partnership that achieves results. Recently awarded the Director General’s Award in the Department of Health’s WA Health Excellence Awards, (see page 5) the program is the only model of its kind in Australia. Diabetes educators are upskilling health professionals in the regions and are providing individual consultations to patients, all through telehealth technology. The outcomes of this service are very positive and continue to be measured. Diabetes WA is also working with Asthma WA to start the process around a chronic conditions hub for telehealth. Deb believes this type of collaboration should become commonplace. “Non-Government Organisations (NGOs) should be partnering together, along with the State, to deliver economical up-scaled services, instead of NGOs developing independent services, all with door-opening costs,” she says. “Health funding models can drive this type of collaboration.”

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The management of chronic conditions is mostly about self-care or self-management. A person living with diabetes will typically see their GP and other health providers for eight hours in a year. This leaves around 8,750 hours a year where they are making decisions from day to day in order to best manage their condition. The WA Diabetes Standards of Care 2014 states that on diagnosis, people should be offered structured diabetes self-management education. The National Diabetes Services Scheme (NDSS), funded by the Commonwealth Government and administered by Diabetes WA locally, is leading the country in this area. Diabetes WA has been particularly influential and innovative with cost saving outcomes being actively measured in an ever-increasing cohort of consumers. “Using the NDSS platform as a driver of quality service would be beneficial for the state,” Deb proposes. “Taking a systematic approach, and utilising this quality platform of national programs, that have proven outcomes, as the standard programs for WA would assure many positive outcomes.” This approach could then be extended to other chronic conditions.

Collaboration with other health agencies is particularly crucial in chronic disease secondary prevention, especially in conditions with similar risk factors such as kidney, stroke, diabetes and cardiovascular disease.

THE HEALTH

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Communication is Key Deb says communication is also key to being effective, while remaining resource-wise. “In health, not all of our databases talk to each other,” Deb says. “Sharing information about an individual who may be living with several chronic conditions, each being managed by a different intervention or primary care provider, means a clearer and more accurate management plan can be developed.” Database systems that can move towards consistency and easy sharing will greatly improve the efficiencies of the health system. “Co-morbidity complicates treatment paths and if we, as health providers, aren’t all talking to each other, and know what else exists for that person or what other advice they are receiving, then how do we come up with the best health solution for that individual?” Deb asks. An initiative to assist with this does already exist. Introduced by the Commonwealth, My Health Record is a secure online summary of an individual’s health information. The user can control what goes into it, and who is allowed to access it and can choose to share their health information with doctors, hospitals and other healthcare providers.

The Australian Government announced in the 2017 Budget the creation of a My Health Record for every Australian to begin nationally from mid-2018, with an opt-out system, rather than an opt-in. Deb believes this initiative is definitely a step in the right direction. “Hopefully My Health Record will help us to move along this pathway of open communication,” she says. Sharing health information not only helps to inform treatment for an individual, but sharing information and resources also makes sense financially. “As much as everyone involved would like there to be more, there is only one pool of money to spend and we need to make sure we are using these resources wisely,” Deb says. “Efficient investment of funds is what sustainability is all about, and sharing these resources allows all agencies to work towards a vision of an equitable health system.” “We also need to talk about connecting not only across health services, but also across other sectors such as local government, sport and recreation and the Department of Transport,” Deb explains.

THE HEALTH

Sustainable Health Review In June 2017, the Government of Western Australia announced the Sustainable Health Review to prioritise the delivery of patient-centred, high quality and financially sustainable healthcare across the State. The project will review the WA health system to put patients first, embrace innovation and technology and improve sustainability. With the health system under increasing pressure from an ageing population, chronic disease and health inequity, the health budget continues to rise. This creates a need to focus on value and innovation to further improve health outcomes; ensure safe and high quality services; improve patient experience; and drive clinical and financial performance. With a final report due by March 2018, the review has involved wide consultation with stakeholders including consumers and carers, front-line staff, key health agencies and health leaders. Diabetes WA has been one of these stakeholders. “It allows our organisation to contribute to the future vision for health in Western Australia,” Deb says. Diabetes WA delivered a detailed submission to the Department of Health, outlining what is needed to develop a more sustainable, patient-centred health system in WA, and have been providing feedback whenever it is welcomed.

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“The leadership skill set that will be required to successfully achieve innovative changes in WA Health is a very important resource which should also not be overlooked,” says Deb. “Additionally, funding programs that have emerging evidence-based outcomes, such as the DESMOND and Smarts self-management programs we offer through Diabetes WA, ensures that quality standards are met. “We need to build robust evaluation into any activity undertaken beyond occasions of service measures.”

WA Primary Health Alliance A significant group within the WA health system, the WA Primary Health Alliance, is also focused on collaborative health care and is a group that Diabetes WA is working with on a number of projects. The WA Primary Health Alliance (WAPHA) is a planning and commissioning body that evolved from a unique partnership of like-minded and committed organisations dedicated to building a robust and responsive patient-centred primary health and social care system. “Like us, WAPHA believes outcomes are achieved through innovative and meaningful partnerships at the local and statewide level,” Deb explains. “We have been working with the Alliance on many WAPHA-driven initiatives (see page 13 for information on our contribution to the development of the Health Pathway WA) and with each project, we are one step closer to bridging the gaps in service provision across the state.”

THE HEALTH

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What could a sustainable WAÂ health system look like?

o what does Diabetes WA think this sustainable person-centred health system for WA should look like when we are talking about helping those living with chronic conditions?

It is important that Diabetes WA continue to be a part of the health agenda and, at every opportunity, we offer our thoughts and expertise to key influencers and decision-makers. The strategic vision of the Diabetes WA Board is working towards a Health Hub model for chronic conditions, which cuts through the complexity and makes everything evolve around patient need. A model that allows a coordinated central contact point to support people with chronic conditions and easily connects people, and their primary care providers, to their next selfmanagement steps. Putting a model such as the Health Hub into action will assist with ensuring that current best practice and evidence is being applied in real time and that there continues to be quality

improvement on the services offered. Establishing partnerships between health agencies and universities and other health professionals will make sure that consumers are getting what is effective and relevant to them. The model will also focus on capacity building to increase reach, and make training available to all health professionals to ensure professionals are delivering self-management support to people with chronic conditions at a high standard and in a consistentÂ way. Each element of the Health Hub includes a notion of ensuring the program or service provided to the consumer is proven to be effective, of high quality and consumer centric.

University-based Research Evaluation of programs to ensure consistency and quality

GP & Primary Care Use hub for care coordination

Government Evidence-based results reported to inform decisions on health spending and focus areas

Health Professionals Have a central source of information

Training & Development Capacity-builds the WA health system through training health professionals

THE HEALTH

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How Diabetes WA is working towards this Vision Leading through Collaboration Amongst many other collaborative projects in which we are involved, the following are some key partnerships that we have created to support and work towards our vision of the Health Hub concept. • Telehealth and the Asthma Foundation – Working closely with the Asthma Foundation on growing and expanding the reach of telehealth services to support people living with chronic conditions.

• Rural and Remote Supply Scheme – Working with the Commonwealth to support diabetes product distribution to Aboriginal Medical Services and people living in rural and remote locations across the country.

• NRMHC partnership – Working with Charles Darwin University and key indigenous researchers around Australia in a National Health and Medical Research Council research partnership to develop a culturally adapted version of the DESMOND program for Aboriginal people.

• Diabetes and Endocrine Health Network – Membership and representation on the Expert Advisory Group of the Network, established by the WA Department of Health.

• NDSS Enhancement Project – a Commonwealth Government project aiming to enhance the NDSS’s services, processes and tools to support and help meet our registrant’s needs into the future, to ensure a registrantfocused experience that assists with the management of diabetes. Currently in the discovery phase of understanding current processes via stakeholder consultation, the project is supported by the following principles; – Simplify processes and systems – Centralise Data – Single capture multiple uses – Access to all NDSS-related information for both Department of Health and its stakeholders – Minimise use of interim systems

• Diabetes Self-Management Project – Working with a number of health services across the state to embed quality programs into pathways of care for people living with type 2 diabetes. The project is funded by Health Networks at the WA Department of Health and aims to increase reach and capacity in regions such as the Great Southern, South West, Peel, Wheatbelt, Mid-West and Goldfields-Esperance. • Pilbara Diabetes Strategy – Working with a number of local health services in the Pilbara to upskill health professionals in quality programs to address the high rates of pre-diabetes and type 2 diabetes in the region. The strategy is funded by WA Primary Health Alliance.

THE HEALTH

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The frontline of health â&#x20AC;&#x201C; primary care F

or most people seeking support for a health issue a primary care provider will be their first port of call. General practitioners (GPs), pharmacies, practice nurses, Aboriginal medical services and allied health professionals are all examples of primary care, who are at the front line of the medical field.

THE HEALTH In order to address the spectrum of primary care needs and to maintain a robust connection to primary health, Diabetes WA is focusing on a new strategic initiative aiming to embed the organisation and its services into the primary care system. Jesse Elliot is the new Primary Care Coordinator at Diabetes WA, and has been charged with leading this initiative. “We are looking at approaching our work with primary care providers in a more sustainable way,” explained Jesse. “We want to determine what role Diabetes WA could have in better supporting GPs and primary care providers to provide quality diabetes services to their patients.” Focusing on developing stronger, more collaborative relationships with primary care providers will enable Diabetes WA to become an integral provider of service to GPs that responds effectively to their needs when managing people with diabetes. “As the leading provider of self-managed diabetes education in WA, we are able to maximise integration of person-centred chronic condition care in a way that no other organisation currently does,” Jesse said. “We have some amazing programs at Diabetes WA, that can really help people living with diabetes and we want to make sure that they are aware of them, and that GPs can easily access them, when they first go to their doctor looking for help.

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HealthPathways WA contains specific pathways to assist GPs in assessing, managing and referring patients through the WA health system in a seamless manner, by combining clinical and health service information in one place. Diabetes WA contributed to the diabetes pathway by highlighting the importance of education programs, such as DESMOND, to enhance and complement care provided by primary care and allied health. “Bringing Jesse on board and devoting resources to this area will ensure the maintenance and strengthening of relationships with local practices,” Diabetes WA Health Services Operations Manager Sophie McGough said. “It is important that this work does not sit as a stand-alone operation, but is integrated into Diabetes WA’s core work and external initiatives to foster inter-agency collaboration.” “We are taking a systemic approach to our work in this area and this includes monitoring, reporting and evaluating our progress to ensure continual improvement along the way.” “We encourage people to work closely with their GPs and primary care teams when managing their chronic condition or conditions,” Jesse concluded. “Open and regular communication is key so that all health care providers involved in their care are informed and can recognise opportunities for enhanced care or education when they come across them.”

“It is all about working together across WA health services to support and educate people living with diabetes. We want to provide them with solutions at every point of their health journey so that they can better self-manage their condition.”

Key stakeholders In recognition of the importance of collaboration, Diabetes WA has initiated the Primary Care Advisory Group to help steer the direction of our services. The Group will provide strategic and operational guidance over the next 12 months and had their inaugural meeting in October. “We are excited to be working with a passionate group of people at the forefront of primary care,” Jesse said. Jesse also ran focus groups in early December to drive the strategy, involving practice nurses, practice managers and GPs with a special interest in diabetes. “We explored the needs and expectations of primary care, tested ideas and attitudes to proposed service delivery and identified gaps in service provision,” Jesse explained. “This feedback allows us to shape the direction of the program in a targeted way that will support the GP and wider practice team managing this chronic condition.” “It is important that we talk to many different stakeholders to gain different perspectives on how we can all work together,” Jesse said. One of these key stakeholders is the WA Primary Health Alliance (see page 13 for more information about WAPHA). Diabetes WA has been working closely with WAPHA to better understand how the organisation can fit within the Alliance’s strategic direction and has contributed to a number of projects, one of which is the development of HealthPathways WA.

Jesse Elliot

THE HEALTH

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Focus on Prevention

esearch has shown that a high percentage of chronic conditions, such as diabetes, can be prevented through health behaviour change and lifestyle modification.

Interventions that target a change in lifestyle in those at high risk of developing chronic disease have the ability to slow or stop the progression of disease and significantly reduce the impact to the healthcare system. A recent article in The Australian newspaper, outlined data released by the Australian Health Policy Collaboration that revealed the most disadvantaged within the population are 60 per cent more likely to die from cancer, live with diabetes and die by suicide. The article quotes Michael Moore, CEO of the Public Health Association of Australia, “There are urgent calls to increase the current ‘pathetic’ level of funding given to health prevention in Australia and without significant investment in health prevention policies from governments there is unlikely to be a reduction in the ‘alarming’ rates of chronic disease in Australia.” “Currently, Australia invests only 1.3 per cent of its health budget on preventive health measures and programs. It really needs to be five per cent of health spending as a bare minimum,” Mr Moore said. In recognition of the impact that prevention programs can have on the health of a community, Diabetes WA recently appointed Prevention Coordinator, Kamila Ambrozewicz to drive activities in this important area.

“We have identified that there are few prevention interventions that address the stage between public health awareness campaigns and the time when a person eventually develops a chronic condition,” said Kamila. “In the case of diabetes, 60% of people could avoid or delay diagnosis with more targeted intervention. “This would help the individual of course, but would also create a huge saving for the health system and reduce the burden on our health services.” Kamila is focusing on reinvigorating Diabetes WA’s existing prevention programs, including; • My Healthy Balance: a free 4 – 12 week online program that equips people with healthy lifestyle knowledge and provides them with motivation to sustain healthy changes in the long term. • Get on Track Challenge: a free online program that pits teams against each other in a race around a virtual track, providing health advice and motivation along the way; and • SHED-IT: an online weight-loss program designed by men for men that includes weekly emails and a logbook with information on how to effectively lose weight and keep it off. “My Healthy Balance is an excellent program that has been running for a number of years and, despite not

having dedicated resources over the last 12 months, has continued to offer people online support with making informed decisions about their health,” Kamila said. Prior to Kamila’s appointment, two students from Curtin University’s Master of Dietetics program were engaged to conduct a review of the My Healthy Balance program to identify the program’s strengths, analyse participation statistics and existing evaluation results and to identify where improvements could be made. Kamila will explore this review and map out the user journey to identify where functionality could be improved to create a better user experience. Kamila will also organise the official Diabetes WA Get on Track Challenges, coordinating teams from around Australia. Participants can sign up online to either a Diabetes WA Challenge or manage their office, friends or family in a private challenge, popular with workplaces. “Coordinating your own team challenge is a great way to encourage some friendly competition – particularly at work where you can support each other through it – while encouraging healthy habits at the same time,” Kamila explained. Even those identified as at high risk of developing type 2 diabetes can prevent or delay the onset of the condition by following a healthy lifestyle.

THE HEALTH As is often the case with men who, typically, delay a visit to their GP until their symptoms are at a critical level, people do not start evaluating their need for a lifestyle change until they have been given a warning by their doctor that type 2 diabetes is imminent. Send in SHED-IT.

The prevention aspect of chronic condition management, also known as secondary prevention, aims to minimise the impact of an established condition and improve function through effective self-management and education, and in particular the development of self-efficacy.

SHED-IT is a low-cost weight loss program that teaches the participant all about the science of long-term, sustainable weight management. There are no group sessions, weekly meetings, pills, potions or fads. A resource pack is provided that contains the knowledge and motivation needed to make sustainable healthy changes.

“There is also the component of prevention that looks at avoiding the development of complications associated with diabetes.” Kamila explained. “Early intervention following a diagnosis of diabetes, greatly reduces costs in later life.

“While ideally we are looking to prevent the development of a chronic condition like diabetes,” Kamila said, “if warning signs of type 2 diabetes do start to appear, then early detection and intervention can minimise the progression of the condition.”

Spectrum

Visit our website for more information about our prevention programs and to find out how to join in diabeteswa.com.au/prevention

“Ensuring people are equipped to adequately self-manage their condition can prevent complications from developing due to poor management of blood glucose levels. The cost saving for every person with type 2 diabetes who avoids a complication is over $5000 per year.”

Kamila Ambrozewicz

Help your family to walk away from diabetes A

s we have discussed, even those identified as at high risk of developing type 2 diabetes can change their health outcomes. One of the big risk factors of diabetes is genetics so if you or a loved one has been diagnosed with diabetes, speak to those close to you and encourage them to think about whether their lifestyle could be improved to avoid their own diagnosis. Send Your Family Members – if you have been diagnosed with type 2 diabetes, then there is a good chance your children or other family members are at risk of also developing the condition. This is where the Walking Away program can help. Walking Away from Diabetes is a free interactive group education program, currently taking place in the Pilbara, for people who are at risk of developing type 2 diabetes. Facilitated by two trained educators, this three hour program helps you to explore and understand your risk of developing type 2 diabetes in the future. By the end of the program you will be able to identify simple changes and strategies you can put in place to help you lower that risk.

Diabetes WA will be ramping up its DESMOND and Walking Away from Diabetes programs in a bid to tackle the growing number of people living with type 2 diabetes in the State’s north-west. We have committed to running more than 100 sessions over the next year. The ultimate goal is to deliver the programs to more than 1,000 Pilbara residents. Look out for our advertisement on GWN and local radio and visit the Diabetes WA website for information about sessions taking place near you or call 1300 001 880 for more information.

Walking Away gives you the chance to: • discuss your thoughts and feelings around your level of risk • develop a better understanding of type 2 diabetes and blood glucose • understand how your current level of risk is affecting your long-term health • learn what factors contribute to your level of risk • learn how physical activity and healthy eating can lower your risk.

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. ShopSmart – this supermarket tour helps you decode food labels ('Classroom' format also available). FootSmart – everything you need to know about caring for your feet.

DECEMBER 2017 Sun

Sat

Fri

Thu

Wed

Tue

Mon

1 Subiaco

(Classroom) Belmont

Melville

Tom Price

(Classroom) Subiaco

Forrestfield

Riverton

Rockingham

South Hedland Subiaco

Belmont

Mandurah

Subiaco

MeterSmart – master the art of blood glucose monitoring. CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass. MedSmart – everything you need to know about your medications.

21 February

JANUARY 2018 3

Rivervale Hall Melville

Type 1 Technology Night

Time: 6-8pm

Belmont

17 (Classroom) Belmont

Subiaco

(Classroom) Mirrabooka

Melville

Where: Tuart Hill Community Centre, Cnr Cape & Stoneham Streets

Connect with Diabetes A 2.5 hour free presentation for people with type 2 diabetes, carers, families and those at risk of diabetes. Connect with Diabetes enables you to understand and manage your diabetes and learn about food choices.

Subiaco

Learn about pumps, CGMs and flash monitoring. Free session, bookings essential.

Sun

Sat

Fri

Thu

Wed

Tue

Mon

DESMOND One day workshop 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.

Diabetes WA offers a 15 per cen t discount on health professional train ing and updates to members.

Telehealth The Diabetes Telehealth Service for Country WA is available to those living out of the metropolitan area. One-on-one appointments via video-conferencing can be arranged through your doctor, or contact Diabetes WA on 1300 001 880.

FEBRUARY 2018 Mon

Tue

Wed

Thu

Fri

Sat

Belmont

Albany

Joondalup6 ECU, Albany & Esperance

Mirrabooka

Subiaco

Esperance

Riverton & Esperance

Willerton

Mirrabooka

Technology Night

(Classroom) Melville

Merredin & Sth Hedland

Upskilling for health professionals in country WA

Armadale

The Diabetes Telehealth Service upskilling sessions are typically 1–2 hours in duration and are easily accessed via a desk top computer. The sessions cover a wide range of diabetes-related topics such as chronic kidney disease, diabetes retinopathy and gestational diabetes. To find out more or to register for any upcoming sessions call 1300 001 880 or go to our website.

Subiaco

Northam, Mt Barker & Geraldton

Mirrabooka

20 Type 1

Bridgetown

Rockingham

Joondalup

Sun 3

Mirrabooka

Belmont

Katanning Helena Valley

Midland

Narrogin

Key

MARCH 2018 1

Collie & Tom Price (Classroom) Armadale Library Subiaco

Joondalup Away 14 13 Walking Diabetes from Cranbrook & Esperance South Hedland Rivervale & Esperance Subiaco

Subiaco

Melville & Denmark

Geraldton

Mirrabooka & Pingelly

Mirrabooka

Melville

28 High Wycombe

Gnowangerup

Armadale

Cockburn

Dongara

ShopSmart

FootSmart

MeterSmart

Rockingham

CarbSmart

Bunbury

Joondalup ECU & Manjimup

Melville

Sun

Sat

Fri

Thu

Wed

Tue

Mon

MedSmart Quairading

Belmont

DESMOND Connect

For more information or to book into any of these workshops, visit diabeteswa.com.au, call 1300 001 880 or email bookings@diabeteswa.com.au 19

Research Round Up The latest in diabetes research

It’s great news for

caffeine addicts A compound of coffee, cafestol, has been found to improve insulin production and appears to delay the onset of type 2 diabetes in mice. Danish researchers said it was a good indication for drug development to treat or prevent the condition in humans.

It’s good news for

blueberry-lovers A French study has reported that regular consumption of antioxidant-rich foods such as tea, walnuts and blueberries can help to lower the risk of type 2 diabetes. Of 64,223 women studied, those with higher antioxidant scores had a 27 per cent reduced risk of type 2 diabetes compared to those with the lowest scores.

eart attacks may feel different for people with diabetes, UK researchers have found. Nerve damage from diabetes may lead with diabetes might not feel the stubbing to those with the condition experiencing of their toe, they also feel less pain from less pain than they would expect, damaged heart muscles when the blood resulting in many not recognising they supply gets cut off.” were having a heart attack and not This may have contributed to delays recognising the classic symptoms like in seeking care, which are in turn acute chest pain. associated with lower survival odds Interviews were conducted with and a higher risk of complications and 39 adults in the UK, who had been disability for people who do live through diagnosed with diabetes (the majority the event, researchers note in the journal of which had type 2) and had also BMJ Open. experienced a heart attack. Participants People with diabetes are three times ranged in age from 40 to 90, were mostly more likely to die from heart disease male, and roughly half were caucasian. than the general population, and The study showed that many felt like possibly six times more likely to have a their pain wasn’t severe enough to be a heart attack, Jones added in his report. heart attack. It’s important to note that the study “Long term diabetes damages your was small, and it wasn’t a controlled heart in many ways, such as increased experiment designed to prove blocking of the heart’s blood vessels, but whether or how diabetes might lead it also damages your nerves,” said study people to experience different heart co-author Dr Melvyn Jones of University attack symptoms. College London. “So a bit like a person

Magnesium may help to prevent type 2 diabetes

large study in the US has shown that patients with high magnesium intake through diet and supplements have a lower risk of progressing to type 2 diabetes.

It’s bad news for

The study also showed that patients with poor quality carbohydrate diets benefit more from high magnesium intake in that diabetes risk reduction is more distinct and that low nutritional diets insufficient in magnesium may predispose patients to diabetes.

US researchers have found that people with psoriasis that covers 10 per cent of their body or more are 64 per cent more likely to develop diabetes than those without psoriasis, independent of traditional risk factors such as body weight.

The study analysed data from two Nurses’ Health Studies (160,647 participants) and the Health Professionals Follow-up Study (42,096 participants). The study aimed to determine whether a higher magnesium intake results in type 2 diabetes risk reduction and how high glycaemic index (GI) diets, those low in cereal fibre and high in carbohydrates, more specifically foods high in sugar and foods made with white flour, affect this

psoriasis sufferers

Does diabetes make a heart attack feel different?

association. Participants were followed for 28 years and evaluated for onset of type 2 diabetes. According to the results, participants with high dietary and supplemental magnesium intake experienced a reduced risk of developing type 2 diabetes. It was also determined that participants with high GI or low cereal fibre — in other words, those with poor diets — who had higher magnesium intake, still had a greater reduced risk of developing type 2 diabetes. This suggests that low magnesium intake can potentially predispose high risk patients to diabetes, especially if they have poor nutritional diets.

Source: diabetesincontrol.com

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.

Local Breakthrough and What Are You Thankful For by Diabetes Research WA Executive Director Sherl Westlund

ith World Diabetes Day behind us for another year, we’re looking ahead to 2018 and working on ways to raise critical funds to help advance the search for a cure for diabetes and better ways to live with and manage it.

WA diabetes researchers are doing an incredible job and we’re proud of their work. In the new year, we’ll share our two latest research projects. For now, you can read about the latest local breakthrough below.

Substance protects cells from triggering type 2 diabetes Western Australia’s Centre for Diabetes Research, which we help support, has identified a substance that protects cells from triggering type 2 diabetes, with the results published in Diabetes and Metabolism. Associate Professor Fang-Xu Jiang said it had been established that low levels of vitamin D3 played a role in the development of the condition, which affects 1.4 million Australians and is caused when insulin-producing cells stop functioning properly. “We’ve known for several decades that low vitamin D3 levels are associated with increased risk for type 2 diabetes, however the underlying mechanism that leads to the condition has never been clear,” he explained. Numerous international clinical trials have tested the benefits of supplementing vitamin D3 in people with pre-diabetes without success. “Our research team began searching for potential drugs that could signal through the vitamin D3 pathway and restore the function of failing insulin producing cells,” Associate Professor Jiang said. Colleague Abraham Neelankal John said the study ultimately discovered a substance that protected insulin-producing cells from shutting down. “Our investigation uncovered a compound that appears to prevent the onset and delay the progression of pre-diabetes and early diabetes,” Mr John said.

“The effect was confirmed in pre-clinical models and we were able to show that the vitamin D3 family prevents insulin producing cells from loss of function. “More research is needed but if proven in clinical trials, it would certainly become a drug for people Abraham Neelankal John at risk of developing type 2 diabetes and/or in the early stages of type 2 diabetes. Our ultimate aim is to regenerate the health of people who are living with type 2 diabetes.”

Time to get grateful In September, we launched our new Thank You Week campaign – a time to be grateful for all things related to diabetes – those who help care for us, the technology that helps us better manage diabetes, the researchers that give their lives to improving our understanding of it, the list goes on. If you missed taking part in the campaign, and with Christmas so close, we ask you to stop for a moment and think about what you are thankful for in relation to diabetes. And, if you’re so inspired, feel free to send us your thoughts at info@diabetesresearchwa.com.au or leave a post on our Facebook page or give us a call (08) 9224 1006. Finally, Merry Christmas from the Diabetes Research WA team! We hope you enjoy the festivities.

For more details, please visit diabetesresearchwa.com.au or call us on (08) 9224 1006.

A Family’s Story

usiness manager and former teacher, Tony Ganzer considers himself an expert in diabetes, despite never being diagnosed with the condition himself. With all three of his children and one of his two step-children diagnosed with type 1 diabetes, he calls himself a “type 3 diabetic” – a term sometimes used colloquially to describe a person heavily involved in the management of a loved one’s diabetes. At the age of 10 months Tony’s second child, Damien became very ill and after some investigation in the emergency department at Princess Margaret Hospital (PMH), a doctor swabbed his nappy. “Code red occurred,” Tony says. “A team of doctors quickly diagnosed him with type 1 diabetes and jumped into action, saving his life. In retrospect he had been in ketosis for more than a week.” Six years later in 1986, when Damien’s older sister, Michelle was also diagnosed with type 1 diabetes at the age of seven, Tony recognised the signs straight away and the trip to hospital was calmer. A second marriage for Tony produced a daughter, Brianna, in the year 2000.

Genetic links “My new wife, Yvonne’s family had a history of diabetes and Yvonne herself has type 2 diabetes,” Tony explains, “so when getting treatment for one of the kids at PMH, they asked us to be involved in a world-wide study looking at genetic links and diabetes.” The PMH endocrinology unit tested Tony, Yvonne, and her two girls to a previous relationship, Danielle and Alana, as well as Brianna. They found that Yvonne and Tony each carried two of four identified carrier genes known at the time, but different ones.

Mother Type 1

Arnie No Diabetes

Brother with Type 1

Danielle Type 1

“My mother came to Australia as a single mother from Italy and committed suicide when I was very young, so I have had little ability to trace or predict any of my medical future or that of my family,” Tony says. “From discussions with her children from another partner though, I am pretty certain she didn’t have diabetes.” The screening also showed that Danielle and Brianna had a high probability of developing type 1, but that Alana’s probability was low. “The prediction was pinpoint accurate,” Tony says. “With my experience of diabetes so far, as Danielle and Brianna transitioned from ‘honeymoon’ to full type 1 diabetes, I picked the onset immediately. “Danielle was 17 and when I heard the toilet flushing more frequently than normal, we used a glucometer and her blood glucose levels tested 30. Her entry to hospital for treatment had minimal issues, with mostly stabilisation and education.” The same diagnosis occurred with Brianna at aged 10. Tony says when they arrived at PMH the staff commented she was so well for a child with diabetes, due to the early intervention. ”Interestingly, while I am one of the only ones in the family without diabetes,” Tony says. “I can’t help but constantly monitor food intake and count carbohydrates and calories.”

Mother Type 1

Mother Unknown

Mother Type 1

Yvonne Type 2

Tony No Diabetes

Rosemary Possible Type 2

Alana No Diabetes

Brianna Type 1

Michelle Type 1

Damien Type 1

Advocating for justice Throughout his own family’s own journey with diabetes, Tony has also been involved in campaigning for the rights of people living with the condition. “When Michelle turned 16 the department that was then known as Social Security, advised me that her disability allowance was to be stopped, as she did not require substantially more care than any other child,” Tony explains. “Frustrated, I appealed to the Social Security Appeals Tribunal but lost on my first two applications.” “I received a letter from a doctor in Victoria, along with a news clipping outlining how they had successfully won back their allowance, so I applied to another branch of the Tribunal. I demonstrated that my child required substantially more care by detailing a day in five minute intervals. “We won the appeal and the story was published in the West Australian newspaper.”

“Due to my exposure as an advocate for the rights of people with diabetes, I was invited onto the Board, and soon became President, of People with Disability – a national disability rights and advocacy organisation. “During my time on the Board I met many members of parliament and played a key role in advocating for the introduction of the policy to provide needles free-of-charge to people living with diabetes,” Tony says proudly. “This positively impacted many families in Western Australia and gives me a great deal of pride.” “I get so frustrated that there is still is no cure for diabetes.” Daughter Brianna recently drew a cartoon strip about diabetes for an English assignment at school. “While working with her on the cartoon, it reminded me how insidious this disease is,” Tony says. “Every minute of every day is about controlling your energy balance.”

Joanne Delaney, head of Social work at PMH then contacted Tony, explaining that a number of families were also looking to have their allowances reinstated. Over the next three years, Tony helped six families successfully go through the appeals process. As a result of these proceedings, those who lost their payments in the future were instead provided with a health care card.

Tony Ganzer

Overcoming adversity to beat diabetes

brain tumour at age 12 left Christopher Van Aurich with a disability. It was around this same time that he was also diagnosed with type 2 diabetes. His mother, Sue, tells us Chris’s story and explains the challenges they faced managing both conditions and how Chris beat the condition, despite his disability. “Christopher’s type 2 diabetes became evident after his first brain tumour aged 12, which left him with vision and other medical issues. Initially, we were able to control his diabetes by monitoring his diet, but after his third brain tumour, aged 15, this became much harder as he developed an eating disorder which made dietary measures ineffective. This was also when his weight became difficult to control.

His quality of life is great now and he has achieved things I never thought he would. He now walks independently and even has a job for the first time, selling the Big Issue newspaper.

He recently walked his sister down the aisle at her wedding, which was a dream of his, and we couldn’t be prouder of him.”

The eating disorder was in part to blame for the weight gain, but he also developed a tumour in his leg, which required numerous surgeries and he was unable to exercise for many months. He spent time in a wheelchair, then was able to use a Zimmer frame and finally moved to crutches. It was very difficult to motivate Chris at this stage as he was very discouraged and thought that he was a burden to his family, despite our reassurances that he wasn’t. Opportunely, Chris was offered a place within Identitywa supported living accommodation just when things were especially tough. The move was something he had wanted for a while, as he craved the same independence that his sisters had. Despite it being a big adjustment for Chris and us, his family, it turned out to be the shift in his life that we all needed. When Chris moved into shared living he could only walk with crutches, was extremely overweight and was poorly managing his diabetes. But with support from his house mates and staff, he lost a lot of weight and, in turn, no longer has diabetes which he is maintaining due to his new diet and regular exercise.

Christopher Van Aurich

Can menopause effect your blood glucose levels? Patricia, type 2 diabetes

Should I consider going gluten-free to help my diabetes? Abigail, type 1 diabetes

DWA Diabetes Educator and Registered Nurse Christine Carne says…

DWA Diabetes Educator and Dietitian Narelle Lampard says… A gluten-free diet is important for people with coeliac disease or a gluten intolerance, but for most people with diabetes a gluten free diet is not a healthier option. Many gluten-free foods are made with grains or cereals that have a higher glycaemic index and a lower fibre content, which means blood glucose levels can be more difficult to manage. Packaged gluten-free foods can also be higher in added fats and sugars, so checking food labels is recommended.

Just like with your menstrual cycle, changes in hormones will affect how your body responds to insulin. Declining oestrogen levels occurring in menopause can increase insulin resistance, leading to higher and more variable blood glucose levels (BGLs). Altered hormones may also cause weight gain, leading to a need to increase diabetes medications. Menopausal symptoms (hot flushes, night sweats, mood fluctuations) can mimic symptoms of low BGLs which, if incorrectly treated with carbohydrates, can also increase weight. Menopausal sleep deprivation can also change BGLs. To maintain glucose control in menopause: exercise regularly, manage stress, get adequate sleep, maintain a healthy diet, check your BGLs regularly, take diabetes medications and get in touch with your diabetes team if you are concerned.

I’m a truck driver so I can’t always have fresh food with me for meals and snacks. What diabetes-friendly food is good for the road? Ron, type 2 diabetes

Narelle says… Pre-planning and packing plenty of quick and easy foods for the trip is the key. Some healthy ideas include: wholegrain crackers, cheese sticks or cubes, unsalted nuts or seeds, fruit (apples and oranges keep well), small tubs of tinned fruit in natural juice, muesli bars, long life milk boxes, unsweetened yoghurt pouches and small tins of tuna or baked beans. Consider getting an esky or portable fridge so you can take more fresh foods. Also, don’t forget to drink plenty of water.

If you have a diabetes-related question that you would like answered, email it to community@diabeteswa.com.au. If you can’t wait until the next quarterly issue of Diabetes Matters to get your answer, you can 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 001 880.

Podiatrist Josh Cheng

Twinkle Toes

odiatrist Perth are Diabetes WAâ&#x20AC;&#x2122;s newest member benefits partner, offering members a 10% discount for private patients on their initial appointment. They are a family run business, passionate about podiatry, with a vision to help as many people as possible and really make a difference for their clients. Senior Podiatrist, Josh Cheng, speaks about the importance of looking after your feet, particularly when living with diabetes. The foot is a complex structure with many bones, joints and muscles. Did you know that all the muscles in the legs end up in the foot? With so much riding on them it makes sense that if you are experiencing any foot pain it needs to be thoroughly examined and addressed. You may be familiar with the more traditional podiatry treatments such as cutting tough or hard to reach nails, removing painful hard skin, managing ingrown nails, removing warts, and providing orthotic therapy and footwear advice. But there are also many different services that can help restore function to feet and legs, including manual therapies such as joint mobilisation, podiatric dry needling, laser therapy, orthotic therapies and foot strength rehabilitation. People living with diabetes need to be aware of the risk of foot complications that can arise from diabetes and, while this is always something to think about in the longer term, feet can also

affect you in the short term â&#x20AC;&#x201C; comfort. It is so important to be able to exercise and maintain a healthy active lifestyle and if your feet are sore or uncomfortable, this may prevent you being able to exercise pain-free. In the bigger picture, neuropathy and detrimental changes to circulation in the foot due to diabetes can result in foot deformity, limited joint mobility, dry skin fissures and callousing, as well as motor dysfunction. These issues contribute to higher plantar pressures in the feet that can lead to ulceration and, in the worst case scenario, lead to amputation. Regular podiatric visits help to prevent such outcomes. The human body is incredibly complex. Chronic conditions often affect many systems within the body, so for people living with chronic conditions it is absolutely vital for allied health professionals and primary care teams to be working together to get the best outcome for a patientâ&#x20AC;&#x2122;s health.

Foot Gymnastics

oot gymnastics are exercises designed to develop and strengthen the muscles in the feet and legs. The barefoot activities are especially helpful for adults who are experiencing foot pain and gait problems, and for growing children who may be displaying signs of flat feet or other foot conditions.

Get your feet moving with this exercise routine.

1 2 3 4

1. Start by standing up straight and balancing your weight. Shift your body weight onto your heels, then curl your toes downward. Straighten them and repeat 10 times. This exercise is good for general strengthening, but also to relieve cramps in toes or in the sole. 2. Put one foot on a towel on the floor. Pull the towel, grasping it with your toes. Repeat five times and change foot. When your foot is used to this exercise, you can increase the effort by putting a book or similarly heavy object on the towel. 3. Sit on a chair or stool and use the sole of your foot to rub the shin of the opposite leg, starting from the knee down to the ankle and vice versa. Repeat 20 times. It helps relieve tension around the shinbone and increases the flexibility of the foot doing the massage. 4. Roll a ball under the ball of your foot for two minutes. This action massages the bottom of the foot and can relieve

5 6 7 8

discomfort and tension in the calf and foot arch.

5. Lying on the floor, rest a leg on a pillow at the height of your calf. Rotate your foot 10 times clockwise and then anti-clockwise. Repeat with the other foot. 6. Starting from the same position as step 5, imagine that your big toe is a pen and “write” the numbers from 1 to 10. Try this with both feet. 7. From the starting position of exercise 5, hold your foot in a vertical position (toes up, heel down). Flexing the ankle, point your toes towards yourself, then repeat in the opposite direction. Repeat 10 times. 8. Finish the exercises by standing up, and raising and lowering yourself on the tips of your toes (with your feet together) 10 times.

Source: scholl.com.au

Try This Drop a bunch of small items on the ground. Try walnuts, small rocks, lego pieces and little balls of fabric. Set a timer and pick up as many items as you can with your toes. See how many items you can get in a certain amount of time and then do it again, trying to beat your previous score.

Full Spectrum Eating E

nsuring you eat well can be as easy as following the rainbow. Incorporating a rainbow array of colourful fruits and vegetables into your diet is a simple approach to healthy eating.

When we are talking nutrition, the rainbow signifies the kaleidoscope of health benefits of eating a full spectrum of natural foods, providing the body with anti-oxidants and phytonutrients.

Phytonutrients Phytonutrients are the chemicals that give plants their colour. Found in fruits, vegetables, legumes, whole grains, nuts, herbs, and spices, they can boost the immune system and support the repair processes of cells. Seek out a rainbow of colourful produce and you’ll find a big pot of phytonutrient gold. Unlike macronutrients (such as proteins, carbohydrates, and fats) and micronutrients (vitamins and minerals), phytonutrients are not considered critical to short-term survival. But nutritionists say they are absolutely essential to warding off chronic diseases, including cancer, type 2 diabetes, and brain disorders. Phytochemicals, such as the beta-carotene orange in carrots and the anthocyanins blue in blueberries, can have antioxidant effects, helping to clear away the free radicals in the body. A free radical is an unstable molecule that latches onto healthy cells making them unstable as well. The antioxidants in anti-inflammatory fruits, vegetables, herbs, whole grains, and fats can help reduce the number and effect of free radicals throughout the body, by neutralising the free radicals and helping to prevent cell damage. But each phytochemical has different strengths, which is why it’s important to eat a rainbow of them, not just one.

Rich palette To maximise the health benefits, experts suggest eating phytonutrients in combination. Some individual phytonutrients do localise in certain parts of the body; blueberry compounds, for example, find their way to the parts of the brain serving memory and learning. But there is no single “cure”. It’s best to focus on smaller amounts of many phytonutrients. To make sure you are getting a diversity of phytonutrients, focus on that rainbow. Start with a simple plate or salad of raw veggies, such as red capsicum, green sugar snaps, yellow cherry tomatoes, orange carrots, and purple cauliflower. Start swapping out starchy white staples for more vibrant ones: Make mashed sweet potatoes or cook up a pot of black and red rice. And, remember, healthy foods that are white, tan, and brown are included in the rainbow, too, such as cauliflower, fennel, garlic, ginger, unsweetened cocoa and lentils. For the most part non-starchy vegetables are a better choice than fruits, as they provide high amounts of fibre and nutrients with less kilojoules. Cruciferous vegetables, such as broccoli, brussels sprouts and kale are especially phyto-rich. While all the colours count, emphasising green in your rainbow will give you the best nutritional boost.

Boost your phytonutrient intake Diabetes WA Dietitian, Amanda Lee says, “Set yourself and your family a goal to try a new fruit or vegetable every week, and you’ll get the colours of the rainbow from new and different sources.” Here are some of her tips for increasing your phytonutrient load. 1. Benefit from nature – Aim for at least 5 servings of vegetables daily. One serving equals a half-cup of cooked veggies, or 1 cup of raw leafy veggies. Think of it as three to four servings per meal. In addition to veggies and fruits, phytonutrients abound in whole grains, legumes, nuts, seeds, and even herbs and spices. 2. Keep it simple – Instead of coming up with complex rotation plans, just follow the rainbow. Throughout your week, include fruits and vegetables that are green, red, yellow, orange, white, blue and purple and you’ll be getting plenty of vital nutrients that enhance your health.

3. Synergistic combinations – Try eating plant foods in combination for an enhanced benefit. For example, pairing the spice turmeric with black pepper and olive oil (try it on cauliflower) has a synergistic health effect. 4. Use creative substitutions – Refresh your old standbys with more phytonutrient-dense versions. Try purple cabbage instead of white. Try mashed sweet potatoes instead of the traditional white spuds. And swap out white rice for red quinoa.

Taste the Rainbow Yellow & Orange

Green

Yellow and orange fruits and vegetables pack a powerful nutritional punch. They are rich in beta carotene, vitamin A and vitamin C and boost your vision while helping to prevent macular degeneration.

Green vegetables are rich in phytochemicals and offer plenty of fibre. Cruciferous vegetables specifically, have sulphurous compounds that help your liver detoxify harmful cancer-causing substances and are believed to protect women from ovarian cancer. Unlike most fruits and vegetables, be sure to lightly cook your cruciferous vegetables to maximise their nutrient value. Other green vegetables and fruits have potassium, which is great for the heart.

The Foods: • Lemons • Carrots • Pumpkin • Yellow capsicum

• Corn • Sweet potatoes • Yellow apples • Golden beetroots

Red Red grapes specifically have a powerful antioxidant known as resveratrol, which has anti-inflammatory properties and may help lower your risk of heart disease and cancer. Another great nutrient in red fruits and vegetables is lycopene, found in watermelon, pink grapefruit and tomatoes, which is known for fighting prostate cancer. The Foods: • Red capsicum • Red chillies • Red onions • Pomegranate

• Pink grapefruit • Red grapes • Red apples • Tomatoes

White Cauliflower has many of the nutrients of other cruciferous vegetables, but it’s the only one that is white. Onions are a great prebiotic – they feed the probiotics (good bacteria and yeast) in your intestines. Onions and garlic can lower blood sugar and have amazing anti-inflammatory and anti-bacterial properties.

The Foods: • Green leaf lettuce • Spinach • Romaine lettuce • Zucchini • Asparagus • Cucumbers

• Artichoke • Okra • Parsley • Rocket • Limes

Blue & Purple Blue and purple vegetables and fruits are protective against some cancers, and good for urinary tract health and maintaining memory function. Many of these blue and purple foods are rich in the phytonutrient anthocyanin, a type of flavonoid that is great for fighting the damage that daily living does to your cells. The Foods: • Purple cabbage • Black currants (unsweetened) • Purple asparagus

• Blueberries • Plums • Purple grapes

The Foods: • Cauliflower • Onions

• Chinese (daikon) radish • Garlic

Get Smooth

hytonutrients, which provide the colours in natural foods, have powerful cumulative antioxidant effects. But no single food is a magic bullet. All of these healthy pigments together can provide support for your body.

Smoothies are the perfect way of combining a variety of rainbow fruits, vegetables and other goodies in one power-packed drink. Remember – don’t just suffer through a smoothie full of bitter green vegetables because you think it’s good for you, make the most of the full diversity of the rainbow. Tips for making the perfect smoothie. •

Use the whole rainbow. The most important principle is a diversity of colours and kinds of ingredients, to include the full spectrum of nutrients.

•

Mix fruits and vegetables. You don’t want just fruits because the smoothies will be high in sugars that will increase your blood glucose levels. On the other hand, you don’t just want

vegetables because you will get hungry again too quickly and they don’t always taste great on their own, pureed and raw. Mix both. A rule of thumb is to use 1 to 1½ cups of fruit per serving and 1-2 cups of vegetables. •

Add fat. Most people forget to add fat to a smoothie, but it’s crucial that you do because many of the phytonutrients are fat soluble. Vitamins A, D, E and K are all fat-soluble, meaning that your body can’t absorb them in the absence of fat. They will just pass right through. Fat (along with the fibre from vegetables) will also help prevent hunger spikes by slowing down the absorption of glucose from the fruits. For healthy fat add chia seeds, flax seeds, avocado, cacao, avocado, peanut butter, walnuts, or almonds.

Try these smoothie recipes for something a bit different.

Peanut Butter & ‘Jam’ Smoothie

Nutritional Information per serve

Energy Protein Total Fat Saturated Fat

688 kJ 7g 7g 2g

Carbohydrate 20 g Sugar 17 g Dietary Fibre 2g Sodium 162 mg

Serves: 3

Ingredients

Method

• 170g light soft silken tofu

• ¼ cup water

• 2/3 cup frozen blueberries

• ½ cup small ice cubes or crushed ice

• 1¼ cups chilled almond milk • ½ cup purple grapes • 2 tablespoons creamy peanut butter

In a blender, combine tofu, berries, almond milk, juice and peanut butter. Blend until smooth. Gradually add ice through hole in lid, blending until almost smooth. Garnish with fresh berries and mint to serve if desired.

• Fresh berries and mint for garnish

Carrot, Mango & Green Tea Smoothie

Nutritional Information per serve

Energy Protein Total Fat Saturated Fat

288 kJ 1g 5g 0g

Carbohydrate Sugar Dietary Fibre Sodium

17 g 14 g 6g 27 mg

Serves: 4

Method

Ingredients • 3 cups water

• 4 green tea bags

• 1 cup sliced carrots or packaged peeled baby carrots

• 2 cups frozen mango chunks

• 1 inch fresh ginger, thinly sliced

• 1 tablespoon chia seeds

• 1 teaspoon honey

Cucumber, Mint & Melon Smoothie

In a small saucepan bring water to boiling. Add carrots; cover and cook for 10 to 15 minutes or until very tender, adding ginger slices for the last 2 minutes of cooking. Remove from the heat and add tea bags. Cover and steep for 4 minutes. Remove tea bags, squeezing out all the tea. Remove ginger slices and let cool. Transfer carrot mixture to a blender and add mango, honey, and chia. Blend until smooth.

Nutritional Information per serve

Energy Protein Total Fat Saturated Fat

347 kJ 2g 2g 0g

Carbohydrate Sugar Dietary Fibre Sodium

21 g 17 g 2g 29 mg

Serves: 4

Ingredients

Method

• 1 cup coarsely chopped fresh cauliflower

• ½ cup lightly packed fresh mint leaves

• 2 cups chopped honeydew melon

• ¼ cup water

• 2 cups chopped cucumber

• 1 cup ice cubes

• 2 -3 tablespoons honey

Cook cauliflower, uncovered, in boiling water until very tender (10-12 mins); drain. Rinse with cold water to cool quickly and drain again. In a blender, add ingredients in this order: honeydew melon, cauliflower, cucumber, mint, water, and honey. Blend until very smooth, stopping and scraping sides of blender as needed. Add ice cubes. Blend again until smooth.

Nutritional Information per serve

Rainbow Salmon Skewers

Serves 4 Cooking Time: 20 Minutes

950 kJ 22 g 18 g 4g 3g 0g 2g 44 mg

Ingredients

Method

• 400g salmon fillet

1. Cut the salmon, capsicums and onion into 4cm chunks.

• ½ each of a red, green, yellow, and orange capsicum

2. Thread your skewers alternately with the onions and capsicum varieties, and then the salmon, leaving some room at the base so you can handle them easily.

• ¼ large red onion • olive oil • salt and fresh cracked black pepper • 1 lemon • Bamboo or metal skewers

Energy Protein Total Fat Saturated Fat Carbohydrate Sugar Dietary Fibre Sodium

3. Brush the skewers liberally on both sides with olive oil, and sprinkle with salt and fresh ground black pepper. 4. Cook on a hot grill, turning once, until the fish is cooked through and the veggies are softened a bit. Don’t overcook! Serve with a squeeze of lemon.

Diabetes WA Brainteasers 1. What’s the missing letter?

J ? M A M J J A S O N D 2. In the group of letters below, cross out six letters so that the remaining letters, without altering their order, will spell a familiar word.

B S A I N X L E A T N T E A R S

Competition

Summer Cookbook Giveaway!

Though the cover image is deceiving, Unicorn Food by Sandra Mahut is full of nutritious recipes. A simple guide to making all things magical. In keeping with our article on eating the rainbow spectrum of foods, Unicorn Food features plant-based recipes for treats and meals that are not only beautifully presented, but are wholesome and made with all things good for you. From unicorn butter biscuits to rainbow sushi, there’s something that everyone will love (and want to photograph!).

Sandra Mahut is a photographer, food stylist and author of several cookbooks. She lives in Paris with her family and works out of her kitchen studio in the city’s 20th arrondissement. Murdoch Books have given us a copy of Unicorn Food to give away. Publisher: Murdoch Books RRP: $19.99 To enter, complete the competition slip and mail to:

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

membership@diabeteswa.com.au

Good Luck! Name: Diabetes WA membership number: Address: Contact number: Email address: Entries close 1 March 2018.

Brainteaser Two Answer: By crossing out 'SIX LETTERS' the word left is 'BANANA'. Brainteaser One Answer: F Explanation: The letters are the first letter of each of the twelve months. The second month is February.

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Prepare to Walk Away from Diabetes

DESMOND and Walking Away from Diabetes sessions are being scheduled in the Pilbara in 2018. Tom Price, Karratha and South Hedland. Go to our website to find out dates and to book in to a session. diabeteswa.com.au

Connect with your diabeteonspresented

Connect with diabetes is a FREE presentati understanding by our diabetes educators to assist you in include and managing your diabetes. Topics covered es. choic food and general diabetes information Confirmed 2018 dates: 19 February - Bridgetown, 16 March - Bunbury

Dec till Mar

rmed New dates and venues are being confi year, the ut ugho thro ions sess weekly for Connect onal with a particular focus on rural and regi website areas. Visit the What’s On page of our you. near ions sess to find out about upcoming u om.a wa.c etes diab

Research Participants Needed – Free FLASH LIBRE device

The UWA School of Medicine and Pharmaco logy is looking for people living with insulin-dependent type 1 and type 2 diabe tes, who have recently experienced a seve re hypoglycaemic episode. Interested participan ts need to contact the researchers within two weeks of having the episode. Participants must be over 18 years of age, and would be required to go to Fremantle Hospital for an initial face to face interview, blood tests and basic observations. Follow up inter views will be conducted over the following six mon ths. Participants may be given a Flash Libre devic e and sensors to use for six months and will be asked to document their use. The device can be kept following the study. Please be awa re that a control group without the device will also be allocated from participants. The UWA study aims to learn whether the Flash Libre device reduces the incidence of severe hypoglycaemic episodes and emergency prese ntations as compared with usual care. If you are interested in participating plea se contact Research Nurse, Penny Dwyer on 08 9431 3230 or email penny.dwyer@uwa.edu.au

21 Feb

Type 1 Technology Night pumps, Diabetes WA is hosting a FREE technology evening where you can learn about insulin nts participa 1 type to open is workshop This g. continuous glucose monitoring and flash monitorin and covers; • Insulin pump therapy, CGM & flash monitoring • Which option is best for me? • New ways to test glucose levels

• How do I get started with a pump?

• Benefits and disadvantages of each device

• Can this technology reduce my highs and lows?

• Costs involved?

with insulin You will have the opportunity to discuss the options with a diabetes educator and meet devices. these about more out pump, CGM and flash monitoring company representatives to find Time: 6 – 8pm Venue: Tuart Hill Community Centre, Cnr Cape & Stoneham Streets, Tuart Hill Bookings essential – Call 1300 001 880 or email bookings@diabeteswa.com.au

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Old Habits Are Hard To Break

Remember: We have a new number

1300 001 880 Diabetes Information and Advice Line

Our specialised diabetes educators are here to help.