Diabetes Matters Autumn 2023

Sophie Watts

From the Editor

Welcome to the Autumn edition of your member magazine!

When I took over editorship of this magazine back in 2021, I was keen that the magazine would feel like your magazine. That meant chasing stories that were part of your world – not only stories about diabetes, but also stories about the bigger picture. I’m happy to say this issue is all about that bigger picture, about the connections we make between our health and happiness, our diet and our wellbeing and, crucially, the connections we make with each other.

That’s why you’ll find stories in this issue about the benefits of singing with others, alongside coverage of the latest diabetes science. We look at a new cookbook allowing coeliacs to join in a Mediterranean feast and we also help you decide what method of checking your blood glucose might work for you.

The central theme of this issue is connection. In our main feature, we examine the benefits of connecting with other people who understand what it’s like living with diabetes. Living well with diabetes isn’t just about taking advice from health professionals. It’s about listening to the lived experience of other people and sharing our own stories.

I hope that’s what it feels like to read this magazine. Happy reading

DIABETES matters.AUTUMN 2023

Editor Myke Bartlett

Editorial & Advertising Enquiries

Diabetes WA, PO Box 1699, Subiaco, WA, 6904 Phone 1300 001 880

Email media@diabeteswa.com.au

Editorial submissions should be sent to Diabetes WA, care of the above address. All care will be taken with contributions however no liability for loss or damage to unsolicited materials will be accepted.

Disclaimer

The opinions expressed in articles and the claims made in advertising materials presented in Diabetes Matters are those of the authors and the advertisers respectively, and do not necessarily reflect the view of Diabetes WA, unless stated. The information provided is for the purposes of general information and is not meant to substitute the independent medical judgment of a health professional regarding specific and individualised treatment options for a specific medical condition. No responsibility is accepted by Diabetes WA or their agents for the accuracy of information contained in the text or advertisements and readers should rely on their own enquiries prior to making any decisions regarding their own health.

Thanks to Diabetic Living magazine.

Brennan, Kasi Keeffe, Kathy

Natalie Jetta, Sophie Watts

A WORD FROM US

Welcome to the first edition of Diabetes Matters for 2023.

At Diabetes WA, we know that everyone’s experience of diabetes is unique. While we’ve been developing our new Diabetes Clinic (see page 3), we’ve had front of mind that you are the expert in your own life – it’s your diabetes journey and we’re grateful to be able to offer you the support you need, when you need it. Support and advice from health professionals is important for diabetes management but, as you’ll see this issue, making connections with your peers can be every bit as powerful.

Living with diabetes shouldn’t feel like something you have to deal with alone. Whether you’re newly diagnosed or have been living with diabetes for most of your life, finding support or understanding from someone who knows what it’s like to walk in your shoes can make a massive difference.

I’m really proud of the level of support Diabetes WA can offer West Australians living with diabetes — from our awardnominated Telehealth service to our programs and workshops including DESMOND (see page 16).

One of the most vital things in our programs is the opportunity they provide for connection and self education. I’ve seen firsthand what happens when participants bond over sharing their own stories and experiences.

Recently, I was chatting to some participants in one of our programs for people living with type 1 diabetes and they told me that the session was the first time they had ever met “other blokes” going through the same thing. It reminded me how people often don’t talk openly about their health, but how meaningful it can be when the chance presents itself.

You’ll see in our main feature (page 8) how isolated people such as Emily Vuong can feel when dealing with diabetes, particularly during those awkward teenage years when the condition can feel like a weakness or even something shameful. For Emily, and for many others of her generation, finding a virtual community of peers has been transformative. She has enjoyed the sharing of experiences, as well as the chance to swap tips and increase her education around diabetes.

Another gentleman I met at that type 1 program said he had been living with diabetes for 40 years but this was the first time he had received any formal education. He told me he wished he had attended a program like ours years ago as he could see the difference it would have made to his journey. Yes, the contact with health professionals was helpful to him, but so was the chance to learn from other people in the same boat.

Attending a similar program for people with type 2 diabetes, I was really touched watching participants connect both inside

the room and during the breaks. Our credentialled diabetes educators tell me this is something they see a lot — those points of connection between education sessions can be just as important as the content they provide.

I could see that the sharing of stories, tips and questions that they asked each other in this safe space was clearly so beneficial for them all. Contact details were shared and future catch ups were planned. And, of course, it’s not just people living with diabetes who benefit from this chance to meet others. Our sessions have always been welcoming of family members and carers, because we know they also benefit from the opportunity to hear the experiences of others and to pick up a few tips along the way.

The best person to know the kind of support you need is you. That’s why we’re so proud to offer a range of programs and services that will allow you to make the connections you need. Whether it’s a connection to support from health professionals, a connection to peer support and or enabling family and friends to be more informed about your diabetes journey, we are here for you.

If you haven’t checked out our programs and services — including our new Diabetes WA Clinic — I encourage you to do so. If you’re looking for ways to make connections with other people on their own diabetes journey, I hope this issue will give you the information and inspiration you need!

Melanie Gates Diabetes WA CEO

Melanie Gates

A QUICK CATCH UP

We look at what’s been going on in the world of diabetes

Ozempic supply update

In February, the Therapeutic Goods Administration (TGA) released a statement on the current Ozempic supply shortage. Supply is expected to improve throughout March around Australia. Speak to your pharmacist to find available stock near you.

Diabetes self-management research project

More OzDAFNE programs starting soon!

OzDAFNE is a five-day diabetes education program for adults with type 1 diabetes which teaches you how to work out the amount of carbohydrate in your food and the right dose of insulin to take. It also teaches you how to make changes to your insulin doses when you need to, and how to manage hypoglycaemia, illness and exercise. The program is available in three formats, giving you the flexibility to choose the one that suits you.

We have sessions coming up soon for:

NDSS Peer Support Website

The National Diabetes Service Scheme (NDSS) has developed an adult peer support website and peer support group directory. The website connects adults living with diabetes to share experiences, establish social connections, and learn from one another. The national directory lists peer support groups available across Australia, face-to-face and online. peersupport.ndss.com.au

Rural Health West Conference 2023

The Diabetes WA team were exhibitors at this year’s Rural Health West Conference. Held on March 11th and 12th, the conference was an opportunity to connect with health professionals from a variety of disciplines that deliver services to rural Western Australia.

We were also delighted to have our Teleheatlh service nominated in the Rural Health West Excellence awards.

ruralhealthwest.eventsair. com/2023warhc.

Diabetes

Are you aged between 18 and 50 years, and have had type 1 diabetes for more than a year? Do you sometimes find it difficult to cope emotionally with diabetes, or self-care routines?

UWA and Fiona Stanley Hospital would love to hear from you. They are running a new study, wanting to understand how to support positive changes to self-care, based on behavioural science and from speaking to those with a lived experience of diabetes.

The study involves visits with a knowledgeable diabetes educator across six months, supported by an experienced diabetes clinical and research team in Perth.

For more informatio jennifer.nicholas@ research.uwa.edu.au

• OzDAFNE Pump program one week program (face to face) - runs Monday to Friday for one week, from 9am to 5pm each day. Week commencing 17 April. Register your interest for our forthcoming 2023 dates at events.ndss.com.au/ details/?eventid=OzDAFNE3106457650

Our other formats incluce OzDAFNE@ home, which runs over six weeks with online lessons and weekly half-day online group meetings. Keep an eye out for new dates.

If you have any questions contact  ozdafne@diabeteswa.com.au

How healthy are your feet?

Foot Forward is an information and education program, funded by the National Diabetes Services Scheme (NDSS), an initiative of the Australian Government.

NDSS has put together a short survey designed to help people living diabetes get a better understanding of their foot health. The quiz only takes about two minutes. www.footforward.org.au/foot-health-check

If you have any thoughts, questions or stories you want to share, get in touch at media@diabeteswa.com.au

Matters wants to make sure our member voices are heard.

LINE

TYPE 1 KIDS CAMP RECEIVES LOTTERYWEST GRANT

Diabetes WA is excited to announce that we have successfully secured a State Government grant from Lotterywest. Co-funded by the NDSS, the grant will go towards April’s type 1 kids camp which will be run by Perth Children’s Hospital (PCH) and Diabetes WA.

The aim of the camp is to connect and support young children with type 1 diabetes. These camps are packed with fun-filled activities, from morning fitness and games to amazing magical races, dress up discos and more. Each camp has a theme and for this year’s forthcoming camp it will Superheroes!

Diabetes WA CEO Melanie Gates said our kids’ camps are part of our commitment to support all West Australian kids and their families living with diabetes.

“Our type 1 diabetes kids camps give children the opportunity to build their confidence by being away from their families, to have fun with their peers, and to be supported to focus on

Diabetes WA unveils new diabetes clinic

Our new Diabetes WA Clinic is coming soon to offer high quality diabetes care from our health professional team. We have credentialled diabetes educators who are nurses, dietitians, and pharmacists -- many of whom you may have chatted to on our Helpline.

But it’s not just our team’s qualifications and skills that guarantee you a great experience. Our team is committed to listening to your issues and concerns.

We consider you to be the expert in

self-care, while learning how to independently manage their diabetes throughout their stay,” Ms Gates said.

“We know how vital these activities are for creating a sense of community for West Australians with diabetes, particularly those younger members who might need extra support.”

Young West Australians with type 2 diabetes are also being catered for, with a special day camp planned for them in May. Registrations are open for this one-day event, also hosted by PCH and Diabetes WA.

The event will be held on Saturday 13 May 2023 in the Swan Valley and is open for people under the age of 15. It promises to be a great day of art, music and storytelling, allowing attendees to meet other young people with type 2, and work closely with professional artists to create, share and have fun. If you would like more information or to enquire how to get your child signed up for a camp, please contact community@diabeteswa.com.au.

your own life and circumstances and it’s our privilege to work alongside you to help achieve your health care goals.

From the moment you walk through the door or pop up in a virtual room, you’ll experience a welcoming and accepting environment.

We can support you with a range of diabetes management areas, including understanding diabetes and its effects on your body, and weight management. We’re planning to launch in April so

those who have already expressed an interest will be contacted and offered appointments first.

If you’re a member of Diabetes WA, you will be offered a special members discount on appointment fees. Additionally, speak to your GP about rebates available through Medicare.

We are currently taking expressions of interest for the clinic opening. To find out more, call 1300 001 880.

FROM LEFT TO RIGHT: Annie Farinosi, PCH Camp Coordinator/ Diabetes Nurse Educator; Amy Fiddes, Diabetes WA Community Education Coordinator; Dr Katrina Stratton MLA Member for Nedlands; Martin Boylen, Diabetes WA General Manager Marketing and Fundraising; Professor Elizabeth Davis, PCH Head of Department Endocrinology and Diabetes.

HBF RUN FOR A REASON IS BACK!

After a three year hiatus, one of the state’s best-loved community fun runs returns – and Diabetes WA will be there!

Diabetes WA is proud to announce that we are once again an official Charity Partner for the HBF Run for a Reason, held this year on Sunday 21 May.

Returning after a three year break, the event is one of the biggest community fundraising events in Western Australia. Around 35,000 participants are expected to take part, running, jogging or walking their way around 4km, 12km and half-marathon courses. Participants are able to nominate a chosen charity and encourage friends and family to sponsor them.

If you choose to run for Diabetes WA, you will be directly supporting those living with diabetes all over Western Australia by helping to deliver diabetes education and resources to both metro and rural areas.

Diabetes WA CEO Melanie Gates encouraged West Australians to take to the streets for a good reason.

“I encourage everyone to get on board, lace up your shoes, and run for a reason – to make a positive impact in the lives of West Australians living with diabetes,” Melanie said.

HBF executive general manager Selina Torrance thanked supporters for their patience after COVID-restrictions disrupted plans over the past few years.

“We’re excited that the community can come together again to train for a common goal and participants can fundraise for the charity of their choice,” Selina said.

“This is a much-loved event which has a special place in the hearts of thousands of West Australians who put so much effort into their training or who generously volunteer on the day.”

Over the past decade, HBF Run for a Reason has raised $10 million for nearly 200 charities, many of whom rely heavily on the donations of participants to fund their operations and activities.

To register as a runner for Diabetes WA, follow the link below. Good cause, good health, or just for a good time –what’s your reason to run?

https://runforareason23.grassrootz.com/diabetes-wa

Those running for Diabetes WA will be directly supporting those living with diabetes all over Western Australia by helping to deliver diabetes education and resources to both metro and rural areas.

LIVING TOGETHER CAN BE GOOD FOR DIABETES MANAGEMENT

Living with a spouse or partner might help people maintain lower blood glucose levels, according to a recent study.

Previous studies have suggested that being married or in a long-term relationship can have a positive effect on your blood glucose levels. A new study, published in the journal BMJ Open Diabetes Research & Care, focuses on the relationship between marital status and quality, and average blood glucose levels in older adults. However, the relationship between social health and the risk of developing type 2 diabetes is complex, and the effects of different social factors on health are not yet fully understood.

To investigate this relationship, researchers from Luxembourg and Canada analysed data from the English Longitudinal Study of Ageing, which collects data from adults aged 50 and over and their partners in England. The researchers looked at the relationship between relationship status, relationship quality, and blood glucose levels in older adults.

The data showed that people who were married or living with a partner were more likely to have lower blood glucose levels. However, the quality of that relationship did not appear to make a significant difference to blood glucose levels, suggesting that simply being in a committed relationship was enough to have a positive effect on health.

The study’s authors argued that having a supportive or strained relationship was less important than just having a relationship at all. In other words, just having someone there to share your life with might help people maintain lower blood glucose levels.

The researchers used biomarker data to measure glycemic

levels in 3,335 adults aged 50 to 89 years old who had not been diagnosed with diabetes. Participants were also asked if they had a husband, wife, or partner with whom they lived and were asked questions designed to measure the level of social strain and social support within the relationship. Information on several factors such as age, income, employment, smoking, physical activity, depression, body mass index (BMI), and other social relationships were also collected.

The data showed that about three-quarters (76%) of the respondents were married or cohabiting. Analysis of the data over time showed that people who experienced relationship transitions, such as divorce, also experienced significant changes in their glycemic levels and odds of pre-diabetes.

The study had some limitations, such as the fact that not all participants were able to provide follow-up data. However, while the study cannot prove cause, the researchers argue that their study’s use of more accurate and precise measures of blood glucose levels is a strength compared to previous studies that relied on self-reported diagnoses.

The researchers suggest that more support should be provided to older adults who experience the loss of a committed relationship through divorce or bereavement, as this may help to mitigate health risks associated with these transitions. Additionally, the dismantling of negative stereotypes around romantic relationships in later life may be a starting point for addressing health risks associated with relationship transitions in older adults.

The study’s findings are significant because type 2 diabetes risk is associated with a number of social health dimensions, including social isolation, loneliness, living arrangements, social support, and social network size. By showing that having a supportive partner, regardless of the quality of the relationship, can help people maintain lower blood glucose levels, the study highlights the importance of social connections in maintaining good health.

In conclusion, the study suggests that cohabiting relationships, even those under strain, may help people avoid high glycemic levels. The findings have implications for policymakers and healthcare providers who work with older adults, highlighting the importance of supporting social connections in promoting good health. Further research is needed to better understand the mechanisms underlying the relationship between social support and blood glucose levels in older adults, but the study’s findings suggest that having someone there can make a real difference in maintaining good health in later life.

INCREASING AMINO ACIDS INTAKE MAY EASE DIABETES-RELATED PAIN

A new study in mice shows that increasing the amount of a particular amino acid may reduce diabetes-related pain in the animals, although human benefits remain unclear.

We don’t usually report on animal studies, as it can be a long time before their findings can be useful to human patients, but a new study from the states shows some interesting, if very early findings. Scientists from the Salk Institute have found that adding an amino acid called serine to the diets of mice appeared to relieve diabetes-related nerve pain – known as peripheral neuropathy. However, they say people with diabetes shouldn’t be making any changes to their diet just yet!

Peripheral neuropathy is a condition that affects many people who have diabetes. It causes weakness, numbness, and pain in the hands and feet, which can make it difficult to do everyday tasks. This condition occurs when high blood glucose levels have damaged the nerves that carry pain and other messages to and from the brain. Researchers have now found another reason why people with diabetes might experience peripheral neuropathy. They have discovered that when the body doesn’t have enough of two specific building blocks, called amino acids, it can make the condition worse.

Amino acids are the building blocks that make up proteins and special fat molecules called sphingolipids. Sphingolipids are found in high amounts in the nervous system, which is why they are important for the health of nerve cells. The two amino acids that the researchers found to be important for peripheral neuropathy are serine and glycine. These amino acids are considered non-essential because the body can make them from other substances. However, the researchers found that when the body doesn’t have enough of these two amino acids, it can lead to changes in the structure of sphingolipids. This can cause atypical sphingolipids to accumulate, which can damage the peripheral nerves and lead to symptoms of peripheral neuropathy.

The researchers conducted a study using mice to test their hypothesis. They found that mice with diabetes who had low levels of serine and glycine were more likely to experience peripheral neuropathy. However, when they supplemented the mice’s diets with serine, their symptoms improved. This suggests that serine could

be a potential treatment option for people with diabetes who have peripheral neuropathy. However, more research is needed to determine if this treatment is safe and effective for humans.

In addition to the potential treatment implications, the study adds to growing evidence that non-essential amino acids play important roles in the nervous system. This could have implications for other conditions that affect the nervous system, such as neurodegenerative disorders.

Serine deficiency has also been associated with other conditions, such as macular telangiectasia, a condition affecting the macular, which causes vision loss. The study’s authors previously found a link between altered serine and sphingolipid metabolism in people with this condition. In mice, reduced serine led to increased levels of atypical retinal sphingolipids and reduced vision. Serine is currently being tested in clinical trials for its safety and efficacy in treating macular telangiectasia and Alzheimer’s disease.

acid called serine to the diets of mice appeared to relieve diabetes-related nerve pain.

While the findings of the study are promising, it is important to note that more research is needed before serine can be recommended as a treatment option for peripheral neuropathy. It is also important to note that there are other ways to manage this condition, such as managing blood glucose levels, getting regular foot checks, daily foot care, medications, physical activity and mobility aids if necessary.

Foods that are naturally rich in serine include soybeans, nuts, eggs, chickpeas, lentils, meat, and fish. However, the study’s lead author Professor Christan Metallo cautions against people with diabetes taking serine supplements without further research, as they may have a negative impact on your health.

“You would likely need to take a lot to make a difference, and not everyone needs extra serine,” Metallo says. “We need more time to understand serine physiology in humans and explore potential downsides to supplementation.”

As always, consult your health professional before making any changes to your diet.

Scientists from the Salk Institute have found that adding an amino

SOMEWHERE TO BELONG BELONG

Knowing

BARTLETT

After being diagnosed with diabetes as a four-year-old, Emily Vuong says she spent most of her youth feeling like she was the only person in the world going through what she was dealing with. While her parents were a great support and helped her live a “normal” childhood, by the time she was a teenager, dealing privately with diabetes had become a source of shame.

where to find support can make a big difference to your diabetes journey, writes MYKE

“I didn't have any connections with anyone else with diabetes during that time in my life,” Emily says.

“Because there was no one really keeping me accountable, I just wouldn't test or take insulin when I was at school. Every single day, I would come home from school and my blood sugar would be through the roof.”

Although she puts this bout of poor management down to the usual adolescent growing pains, Emily says it wasn’t until she found a community of peers that she developed a more positive attitude to managing her diabetes.

“I did go to a kind of mother’s group when I was younger, where all the other kids had type 1, but we only saw each other a handful of times. Then I started following a few diabetes accounts on Instagram, just out of curiosity, and I saw that there was a whole community of diabetics online from all around the world. It was very inspiring to me how open they were with their own diabetes.”

A 2016 survey by NDSS found that Emily isn’t alone in

benefiting from peer support. Adults with type 2 diabetes said peer support helped them access to diabetes resources and gave them the motivation to manage diabetes, while adults with type 1 most commonly said peer support helped to “make me feel like I’m not alone”.

Emily says being able to share her experiences with her online community was empowering – and very helpful!

“It was a real turning point. Other people have a lot of tips and advice that you would just never have time to get from the doctor. And I think just seeing people wearing their medical devices, not trying to hide them but wearing them proudly, just normalised diabetes for me. Growing up, I was the only diabetic at my school, I didn’t see people like me in the media and I didn't know any celebrities who had diabetes. Finally, I felt like I had somewhere to belong.”

Support at home

Deborah Schofield, general manager of health at Diabetes WA, says that finding that “somewhere” can have a profound impact on an individual’s diabetes journey. For some, having an understanding family can make all the difference, for others it will be a network of supportive friends. For many, such as Emily, peer support can be transformative.

“When we talk about support, we’re talking about a number of different levels,” Deborah says. “There’s the connecting with other people who are living with the same condition, because there's a lot that you can learn from each other and you know that they understand what you're going through. But it’s important to remember that there are many ways people with diabetes can find support or be supported.”

Educating the people around you – who may not have had much experience of diabetes – is key, Deborah says.

“In a lot of our programs, we encourage people to bring

“Growing up, I was the only diabetic at my school, I didn’t see people like me in the media and I didn’t know any celebrities who had diabetes. Finally, I felt like I had somewhere to belong.”

along a significant other, whether that be their partner, a friend, or a family member of some sort. Because you're living with these people, and it's really important for them to understand what diabetes is all about, and how they can best support you.”

There can be benefits for the family too, given that diabetes management tends to involve a greater awareness of the importance of diet and physical activity.

“In many ways that can be a plus for the whole family, if the family can look on these changes as a positive and say, well, the health of all of us can improve. There may be also family members who, without those changes, are high risk of type 2 diabetes, because their immediate family member has it.” This support can be a double-edged sword, however, if family members play too much of a role in helping someone manage their diabetes.

“A lot of people can sometimes feel judged within their family. It's important to be non-judgmental, because people living with diabetes can make their own choices about what they eat, and they're managing a lot of different things. It doesn't help for others around them to be the food police.”

Finding support

As Emily discovered, family support is crucial in the early years following a diagnosis of type 1 diabetes. Endocrinologist Professor Tim Davis says that the way a family does or doesn’t support a young person with type 1 can determine the course of the condition.

“Ideally, you have a very supportive family that doesn't dominate but allows the young person to develop the maturity to manage their own condition,” Tim says. “Some family support networks can be a bit suffocating for the patients and they don't develop the appropriate level of independence of self-care.”

For young people with type 1, the crunch point often comes in young adulthood, as family support starts to fall away somewhat.

“What tends to happen when people progress out of pediatric clinics into the adult outpatient world is they tend to fall between the cracks. The family support falls away and kids want their independence. Often they don't want their social circles knowing they have diabetes and all that sort of thing.

ABOVE: Emily Vuong and her mother Natalie

“Ideally, you have a very supportive family that doesn’t dominate but allows the young person to develop the maturity to manage their own condition.”

If you don't have the right support, your diabetes suffers and that's obviously not good for long-term complications.”

It’s easy to underestimate how important support from family and friends is for older patients, whether it’s a partner helping a woman living with gestational diabetes or children caring for an elderly parent with type 2.

“Yesterday, I saw a patient in her late 70s with cognitive issues who lives on her own and is obviously forgetting to take her insulin,” Tim says. “We can try and simplify her insulin regimen so that it's just once a day given by Silver Chain, but that's only Monday to Friday. Relatives, friends, or neighbours have to come in and help at times that are not covered by the community nurse support.”

For those without extensive family or friend networks, the support services offered by Diabetes WA — notably our Telehealth and Helpline — can be a vital point of connection.

“Our helpline is accessible five days a week, so people can call us and have a chat to someone. If you find the phone difficult, you can email us or give us a web inquiry and speak to someone that way,” Deborah says.

Professor Tim Davis says those who might feel lost after an initial diagnosis should be reassured that pathways exist to help them find the support and connections they need. Most people will be put on a care plan by their GP, who will help them find appropriate education resources, start them on medication and connect them to helpful organisations such as Diabetes WA.

“Your GP is your first point of contact and most practices would have a nurse who does care plans and who can help someone get their education sorted out, dietetics sorted out, and start on medications. If things don't go to plan, people like me get called in. But I also work very closely with educators on my complex patients and they’re a very important part of the team, as are dietitians, and we have

a clinical psychologist here at Freo that I use quite a lot, especially for younger patients who are not coping well with having diabetes on top of other life stressors. By and large, the Australian system is pretty good at supporting people who need it with diabetes.”

Increasingly, those seeking to find peer support prefer to do so online (even back in 2016, a majority of those surveyed by the NDSS chose virtual networks where available). For Emily, finding her own community of support has transformed her experience of living with diabetes and she encourages others to reach out — even if meeting up in person isn’t always possible.

“I think it's a lot easier for me to be open with my feelings and my experiences if we don’t meet face-to-face, because, yes, we're all connected by diabetes, but that might be all we have in common. We can just talk about diabetes and appreciate that everyone's on their own journey, but that we have that little path we're walking on together.”

For those without extensive family or friend networks, the support services offered by Diabetes WA — notably our Telehealth and Helpline — can be a vital point of connection.

FINDING THE

THAT WORKS FOR YOU SUPPORT

Everyone’s diabetes journey is unique. Just as there is no single right way to manage your diabetes, the best kind of support will look different for everyone. Family and friends can be great, but sometimes it helps being around people who know firsthand just what you’re going through.

Deborah Schofield, general manager of health services at Diabetes WA, says that peer support comes in many different forms.

“It can be an informal coffee that you have with someone once a week through to a group that you meet with in a structured setting, or it can be

an online forum where you chat with other people,” Deborah says. “People shouldn’t feel that there’s one ideal way — however you wish to regularly engage with other people is peer support for you.”

Studies of peer support have shown definite benefits for people living with diabetes, including improved feelings of social and emotional health and improved diabetes self-care. There is a comfort in connecting with like-minded people (who might have more time to talk about diabetes than many health professionals), and a freedom in being able to share experiences, thoughts

While family and friends can provide valuable assistance for people living with diabetes, there is a special power in finding support from your peers, writes MYKE BARTLETT.

and feelings without fear of upsetting friends or family.

Diabetes can be a lonely journey for many, particularly those without extensive friend or family networks, but peer support can provide an important sense of connection, as well as allowing people living with diabetes to learn from the experiences and insights of their peers — and inspire each other to improve their quality of life.

While peer support should never replace advice from health professionals, it can help you find “life hacks” that might make living with diabetes feel easier.

The NDSS peer support website, which exists to help people with diabetes find support groups either online or in their local area, identifies four main roles for peer support:

• to improve diabetes self-care through the sharing of useful tips, knowledge and lived experiences from peers

• to offer emotional and social support through listening to peers

• to help peers find and use healthcare systems and community resources

• to offer ongoing support and encouragement to peers.

This support can be particularly beneficial at key transition points on your diabetes journey, such as when you are first diagnosed, changing medications, or trying out an insulin pump.

Deborah says the online support groups can be a great starting point for people who might find it difficult to get along to a face-to-face session — for reasons of distance, time or even shyness.

“The peer support website is a great place to find information on how to find a support group that suits you, or even how you can set up your own support group if you’re keen to do that,”

Deborah says, “and if you run a peer support group or forum that isn’t listed, be sure to apply to have it included so others can find you.

“You can proactively seek support, even if it’s simply being part of an online forum where you can be a fly on the wall and just listen to the chat.”

Along with the peer support groups listed on the peer support website, MyDESMOND – the self-paced online program for type 2 diabetes – has an inbuilt forum where you can chat to others as you progress through the program. Baby Steps online program also has a similar chat forum available for women who have had gestational diabetes so they can share experiences.

“MyDESMOND is a fully self-paced online program where you can chat to others who are also using the program, and the Baby Steps program, for women who have had gestational diabetes, has a dedicated chat forum built in,” Deborah says.

“Some participants have called it a mother’s group for people with gestational diabetes!”

Additionally, anyone who has attended a Diabetes WA DESMOND face-to-face

session anywhere in the state can join a special Facebook group where they can chat to peers who have also been through the program.

Deborah says she sees these peer support mechanisms as being an important part of a larger picture of diabetes care that includes services such as the Diabetes Helpline and Telehealth, which allow West Australians living with diabetes to access support when needed.

“Peer support is a great compliment to mainstream care. Quality programs and services provided by Diabetes WA increase your understanding and confidence to manage the challenges of living with diabetes.

Peer support can give a feeling of social support and encouragement beyond this, which can really help with your day to day management of diabetes.

“You don’t always need a health professional to be giving you encouragement and advice. It’s very powerful when it comes from each other.” peersupport.ndss.com.au

“MyDESMOND is a fully self-paced online program where you can chat to others who are also using the program.”

GIVING IT A GO

I was four years old when I was diagnosed with type 1 diabetes. That was 21 years ago now.

I do actually remember sitting in the doctor’s room and being quite disappointed because I had a birthday party that afternoon, and I wasn’t allowed to go because I had to go to hospital and learn about diabetes.

I don’t remember too much about life before diabetes. It’s just been something I’ve had to live with. There were moments, especially at high school when I was having to test my blood or take insulin, when I felt a little bit different from all the other kids. But my close friends were very good and understood what was going on.

I don’t remember much about life before athletics either. I was always very involved at school. The athletics carnivals were my favourite days of the year. I started doing little athletics when I was about 10 years old and I’ve been doing Surf Lifesaving since I was eight or nine. I was quickly drawn to the sprinting side of things, both on the track and on the beach. I found out that I was reasonably good at it and I loved to train. My peak achievement in that area is probably becoming the 2021 National Beach Sprint Champion. It was amazing to win that title. For the last couple of years, I’ve also been sprint cycling, and I got talent identified for sprint cycling, so I’ve been pursuing that area more.

Having diabetes definitely did make it more challenging. There were a lot of things I had to be aware of, and a lot of things I had to get to know about myself and how I responded to exercise and things like that. So it was, and still is, a difficult thing to manage. But I think the key point is I didn’t let it hold me back and it didn’t stop me from doing the things that I love. You need to find a way of managing it that works for you, so you can do the sport. Once you’ve got your diabetes under control, you know how your body’s going respond to that to those activities. There’s an element of wanting to prove myself. I’ve got a condition that the majority of the other competitors

Champion cyclist SOPHIE WATTS hasn’t let type 1 diabetes stop her from pursuing a sporting career.

PHOTO BY MICHAEL SHIPPLEY

don’t have. Getting your diabetes under control and getting your blood sugars right, so you can produce the best performance possible is definitely challenging. But when you overcome those challenges, it just makes it so much more worth it, I guess, and meaningful.

The advice I’d give anyone like me is — you need to get to know yourself and how you respond to different types of exercise. The only way to do that is through trial and error. You just have to be a prepared to potentially have a low or a high. Make sure that you are prepared for those moments. If you’re doing some exercise, make sure you’ve got snacks or glucose nearby or with you.

Another thing that made a big difference for me was going on a type 1 camp when I was younger. Before that, I hadn’t

actually met many other diabetics. It was an eye opener to see that, okay, there’s quite a lot of other people out there with diabetes, and you know, seeing them having the same challenges that I had was super important.

It made me realise there is a community out there. I also follow quite a few people who are diabetics on social media, and it is really helpful

to know that the community is there and other people are going through the same thing, same challenges as me. I find that inspiring.

When I meet young people like me who want to compete, I always say don’t let diabetes hold you back. Don’t let your fears hold you back. Because you don’t know what you can achieve when you just give it a go.

When I meet young people like me who want to compete, I always say don’t let diabetes hold you back.

WORKSHOPS

DESMOND

For people living with type 2 diabetes. The DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) program provides you with a welcoming and non-judgmental space where you can plan how you would like to manage your diabetes.

DATES LOCATION

Thursday 6 April Two Rocks

Wednesday 19 April Scarborough

Friday 12 May Cockburn

Thursday 18 May Subiaco

Monday 22 May Cannington

Wednesday 7 June Heathridge

Friday 9 June Mirrabooka

MID WEST REGION

Thursday 20 April Geraldton

Wednesday 14 June Geraldton

WHEATBELT REGION

Monday 29 May Northam

Monday 19 June Northam

GREAT SOUTHERN REGION

Monday 17 May Albany

Monday 12 June Albany

PILBARA REGION

Wednesday 26 April South Hedland

SOUTH WEST REGION

Wednesday 12 April Busselton

Tuesday 23 May Bunbury

Wednesday 7 June Busselton

GOLDFIELDS REGION

Thursday 22 June Kalgoorlie

Diabetes WA Online Workshops

Diabetes WA’s series of online educational webinars offers a convenient way to hear about a variety of hot topics on diabetes from our credentialled diabetes educators from the comfort of your living room. Free for Western Australians who are registered on the NDSS, the webinars are held via Teams, with new sessions added regularly.

CarbSmart

For people living with type 1 diabetes, type 2 diabetes or gestational diabetes. CarbSmart will help you enjoy quality carbohydrates in a way that suits you and your diabetes.

DATES LOCATION

Wednesday 5 April Heathridge

Tuesday 18 April Bentley

Friday 19 May Subiaco

Wednesday 24 May Scarborough

Thursday 8 June Armadale

Friday 16 June Cockburn

Monday 19 June Rockingham

Wednesday 21 June Cannington

MID WEST REGION

Wednesday 17 May Geraldton

GREAT SOUTHERN REGION

Friday 2 June Albany

SOUTH WEST REGION

Tuesday 9 May Bunbury

Wednesday 31 May Busselton

Beat It!

For people living with type 1 diabetes or type 2 diabetes Beat it is an 8-week group exercise and lifestyle program to help you better manage your diabetes and improve your general health.

DATES LOCATION

SOUTH WEST REGION

Tuesday 2 May Busselton

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

FootSmart

For people living with type 1 diabetes or type 2 diabetes. Living with diabetes means living with an increased risk of foot problems. FootSmart gives you the skills and knowledge to create a care routine that will help avoid future foot problems.

DATES LOCATION

Friday 14 April Mirrabooka

Friday 19 May Subiaco

Friday 16 June Cockburn

Wednesday 21 June Cannington

MID WEST REGION

Wednesday 21 June Geraldton

GREAT SOUTHERN REGION

Friday 2 June Albany

SOUTH WEST REGION

Tuesday 30 May Busselton

Ready set go - let’s move

For people living with type 1 diabetes or type 2 diabetes. Get support and be empowered to take the first step in making exercise a part of your routine, or perhaps increasing the amount you are already doing.

DATES LOCATION

Monday 29 May Mirrabooka

Thursday 22 June Bentley

Living with insulin

For people living with type 1 diabetes, type 2 diabetes—and who are using insulin. This program will help you understand insulin, the different products and equipment available, and the importance of looking after your blood glucose levels.

DATES LOCATION

Thursday 11 May Bentley

Thursday 1 June Midland

Tuesday 6 June Cannington

Thursday 8 June Melville

Friday 23 June Subiaco

Thursday 29 June Rockingham

Friday 30 June Cockburn

MedSmart

For people living with type 2 diabetes. Making sense of your medications can be difficult but it doesn’t have to be. MedSmart will give you information about your medications, how they work, how to take them and how they help manage your diabetes.

DATES LOCATION

Wednesday 12 April Cannington

Friday 14 April Mirrabooka

Wednesday 24 May Cockburn

MID WEST REGION

Wednesday 21 June Geraldton

GREAT SOUTHERN REGION

Friday 5 May Albany

SOUTH WEST REGION

Tuesday 30 May Busselton

ShopSmart

For people living with type 1 diabetes, type 2 diabetes or gestational diabetes. ShopSmart will help you to understand how to read food labels, and what to look for when choosing healthy options for yourself and your family.

DATES LOCATION

Wednesday 5 April Heathridge

Wednesday 12 April Cannington

Tuesday 18 April Bentley

Wednesday 24 May Cockburn

Wednesday 24 May Scarborough

MID WEST REGION

Wednesday 17 May Geraldton

GREAT SOUTHERN REGION

Friday 5 May Albany

SOUTH WEST REGION

Tuesday 9 May Bunbury

Living Well

For people living with type 2 diabetes. This free event will showcase the latest information on diabetes with a focus on living well with diabetes, delivered to you by experts in the field.

DATES LOCATION

Tuesday 18 April Armadale

Wednesday 17 May Mirrabooka

Thursday 15 June Floreat

WHICH IS BETTER

– FINGER PRICK OR CGM?

outside of the body (the location may vary depending on brand) with a small filament sitting in the interstitial fluid (fluid surrounding the cells) which either sends readings to a device every 1-5 minutes or the CGM is scanned by a device to get a reading.

As technology is improving there are more options available for diabetes monitoring. Most recently CGM (continuous glucose monitoring) has been making headlines in the community promoting “zero finger pricks” and continuous glucose data. It has left people wondering which is better.

Understanding how CGM works is crucial in deciding what the better option is to manage your diabetes. CGM is a small device worn on the

Finger pricking involves using a lancet to get a small drop of blood from your finger to place on a blood glucose test strip. This gives you your blood glucose levels at the specific time. There is no delay and, as a bonus, you can also use most machines to check ketones.

After reviewing the pros and cons list there are a few questions you can ask yourself:

• What CGMs are on the market?

• Which one suits my situation?

• What do I want to find out about my blood glucose levels?

• Is this covered by the NDSS for my type of diabetes?

• What will the out-of-pocket costs be?

• Am I happy with my current method?

It’s important to note that you can start, stop and change your method whenever you like. If you try a CGM and it is not right for you, going back to finger pricking is as easy as just removing the device from your arm. Changing between finger pricking and CGM is fine and can reduce the feelings of alarm fatigue and information overload.

Technological changes are exciting, but can leave people confused about the best way to check their blood glucose, writes KASI KEEFFE

Kasi Keeffe is a registered nurse and a credentialed diabetes educator.

FINGER PRICKING

Pro Cons

Blood glucose (BG) level at time of checking – no delays

Some monitors can link to sperate devices to produce reports

With some monitors can check blood ketones at the same time

Multiple finger prick throughout the day

Only snapshots of BG data

Potential missed high and lows

Discrete, nothing worn on body No alarms

Less room for environmental changes i.e cold, high altitude

Flying with diabetes

Do I need to remove my CGM when flying?

Issues for people with poor dexterity

CGM Pro Cons

24/7 monitoring

High/low alarms

Limited finger pricks (ketones, calibration where needed, unsure of readings)

Link up with health professionals, family members and/or friends

Identify patterns that may help with food and physical activity

Trend arrows – to show you where you BG levels are going.

Can connect with some pumps to pause insulin when going low. Improve independence for people with poor dexterity

Having something attached to your body

Learning new technology

Lag time – delayed readings (around 5 minutes)

Needing to trouble shoot with finger pricking when symptoms do not match the CGM readings especially when at high altitudes and when it is cold

Alarm fatigue

Overwhelming

Going through airport security can be daunting with or without diabetes. Fortunately, there are government endorsed guidelines when dealing with CGMs and insulin pumps.

CGMs can go through metal detectors in much the same way as insulin pumps, but the airport x-rays can damage the devices. It is important to alert the airport staff of your medical alert and ask for a physical check of person and luggage. CGMs and pumps must not be removed even when going through security.

You should carry a letter from your doctor detailing your medical condition, your need for medication, blood glucose checking or monitoring, CGMs and pumps. Making several copies of this letter is advised as it will be needed at customs. Carrying additional photographic identification is also recommended, along with your NDSS card.

When flying it is recommended you take your blood glucose monitor aboard so you can check perform a check if your symptoms don’t match your CGM reading.

EXERCISE INTENSITY

Physical activity is good for us and can do wonders for diabetes management, but what sort of exercise and how much do we need to do to get all these benefits? MARIAN BRENNAN writes.

Physical activity guidelines in Australia encourage us to engage in 150-300 minutes per week of moderate intensity activity or (for those aged between 18-64 years) 75-150 minutes per week of vigorous intensity activity, and to include muscle strengthening activity on at least two days per week. But what is ‘moderate’ or ‘vigorous’ intensity exactly? What does it look like, and will it look the same for everyone?

Intensity is just a gauge of our heart and breathing response to activity. We know that for those aged between 18-64 there are some great benefits to

activity done at vigorous intensity, if it is right for us and we enjoy it! But as you will start to see, the right type of activity for one person may not be the same intensity for the next person, even if it is done at the same pace, distance, and duration. It is quite possible that running, for example, might be moderate for one person and vigorous for someone else. For this reason, it can be more useful to refrain from thinking about a certain type of activity (running, walking, cycling, swimming) as having a set intensity because this is likely to be different for everyone, depending

on how accustomed they are to that activity. Instead, we can gauge the intensity of an activity (for you) by using one of these three different measures:

 Talk test: Can you speak comfortably?

 Rate of perceived exertion (RPE) scale: A scale from 0-10, where zero is you at rest and 10 is 100% exertion where you can’t go any harder and need to stop

 Heart rate: Working at a certain percentage of your maximum heart rate (max heart rate = 220 – your age)

So, for example if I (50 years of age) were walking with my friend Bob (60 years of age) and I was chatting away to Bob, was a little bit breathless, but couldn’t sing to him, or I rated exertion to be a 3-4 out of 10, or my heart rate was between 93 – 117 beats per minute, I would be exercising at a moderate intensity. Bob, on the other hand starts to break out in song and is singing to me, he rates his exertion to be 1-2 out of 10, and his heart rate was 64 – 86 beats per minute. Although we are doing exactly the same activity, Bob is working at a light intensity.

HOW TO GAUGE INTENSITY

Adapted

et al. J Sci Med Sport 2009

activity can be a good way to get more ‘bang for your buck’. On the other hand, moderate intensity activity, done over longer periods has been shown to be more effective in achieving sustained weight loss as our bodies are better able to utilise fat as a fuel source at these intensities.

Although the benefits of physical activity are vast, some specific benefits require us to do a bit more than others. For example, we can enjoy benefits to our heart, blood vessels, blood glucose levels, mental health and well-being by engaging in 150-minutes of moderate intensity activity or 75-minutes of vigorous intensity activity. If you want to increase your activity to reduce weight or reduce your risk of some cancers, we need to do a bit more, closer to the 300-minutes per week of moderate or 150-minutes per week of vigorous intensity activity. As you can see, by working at a vigorous intensity, we can get the same benefits of moderate intensity activity by doing half as much. So, if time was a barrier for you, including some vigorous intensity

The good news is you don’t need to commit to any one type of intensity! Simply adding in small bouts of vigorous activity amid your moderate intensity activity can maximise those benefits and make things a bit more interesting. For example, try walking at a faster pace or up a hill for 30 second bouts a few times during your moderate intensity walk.

If you have never tried vigorous intensity activity and are living with diabetes, it is worth having a conversation with your GP and or exercise physiologist to make sure it is right for you. If you are new to exercise or haven’t done anything for a while, we would suggest starting with moderate intensity activity for a duration that you are comfortable with and progressing slowly towards the above-mentioned recommendations.

A Common VOICE

For people experiencing loneliness or dealing with a chronic condition, getting together to sing with strangers can be life-changing, writes MYKE

BARTLETT.

Finding a support group doesn’t always mean finding people who all going through the same thing as you. There is often comfort to be found in getting together with a bunch of strangers to work on a common project. In his book Lost Connections, journalist Johann Hari details the positive impact on mental health experienced by people who find communities of purpose — whether that community is market gardening or neighbourhood watch. But there’s one group activity that seems to have particular benefits for wellbeing — singing!

A new memoir, Why We Sing, by singer and community music teacher Julia Hollander details the power of singing in healing, sharing the inspiring story of how singing in a community choir helped her and her daughter Immie, who was born with cerebral palsy. She argues that singing is a gift that shouldn’t be “confined to music-making people, let alone to designated times and places”. In short, everyone can — and should — find someone to sing with.

Community choirs have been popping up all over Australia in recent years. Most famously, the Choir of Hard Knocks brought together people who, for reasons of illness or circumstance, might have struggled to join a choir. Pub Choir brings together ‘tipsy strangers’ and encourages them to belt out popular songs, even if they’ve never sung before. The UWA Choral Society is one of Australia’s more established choirs. They’ve been performing for almost a century but continue to draw new recruits from a range of ages and backgrounds.

Kris Bowtell is the conductor for UWA Choral Society. He says he joined the society as a young singer around a decade ago and has never looked back.

“Choral singing is one of the few things in life where feeling better is pretty much guaranteed,” Kris says.

“It has some of the elements of playing sport, in the sense of being part of a team working together towards a

common goal, but it’s communal, not competitive. Everybody wins at the end of the day. It’s also just the most marvellous therapy.”

Kris likens the kick of communal singing to the endorphin rush experienced by long-distance runners. This isn’t just anecdotal — there’s science to back it up. Why We Sing notes that biologists have observed the benefits of “gregarious singing”

and-bloody resonance with theirs,” she writes.

Kris agrees that there’s no beating actually being in the room with your fellow choristers.

“I was really struck personally, when we came back together, after having not been able to rehearse for for about four or five months. I didn’t realise how much I’d missed actually seeing these people on a weekly basis. People

in wildlife. The brains of starlings who sing together have shown raised levels of endogenous opioids (natural painkillers) and biologists have found that birds are particularly drawn to areas where they can gather in large numbers and sing tunes that are quite different to their usual, solo birdsong. Coming back together to sing has proved to be even more important after the disruptions of the past years.

Julia Hollander writes about how difficult she found it suddenly not being able to sing in choirs when COVID hit. The forced separation of the rolling lockdowns reminded people how important connection and community was and what better way to build an instant connection than start singing?

Some choirs — including the Pub Choir — tried to bridge the gap by hosting online sessions (dubbed the “Couch Choir”), but Julia writes that these efforts just brought home for her that choirs aren’t just about singing but “being present with other people in real time and space.”

“Never again will I take for granted the joy of being immerse in my fellow humans’ sound, melding my flesh-

were just so happy to be there, back together.”

Julia’s book aims to help readers understand how singing can help people — whatever their age or background — deal with the trials of modern life, which might include living with a chronic condition. In an age when we are divided by the screens that connect us, choral singing gives people a reason to get together faceto-face. People more accustomed to warbling in the shower might feel shy at first, but there’s comfort in the fact that singing is one activity where there’s no need for awkward small talk.

For Kris, there’s an additional unifying power in singing classical music that has lasted through the centuries. It’s a reminder that, no matter how things change, the joys of belonging to humanity are remarkably consistent.

“One of the works in a recent concert was written almost two hundred years ago. The remarkable thing is, despite being written so long ago, it still speaks to you and it moves you. It makes you think about just how much people remain people.”

uwacs.com.au

“It has some of the elements of playing sport, in the sense of being part of a team working together towards a common goal, but it’s communal, not competitive. Everybody wins at the end of the day. It’s also just the most marvellous therapy.”

THE GLUTEN-FREE MEDITERRANEAN DIET

It took a visit to the IVF clinic for Helen Tzouganatos to discover she had coeliac disease – a condition where your immune system attacks your own tissues when you eat gluten. For someone brought up in the Mediterranean tradition of eating, where meals tend to be shared, celebratory occasions featuring a lot of baked goods, this news came as a shock.

“I had all the common complaints of fatigue, lethargy, anemia, stomach cramping, all those everyday complaints that quite often go unnoticed,” Helen says. “When I went to my IVF doctor, and he asked me if I had any health problems, I said, No, no, I just get tired quite easily because I’m always anemic. He said to me,You may be a coeliac.”

Helen had never heard of the term, but a blood test and biopsy soon confirmed the diagnosis.

“There’s a happy ending to that story, which is I had two kids through IVF, and the third one I conceived naturally, five years after going gluten free. It can take about that long for your body to heal from the damage.”

That level of system-wide inflammation is not unusual for coeliacs, despite common belief that the condition is limited to digestive symptoms. Coeliac disease is an autoimmune condition, which may explain why it seems to be roughly five times more common for people who have type 1 diabetes.

When Helen was diagnosed 15 years ago, finding gluten free products was a struggle. Shop-bought bread substitutes tended to be inedible. Not wanting to miss out on the communal meals that are such a big part of the Mediterranean lifestyle, she turned to making her own.

“I wanted to eat all those classic Mediterranean dishes that I grew up with, so I started experimenting with recipes and flours that I would have to buy from a health food store 20 kilometres away,” Helen says. “Now you can find buckwheat flour, tapioca flour, rice flour on your supermarket shelves.”

Helen’s new book, Gluten Free Mediterranean contains an extensive collection of her coeliac-friendly spins on these classic recipes. Even if you’re not coeliac, Helen’s easy-tofollow approach makes the cookbook a good place to start if you’re wanting to give the Mediterranean diet a go – it has been shown to have wide health benefits, including improvement in diabetes management.

While some might be wary of substitutes, Helen says her version of the recipes are good enough to fool the most breadobsessed of diners.

“We’ve come a long way in terms of packaged goods, but they’re still not great. If you’re making something from scratch, like my baked cakes, and breads and pies, you would

not know they are gluten free. Your friends and family won’t even know.”

The focus throughout the book is on making meals as inclusive as possible, rather than banishing anyone whose intolerances or lifestyle choices might make it hard for them to share the table.

“In the Mediterranean, we show our love by cooking for people and sharing a family meal together and enjoying a glass of red wine,” Helen says.

“What I’m doing is making it so nobody is excluded at the table. Everyone can have a slice of Easter bread, nobody’s left out. Who doesn’t have a member of their family or their circle of friends with a food allergy?”

To that end, her book offers suggestions to further tweak the recipes to make them work for people who avoid meat or dairy.

“A lot of people who don’t eat gluten also don’t tolerate dairy very well. I do eat dairy, but only in small amounts. The recipes are probably 70 to 80% dairy-free and, where I have used dairy, you can just leave it out or use dairy-free substitutes.”

And if she had to pick one recipe to convince the gluten-free sceptics?

“One that people have given me great feedback on is a moussaka that you can eat if you’re gluten-free or dairy-free. Instead of making a bechamel sauce, which is cheesy and creamy, replace it with a whipped pumpkin and cauliflower mash on top. When you bake it, it’s so beautiful and rich and comforting, you don’t even miss the meat or the dairy at all!”

Gluten-free Mediterranean: Your favourite Mediterranean dishes reimagined, from pillowy breads and hearty mains to syrupy sweets by Helen Tzouganatos is out now from Pan Macmillan Australia.

For more information on living with coeliac disease and diabetes: www.ndss.com.au/about-diabetes/resources/ find-a-resource/coeliac-disease-fact-sheet/

After discovering she was gluten intolerant, foodie Helen Tzouganatos has dedicated herself to making sure her fellow coeliacs aren’t left out of the feast, writes MYKE BARTLETT

Diabetes WA dietitians suggest using 500g of mince and adding in a tin of brown lentils to reduce the fat content. This will increase the amount of carbohydrates in the meal slightly, which you may need to consider.

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

BBQ KOFTE WITH WHIPPED FETA AND TAHINI SLAW

Prep: 15 mins

Cook: 15 mins

Serves: 6 (as a main meal)

800g extra lean beef mince

1 small brown onion, finely grated

Pinch dried chilli flakes

2 tsp ground cumin

1 tsp ground turmeric

Freshly ground black pepper

6 warm flatbreads or gluten-free flatbreads (see recipe page XX)

Handful of mint leaves

Pinch of ground sumac, to serve

3 tbsp pine nuts, toasted, to serve

Whipped feta

150g reduced-fat feta, crumbled

21/2 tbsp Greek natural yoghurt

Tahini slaw

2 carrots, cut into thin sticks

¼ white or red cabbage, finely shredded

3 green shallots, shredded

2 tbsp tahini

2 tbsp olive oil

Squeeze of fresh lemon juice

1 Put the beef mince, onion, chilli flakes, cumin and turmeric in a large bowl. Season with pepper. Use clean hands to mix until well combined. Divide the mixture into 12 balls and mould onto metal skewers. Place in the fridge until ready to use.

2 Meanwhile, to make the whipped feta, put the feta and yoghurt in a small food processor or blender and process until smooth and creamy.

3 To make the tahini slaw; put the carrot, cabbage and shallots in a large bowl. Toss to combine. Whisk the tahini, oil, lemon juice and a splash of water in a small bowl. Whisk to combine. Add to the vegetable mix and toss to combine.

4 Preheat a barbecue grill or chargrill on high. Add the kofte and cook, turning regularly, for 8-10 minutes or until golden brown and cooked through.

5 Spoon the whipped feta over the warmed flatbreads and add the kofte. Serve with the slaw alongside, and sprinkle over the mint leaves, sumac and pine nuts.

BROCCOLI PASTA SALAD WITH SALMON & SUNFLOWER SEEDS

Prep: 10 mins

Cook: 10 mins

Serves: 2 (as a main)

75g dried wholemeal penne or gluten-free pasta

125g broccoli florets

125g green beans, trimmed and halved

1 Tbsp white miso paste or gluten-free miso paste

1 tsp grated ginger

2 tbsp sunflower seeds

2 tsp extra virgin olive oil

2 x 150g skinless and boneless salmon fillets

1 Bring a medium saucepan of water to the boil over high heat. Add the pasta and simmer for 7 minutes. Add the broccoli and beans and simmer for 3-4 minutes or until the pasta is al dente and the vegetables are tender.

2 Heat a chargrill pan on medium-high. Spray both sides of the salmon with cooking spray. Add to the grill and cook for 3-4 minutes each side or until just cooked. Transfer to a palte. Set aside to cool slightly.

3 Drain the pasta and vegetables, reserving the cooking water. Tip the pasta and vegetables into a bowl. Add the miso paste, ginger, sunflower seeds, oil and 3 Tbsp of the reserved pasta water.

4 Flake the salmon into large pieces and add to the pasta. Toss well. Serve.

Nutritional Information

PER SERVE 2230kJ (534Cal), protein 42g, total fat 26g (sat. fat 7g), carbs 28g, fibre

9g, sodium 453mg

• Carb exchanges 2

• GI estimate low

• Gluten-free option

LOWER-CARB OPTION:

Swap the green beans for 125g asparagus, roughly chopped

Nutritional Information

PER SERVE 2220kJ (531Cal), protein 43g, total fat 27g (sat. fat 7g), carbs 26g, fibre

8g, sodium 455mg • Carb exchanges 1½ • GI estimate low

• Gluten-free option

• Lower carb

THE POWER OF YARNING

When we saw the theme of this issue was Connection, it got us thinking about how important it is to have a yarn about your diabetes now and then, whether that yarning is with your family, with your health team, or with a health worker down at your local Aboriginal Medical Service. It’s good to just have a yarn about your concerns, as well as letting others share some important information. The more you talk, the more you’ll find support.

That kind of yarning is at the heart of how we’ve approached the training for our Aboriginal Health Worker Development project —the purpose of which is to get more Aboriginal health workers into remote Communities to deliver our Diabetes Education Self Management Yarning (DESY) programs. We know that Aboriginal health workers are best placed to talk to people within their own community, because they already have the respect, trust, knowledge and connection they need to nurture their clients.

We’ve just finished the last of the five-day training sessions with the

new workers. We’ve now trained 20 Aboriginal health practitioners and 10 health professionals. Now we’re on to the mentoring stage and getting these these guys slowly on the pathway to be accredited diabetes educators.

It’s going to make a big difference to us. Now we’ve got so many people trained up across the State, the two of us won’t have to spend our time flying everywhere. We’ve got other people who can go in those communities and run the DESY sessions for us. We’ll support them to help plan their sessions and sort out venues and recruit clients, but they’ll be there on the ground, working with people they know and already have a connection with.

We led the DESY training as a kind of yarning group because we know that’s a good way to help people to relax and open up. It’s what DESY is all about. We’ll kick off the workshop by telling them a bit of a yarn about ourselves — a personal story, not a professional story. And that helps gets the rest of the people in the room in a relaxed atmosphere, which makes it

easier for them to make a connection with you. Because when you’re opening up personally about yourself, they can relate to you.

Hopefully, that sets the scene for the rest of the workshop. It should feel like we’re just having a chat about diabetes. Even though we have a structure, they’re not really aware of it. What we’re really doing is we’re modelling that for the trainers. We tell them “when you’re running your DESY workshop, it’s not a structured format, with students sitting in front of a teacher like a classroom.”

We raise topics with open ended questions, so it feels like everyone is on the same journey. We’re just having a yarn and they’re learning about their diabetes and learning about their own journey and how to self-manage their diabetes.

The way that the comfort of a relaxed environment expresses itself can be surprising. At one of our sessions in Joondalup recently, one of the women taking part started weaving earrings

Our Aboriginal Health Worker Development project is proof of the power of a good yarn to build connections and understanding, write KATHY LEMON and NATALIE JETTA.

while we were yarning. When the session was finished, she gave a pair to each of the participants. That’s a good example of community building!

It’s a particular skill being able to run a session that feels relaxed but still covers all the necessary material. What we’ve picked up on while running this pilot program is how this approach really works for Aboriginal health workers. It just seems to come more naturally to them compared to people from other populations.

We’re hoping this pilot program will just be the start of getting more Aboriginal health workers trained to deliver diabetes education in their communities. What happens next will be dependent on funding, but we know how important this project will be to people living with diabetes across Western Australia — particularly those living in Aboriginal Communities.

We led the DESY training as a kind of yarning group because we know that’s a good way to help people to relax and open up.

AUTUMN READS TO SHARE

Fantastical adventure abounds in The Dangerous Business of Being

It’s that time of year when our minds turn from beach reads to cosying up with a good book – and what better way to do that than by reading with one of the little people in your life? Thankfully, there are plenty of new titles out there guaranteed to keep adults and kids equally entertained.

The Wolves of Greycoat Hall: Boris In Switzerland is the second in a series by Australian author and illustrator Lucinda Gifford. Our lupine hero Boris is from Morovia, where wolves and humans live happily side-by-side. In the first book, he and his family travelled to Scotland to save a family castle, in the sequel he’s been sent to a prestigious boarding school in Switzerland. Once there, he’s troubled to find he’s the

only wolf at the school, but he and his new friends are soon drawn into a tantalising mystery. Like the first book, the characters are engaging, the worldbuilding is rich and the writing packed with easter eggs for grown ups. Most importantly, it’s great fun to read aloud. Slightly older kids (9+) should enjoy Crookhaven: The School for Thieves by J.J. Arcanjo – the first in a new series set at a training school for young criminals. Teen pickpocket Gabriel thinks his career might be over when he’s caught, but instead finds himself invited to Crookhaven, where larcenous youth are trained in lockpicking, forgery and other key skills. Thankfully, it’s all for a good cause, with these young Robin Hoods using their talents to trick evildoers and give back to the innocent. Ideal for fans of Alex Rider and Harry Potter.

Trilby Moffat by Kate Temple (another Aussie author). Promoted to the most important job that ever existed – that of Time Keeper – Trilby has to travel to an island outside of time, cure a mystery illness that is making people fall asleep forever (after baking ancient cakes) and wrangle rude cats. Fast, clever, funny and wonderfully weird, this is one to treasure.

Those with a taste for things that go bump in the night will find spooky thrills in Colin Meloy’s The Stars Did Wander Darkling, in which young horror movie fan Archie and friends confront an ancient evil unearthed in their small seaside town. The 1980s setting might recall TV hit Stranger Things, but Meloy’s world has a whimsy all its own, as the kids hang out in the local video store to research scary happenings. Hip parents will be pleased to recognise the author as the frontman of cult band The Decemberists.

As the weather cools, MYKE BARTLETT looks at the best new books to cuddle up and share with the little ones in your life.

Win three months at the gym

Looking for an excuse to get active?

Thanks to VenuesWest, we have a 3 month Universal Gym Membership Prize for HBF Stadium in Mt Claremont or HBF Arena in Joondalup to be won.

To enter, email media@diabeteswa.com.au with your name and member number and write VENUESWEST PRIZE in the subject line.

Win tickets to comedian Urzila Carlson

Multi award-winning South African-New Zealander comic Urzila Carlson (pictured above) has won a legion of fans worldwide in recent years, not least of all thanks to her hit Netflix hour-long comedy special Overqualified Loser. You may also have seen her on smash-hit panel show, Have You Been Paying Attention? Now she’s bringing her new show Just No! to HBF Stadium in Mt Claremont on 27 May. Thanks to VenuesWest, we have a two double passes to be won.

To enter, email media@diabeteswa.com.au with your name and member number and write JUST YES! in the subject line.

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This product is indicated for measuring interstitial fluid glucose levels in people (age 4 and older) with insulin-requiring diabetes.

*Data based on the number of users worldwide for FreeStyle Libre family of personal CGMs compared to the number of users for other leading personal CGM brands and based on CGM sales dollars compared to other leading personal CGM brands. †Finger pricks are required if your glucose readings and alarms do not match symptoms or expectations. ^The FreeStyle LibreLink app is only compatible with certain mobile devices and operating systems. Please check www.freestylelibre.com.au/compatibility for more information about device compatibility before using the app. Use of FreeStyle LibreLink requires registration with LibreView. #Compared to other on-market CGMs in Australia. §Notifications will only be received when alarms are turned on and the sensor is within 6 meters of the reading device. ‡The LibreLinkUp app is only compatible with certain mobile device and operating systems. Please check www.librelinkup.com for more information about device compatibility before using the app. Use of LibreLinkUp and FreeStyle LibreLink requires registration with LibreView. The LibreLinkUp mobile app is not intended to be a primary glucose monitor: home users must consult their primary device(s) and consult a healthcare professional before making any medical interpretation and therapy adjustments from the information provided by the app.

1. Haak T. et al. Diabetes Ther 2017; 8(1): 55-73. DOI: 10.1007/s13300-016-0223-6

2. Leelarathna, L. et al. N Engl J Med 2022; 387(16): 1477-1487. DOI: 10.1056/NEJMoa2205650

3. Evans, M. et al. Diabetes Ther 2022; 13(6): 1175-85. DOI: 10.1007/s13300-022-01253-9

4. Bolinder J. et al. Lancet 2016; 388(10057): 2254-2263. DOI: 10.1016/S01406736(16)31535-5

5. Lameijer, A. et al. BMJ Open Diabetes Res Care 2021; 9(1) e002124. DOI: 10.1136/bmjdrc-2021-002124

FreeStyle, Libre, and related brand marks are marks of Abbott. Information contained herein is for distribution outside of the USA only. Abbott Australasia Pty. Ltd., Abbott Diabetes Care, 666 Doncaster Road, Doncaster Victoria 3108, Australia. ABN 95 000 180 389. ADC-69116 V1.0

ALWAYS FOLLOW THE DIRECTIONS FOR USE. READ THE WARNINGS BEFORE PURCHASE. Find out more at FreeStyleLibre.com.au