Diabetes Matters Summer 2022

From the Editor

Welcome to the Summer edition of your member magazine!

Welcome to Birak!

As you may know, we West Australians are in the Noongar season of Birak. Throughout this season, rains will ease up, and the warm weather will return. Afternoons are cooled by sea breezes. It’s the perfect time to get outside and get active (in a sun-smart way, obviously!)

This issue is dedicated to Aboriginal health and diabetes. We look at how Aboriginal Communities are disproportionately affected by diabetes and related complications. We speak to our Aboriginal Health Coordinators about their experiences and the importance of our Aboriginal Health Workforce Development project.

We also speak to people who are doing great work in this space, including Rural GP of the Year Seema Basil and Caroline Mori of EON – an organisation that brings edible school gardens to remote communities.

The holiday season can be one of overindulgence, so (alongside our Summer Reading Guide) we also take time to think about ways of staying active while running between social events.

Happy reading and here’s to a great 2023! Myke

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.

Contributors

Marian Brennan, Denise Brownsdon, Amy Fiddes, Neline Goosen, Nyaree Lawler, Kathryn Lemon, Carly Luff, Ella Mills, Janice Powell, Jessica Weiss

Photography DWA staff, Shutterstock Design Glide

Contents

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

Postal Address: PO Box 1699, Subiaco WA 6904

Diabetes WA – Belmont Office 172 Campbell Street, Belmont WA 6104

Postal Address: PO Box 726, Belmont WA 6984

A WORD FROM US

Welcome to the final edition of Diabetes Matters for 2022. What a year it has been! For many of us, it has been a year of disruptions, delays and unpredictability, as Western Australia opened its borders to COVID-19. It’s almost surprising then, when looking back on the past 12 months, to realise just how much Diabetes WA has achieved over the past 12 months.

If you’d like to find out more about what we’ve been up to — and where we’re heading in the new year — you can find our Annual Review for the 2021-22 financial year on our website. It’s a great summary of what’s most important to us and how we’re supporting the diabetes community across our wide state. We’d like to take this opportunity to thank those who made it possible for us to do so much across the past year. Thank you to all of our supporters, our partners and our dedicated team. Of course, we would be nothing without our members and our consumers, who continue to be at the centre of everything we do — so thanks to all of you too!

Looking back over our achievements for 2022, one particular point of pride is the publication of our Reconciliation Action Plan. As an organisation, we are committed to a journey of reconciliation

and to our role and contribution in addressing the five dimensions of reconciliation race relations: equality, equity, institutional integrity, unity and historical acceptance. We have already taken significant actions to develop strong relationships and improve staff knowledge and understanding of Aboriginal and Torres Strait Islander cultures. Our Reconciliation Action Plan is both testament to that commitment and an acknowledgement that we still have a long way to go. We will continue to move forward with open hearts and minds on our reconciliation journey in 2023 and beyond.

As you will read in this issue, there is no avoiding the fact that Aboriginal Communities face a disproportionate burden of diabetes and diabetes-related complications. Diabetes WA is committed to helping to close the gap when it comes to health outcomes and you can read about some of the work we’ve been doing in the pages that follow. We will continue to work closely with Aboriginal Medical Services and Aboriginal Community Controlled Health services to support individuals by the most appropriate and culturally safe means.

Over the past 12 months, we have journeyed to many corners of the

state, supporting individuals living with diabetes through the delivery of education programs and clinical services. Our team has travelled as far north as Kununurra, as far east as the Ngaanyatjarra Lands and deep into our great southern area. We are constantly expanding our understanding of what our consumers need from us on their own diabetes journey and how we can best support them. Alongside our faceto-face services, we are also dedicated to expanding our virtual offerings to ensure the best outcomes for every West Australian, no matter where they live in our state.

Once more, thank you for your support over the past year. We hope you are able to enjoy the summer break and wish everyone the best for 2023.

Mary Anne Stephens

Diabetes WA Board Chair

Melanie Gates

Diabetes WA CEO

Mary Anne Stephens

Melanie Gates

What’s new at Diabetes WA?

Metro Diabetes Clinic

You’ve spoken and we’ve listened!

Coming in 2023 is Diabetes WA’s Metro Diabetes Clinic where you can book individual appointments with one of our friendly diabetes educators.

You can attend in person at our Subiaco office or via video call – you can choose what suits you best.

There are discounted prices available to Diabetes WA members, and a GP referral will give you access to a Medicare rebate.

Anyone living with diabetes can book in and you are welcome to attend with a family member, friend or support person.

To find out more or to register your interest, call 1300 001 880

In the media

Did you see us on the news? Our general manager of health services Deb Schofield (pictured) appeared on 7News at the start of December, speaking about the recent changes to subsidised access to glucose monitoring technology.

The news item followed the announcement by the Australian Government of further subsidies for people living with type 1 diabetes, adding Omnipod Insulin pumps to the National Diabetes Services Scheme (NDSS) from 1 December.

The Omnipod DASH Insulin Management system includes a waterproof adhesive pod which delivers insulin, alongside a touchscreen device to program and control the pod.

This is an excellent initiative for the type 1 community, allowing people living with diabetes to manage their condition in the way that best suits their needs.

Getting out and about

A month earlier, we marked World Diabetes Day. Held on 14 November to commemorate the birthday of Sir Frederick Banting, the co-discoverer of insulin, World Diabetes Day aims to promote the importance of diabetes awareness as a global health issue. This year’s theme was ‘Access to Diabetes Care’, focusing on ‘education to protect tomorrow’, so we spent the following week sharing some tips to support West Australians living with diabetes. Our Teleservices manager Jessica Weiss appeared on RTRFM to talk about how important diabetes education is to the local community.

Also in November, Jessica could be found as part of the team at Seniors Have a Go Day at Burswood Park (pictured right). We had a great day and enjoyed chatting with lots of interesting and interested folk!

We were delighted to be chosen to be part of Grill’d Subiaco’s Local Matters fundraising program (pictured below left). Thank you to Grill’d for their generous contribution to Diabetes WA and to everyone who supported our cause. The whole team is grateful for the support of our wonderful Subiaco community.

Finally, in October our Diabetes Telehealth for Country WA team attended the 2022 Rural Health Awards after being nominated in the category ‘Building Healthy Country Communities’ (pictured below right). While the team were not successful this time, it was an excellent opportunity to reflect on our efforts to build this service. We are proud and grateful to have our service recognised by the people of regional Western Australia.

Diabetes Matters wants to make sure our member voices are heard.

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

CAMPING OUT

October’s camp for kids living with type 1 diabetes was a great success, writes AMY FIDDES. Held over the October school holidays, the latest kids camp for kids with type 1 diabetes gave campers a safe space to go ‘wild’ with their peers. The ‘At the Zoo’ themed camp saw kids donning their favourite furry costumes for an animal themed disco one evening before enjoying a visit from a Perth Zoo keeper on the final day.

Held at Point Walter Recreation Centre, Bicton, the twonight, three-day camp attracted 35 children from regional and metro Western Australia. Our type 1 camps, run twice a year during school holidays, are hosted in partnership with Perth Children’s Hospital (PCH) and Diabetes WA, and co-funded by Lotterywest and the National Diabetes Services Scheme. Diabetes WA is committed to supporting all West Australian kids living with type 1 diabetes (currently around 1,000 in WA) and our camps are a fantastic way to encourage confidence and independence skills in children when managing their diabetes away from home. They’re also a great way to help kids develop important friendships and peer support networks.

The October camp was packed with fun activities including a flying fox, kite making and a treasure hunt, alongside educational sessions held by a dietitian, social worker and

doctor from PCH. Campers learnt how to build physical activity into their daily lives while safely managing their glucose levels through insulin and food intake. Activities were centered around the animal theme and focused on identifying individual strengths and abilities in an empowering light. Each camper was supported to have more confidence in themselves and within their wider community. October’s cohort were also inspired by the accomplished cycling athlete, Sophie Watts, who pre-recorded a video especially for the campers about her journey of living with type 1 diabetes and becoming a star athlete. On the final day, Simone from the Perth Zoo gave an engaging presentation about the Orangutan Tsing Tsing who lived with type 2 diabetes at the Perth Zoo.

Feedback from campers was that it made a real difference to them seeing there are other kids in WA living with the same chronic condition that they do. Many reported a sense of joy from feeling they belonged to a community.

“You can make friends who have diabetes. You can learn things about your diabetes.” participant

NEW DRUG APPROVED TO

DIABETES

A new medication has been shown to delay the onset of type 1 diabetes in children and adults, writes JESSICA WEISS.

A new American drug offers a groundbreaking treatment option to people diagnosed with type 1 diabetes, according to a recent announcement by the US Food and Drug Administration (FDA). In November, the FDA approved a Tzield (teplizumab-mzwv) injection to delay the onset of type 1 diabetes in adults and pediatric patients 8 years and older who are not yet diagnosed with type 1 diabetes. The delay is described as being “significant”.

UK STUDY WILL SCREEN 20,000 CHILDREN FOR DIABETES

burdens of disease.”

Tzield works by binding itself to certain immune system cells and delaying progression to a stage where someone would usually be diagnosed with type 1 diabetes. Tzield may deactivate the immune cells that attack insulin-producing cells, while increasing the proportion of cells that help moderate the immune response. Tzield is administered by intravenous infusion once daily for 14 consecutive days.

The medication’s safety and efficacy were evaluated in a randomised, double-blind, event-driven, placebo-controlled trial with 76 patients who were not yet at the stage where they might be diagnosed with type 1 diabetes. In the trial, patients randomly received Tzield or a placebo once daily via intravenous infusion for 14 days. The primary measure of efficacy was the time from injection to development of type 1 diabetes. The trial results showed that over a median followup of 51 months, 45% of the 44 patients who received Tzield were later diagnosed with type 1 diabetes, compared to 72% of the 32 patients who received a placebo.

The mid-range time from injection to developing type 1 diabetes was 50 months for the patients who received Tzield and 25 months for those who received a placebo.

John Sharretts of the FDA’s Centre of Drug Evaluation and Research said Tzield promised to be an important new treatment option.

“The drug’s potential to delay clinical diagnosis of type 1 diabetes may provide patients with months to years without the burdens of disease.”

A new trial will screen children aged three-13 in the hope of improving early intervention for type 1 diabetes, writes CARLY LUFF. Scientists in the UK are launching a trial screening program for type 1 diabetes in the hope of improving rates of early detection and reducing long-term complications.

Led by the University of Birmingham, the study will use blood tests looking for autoantibodies. Autoantibodies, which the immune system uses to earmark insulin-producing cells for destruction, can appear in the blood years before people begin to experience any diabetes symptoms.

More than a quarter of children in the UK diagnosed with type 1 diabetes are not diagnosed until they are in diabetic ketoacidosis.

Currently, more than a quarter of children in the UK diagnosed with type 1 diabetes are not diagnosed until they are in diabetic ketoacidosis and require urgent hospital treatment. Monitoring for autoantibodies will reduce the risk of developing DKA prior to a diagnosis.

Early intervention also means children with type 1 diabetes will have access to evolving therapies and treatments that could delay them developing diabetes. Additionally, participating families would be offered support and education to help prepare them for a diagnosis.

Around 400,000 people in the UK are believed to have type 1 diabetes. The study, dubbed Early Surveillance for Autoimmune Diabetes (ELSA 1), is currently in its early stages but will follow 20,000 participants between the ages of three and 13.

DELAY TYPE 1

“The drug’s potential to delay clinical diagnosis of type 1 diabetes may provide patients with months to years without the

CLOSING THE GAP

DIABETES AFFECTS WEST AUSTRALIANS FROM ALL BACKGROUNDS, BUT THERE IS NO IGNORING ITS DISPROPORTIONATE IMPACT ON THE LIVES OF ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE.

As recently as 2017, diabetes was the second highest cause of death for Aboriginal and Torres Strait Islander people in WA. Diabetes death and hospitalisation rates in remote and very remote areas are two times that for people living in cities. The latest government figures suggest diabetes death rates for Aboriginal Australians are four times those for nonAboriginal Australians.

Diabetes WA is committed to helping to close the gap between remote and urban areas, and between outcomes for Aboriginal and Torres Strait Islander people and for everyone else. In a series of special features, we look at some of the challenges ahead when it comes to tackling Aboriginal health and diabetes and some of the programs that are already making a big difference.

BREAKING the cycle

The starkest fact about Aboriginal health and diabetes is that, for many Aboriginal and Torres Strait Islander people, diabetes has become a seemingly inevitable part of life. As Aboriginal Health Coordinator Natalie Jetta explains, in remote and rural communities, diabetes is everywhere.

“In my own experience, almost everyone knows stories about family members and good close friends,” Natalie says. “What they tell me is they’re first told they have diabetes when they’ve gone in just for their normal health checkup, or just to get some medication for something else, and they’re told they’ve got type 2 diabetes.”

That shock diagnosis, usually accompanied by a torrent of information about blood glucose, optometrists, nutritionists, and podiatrists can be overwhelming. As a result, Natalie says it’s common for people, many of whom aren’t feeling ill,

to put diabetes management on the back burner.

“That initial contact can be so scary. So many friends and relatives who have gone through that have left the clinic thinking, I feel fine, so I don’t have to deal with it for a while. And then two or three years down the track, they start seeing some of those long-term complications.”

These surprise diagnoses reflect the understanding that, as high as they already seem, prevalence rates of diabetes in remote Aboriginal Communities are significantly underreported. The most recent Australian Government study highlights that Aboriginal Australians are three times more likely to have diabetes than non-Aboriginal Australians, with around 8% of Aboriginal Australians reporting a diagnosis.

The actual figure may be much higher. Aboriginal Community Controlled Health-led studies have found prevalence rates

as high as one third of people living in these Communities. These numbers worsen with age. One study of three remote Aboriginal Communities demonstrated 60-70% of people over 65 years had diabetes. We’re also seeing a startling increase in the number of younger Aboriginal people diagnosed with type 2 diabetes (see story on p17).

One problem is that, despite being very common in these Communities, diabetes isn’t often talked about openly.

“People don’t really talk about it,” Natalie says. “But if you’re in a room and then someone mentions they have diabetes, you know someone else will suddenly go ‘Oh, I’m diabetic too!’ You’ll have two people who know each other quite well but didn’t know they both had diabetes because they just don’t talk about it.”

This silence around diabetes is one reason that much of the effort around closing the gap focuses on improving education. Natalie and fellow Aboriginal Health Coordinator Kathy Lemon travel around the state delivering Diabetes WA’s unique DESY (Diabetes Education and Self-Management Yarning) program, which is the adapted and culturally safe face-to-face diabetes education program for Aboriginal and Torres Strait Islander people living with type 2 diabetes. The program teaches skills, behaviours and practices to self-manage their diabetes and has been developed in collaboration with Aboriginal Communities.

Kathy says the success of the program – and others such as the Feltman™ and Smarts workshops – relies on the rapport facilitators build with their clients, many of whom are living in difficult conditions. She spends much of her time working with Aboriginal women in prison, people in crisis centres and the homeless.

“They know who we are now, they know our names, so they have opened up,” Kathy says. “We can sort of see how they are feeling on the day, and that lets us know how far we can go into things. Some days it’s good. Other days, it’s not so good. Sometimes they’ll just sit there and I’ll ask questions.”

Flexibility is key, she says.

“There’s got to be an understanding that it’s not like mainstream sessions where you can just put up programs and people will register for it. With an indigenous mob, there’s so many other factors that you have to allow for. There could a death in the family or in the community, there could be domestic violence, or a simple thing like lack of transport.”

The understanding that Aboriginal Health Workers like Kathy are the best people to take diabetes education programs into remote Communities lies behind Diabetes WA’s Aboriginal Health Worker Development Project.

The project, which is already leading to an increase in Aboriginal Health Workers available to deliver diabetes

One problem is that, despite being very common in these Communities, diabetes isn’t often talked about openly.

education programs such as DESY, is a collaboration with other leading health organisations across the state. This project targets ‘diabetes hotspots’ identified in the Pilbara, Goldfields, Kimberley, Southwest, Peel and Perth Metro regions. The end goal is the development of a collaborative diabetes model of care tailored for each region, enabling structured diabetes education to be delivered sustainably by a local Aboriginal Health Workforce and cofacilitated by culturally safe health professionals.

If successful in WA, this workforce development project has the potential to be rolled out nationally. Over the past year, our Aboriginal health team has supported 231 Aboriginal health workers in WA with training and engagement activities.

“We know that these workers are in the best position to deliver culturally safe content to people in Aboriginal communities and help them better manage their diabetes journey,” Natalie says. “I think they can empathise more with a person from their own Community who is ready to help them in their self-management of their diabetes. And they’re

diabetes

on the ground, they don’t fly in and leave. People know they’re going to have this nurturing and support available on an ongoing basis.”

But while education can help close the gap, there are broader factors that need large-scale solutions. The nature of living in remote Communities means that there isn’t always access to a reliable or affordable source of healthy food (see story on p14). Making the sort of lifestyle changes supported by programs such as DESY can be difficult if less healthy options are cheaper and more accessible.

“Dominos opened up here two months ago and oh my gosh, the town was super excited,” says Natalie, who currently lives and works in the Pilbara. “The price of food up here in the supermarkets are ridiculous, so it’s always cheaper for people to go get a pizza or a McDonald’s.”

Despite these challenges, both Natalie and Kathy hope that diabetes education programs such as DESY – delivered by a sustainable workforce of Aboriginal Health Workers – will help bring about generational change for Aboriginal Communities.

“We can break the cycle,” Natalie says. “Hopefully the younger generation will learn this stuff and go home to their parents and say maybe we should have something healthier than having a takeaway. Those little changes will have a big impact.”

Kathy agrees.

“I think we are planting the seed. And, somewhere out there, it’s growing behind closed doors.”

Diabetes WA acknowledges the Traditional Owners of the land on which we work and live and pays respect to the Elders – past and present – for they hold the memories, traditions, culture and hopes of Aboriginal and Torres Strait Islander peoples across our region.

We are proud and committed to embrace the spirit of reconciliation and learn more from the local Aboriginal and Torres Strait Islander community about how best to improve the health, social and economic outcomes of First Nations’ people.

Diabetes WA respects and celebrates all forms of diversity. We welcome and value people from all walks of life to access our services and join our team.

HARD FACTS

Prevalence rates of diabetes in remote Aboriginal communities are believed to be significantly under-reported at 13%. Some studies have found incidence rates of diabetes as high as one third. Prevalence rates escalate with increasing age. Around two-thirds of people over 65 years had diabetes across three remote communities studied.

Aboriginal Western Australian (aged 25–49 years) experience a 38 fold higher rate of major lower limb amputation and 27 fold higher rate of minor amputations.

Aboriginal people living in remote areas have 20 times the incidence of end stage renal disease compared with the national average. Diabetes is the leading cause of preventable dialysis.

Cataract and diabetic retinopathy continue to be the second and third leading causes of vision loss among Aboriginal people in Western Australia. Both are complications from diabetes.

There are 290 Western Australian children on the Type 2 diabetes database. 60% of these are Aboriginal children. The life expectancy of a child with type 2 diabetes is 15 years less than a child diagnosed with type 1 diabetes. Some of these young people have already died from their diabetes complications.

Australia has the highest recorded rate of pre-existing diabetes in pregnancy in the world. Inequity of access to practical and culturally safe antenatal screening and care to support the diagnosis and self-management of diabetes in pregnancy is leading to obese babies, metabolically programmed for obesity and diabetes – the intergenerational cycle of diabetes must be stopped.

MEET THE AHC s

difference before complications kicked in.

The most rewarding thing about my job is being out in the community to deliver the DESY program and hearing the responses from community members. They tell me there is so much they have learnt because of the DESY program. I love working with Diabetes WA as I have had so much support. From management right through to operations, everyone is always willing to help out or find solutions to any problems that arise.

within the organisation as a health promotion officer. That was amazing, because I got to go into schools and tell these kids about healthy lifestyle changes and we did a lot of events around the southwest.

Meet KATHRYN LEMON: Diabetes WA

Aboriginal Health Coordinator. Her mob is Ghangalu on her mother’s side and Baradha on her dad’s side.

I always wanted to work in health. When I was living in Broome, I did the Aboriginal Health Worker training and then moved to Derby, where I worked as an Aboriginal health practitioner. I was there for nearly two years at the Aboriginal Health Services clinic before I moved down here and started working for Diabetes WA.

I loved that clinic. The first day I was there, I nearly had a heart attack. This elderly woman came in to be seen and both her legs were so swollen it looked like she had elephantitis. There was this big black outer layer of skin from her knees down to her toes. It was just horrific. She was in that state because she had diabetes and she wasn’t looking after herself. Her legs were all bandaged up in a big animal club and the smell was just next level. They opened up the bandages and all these maggots fell out. That was my initiation to working in health! It was scary, but fascinating too. Some of the things I saw there made me wonder how people could still be walking around. Having seen that, I really wanted to help prevent people reaching that stage – to make a

Before I joined Diabetes WA, I worked for nine years at the Southwest Aboriginal Medical Service in Bunbury. I started working there because I had to get out of the house, really. I was a stay-at-home mum and I was going insane! I ended up getting a job in my local AMS just as a home community care support worker. And I was really, really lucky because they had their own training departments, so I got qualified while I was working. I worked full time and trained on the job.

Later, I applied for a new role as a tobacco action worker to help people develop an action plan on how to quit smoking. That lasted for a couple more years and then I got another position

We actually had a clinic on wheels, a big truck with consulting rooms in there. We had a fully functional female team and we drove around the southwest of WA, doing women’s health care and talking about pap smears. We could even do spontaneous pap smears in the back of the bus. We also did our best to make it a peaceful relaxing environment. We had a lot of pampering things set up, so you could sit there to get your nails done or do some mindfulness colouring. We found some ladies out there who hadn’t had a pap smear in over 20 years. I got to drive that truck around to all different festivals and events and park it up and then do all this health promotion. I loved it. It was so much fun.

I didn’t know a lot about diabetes before I started working here, but I caught up quickly. I had to! On day one, I found myself sitting in a two-day training session about how to run our DESMOND self-management workshop. I knew this was a program I was going to have to go out and deliver. I thought my head was gonna explode. I was freaking out, have I done the right thing?

But I was given so much support from the other staff and that helped me become more confident. Actually, my going through that journey helped us plan the pathway and develop our training package for our Aboriginal Health Workers who we are now training to deliver DESY. We’ve changed that training from being a two day session to a five day one, so it’s not too overwhelming. And we’ve increased the support and the mentoring on offer after the training to help participants build up their confidence.

I love all the work I do, but the most enjoyable part of my job is meeting interesting people and helping our mob improve health in all areas.

Meet NATALIE JETTA: Diabetes WA Aboriginal Health Coordinator, Project Lead and Nyoongar woman.

NATALIE JETTA

KATHRYN LEMON

COLLABORATING WITH COMMUNITIES

Nyaree in the Ngaanyatjarra Lands

We know that it makes a real difference to be able to get out into remote Communities and meet up with the people living there. Even after a couple of years of communicating via a screen, nothing beats talking face-to-face. At Diabetes WA, we’re very conscious of making sure that our visits to remote Communities are as culturally safe as our programming. We are committed to being led by the needs of these Communities and collaborating with organisations that live there.

Recently, we’ve been working collaboratively with Ngaanyatjarra Health Service (NHS) to support the visiting specialists during the weeks that the Endocrinologist and Nephrologist visit Communities on the Ngaanyatjarra Lands.

NHS is an Aboriginal Community Controlled health service providing care to Aboriginal people living in communities in the Ngaanyatjarra Lands in remote WA, close to the Northern Territory and South Australia borders. That area amounts to approximately 250,000km2. Warburton, the largest community in the region, is about 900km from Kalgoorlie and 1000km from Alice Springs — a long drive from anywhere!

Around 2,000 Ngaanyatjarra people live in these Communities and most of them speak Ngaanyatjarra as a first language, although some also speak English, Pitjantjatjara, Yankunytjatjara and other Indigenous languages.

During the visits in September, we provided a diabetes educator and an exercise physiologist (through the Perth Physical Activity and Diabetes Institute) and the team rotated visits to a number of Communities, including Warburton, Warakurna, Wanarn, Blackstone, Jameson,

Kiwirrkurra and Wingellina. These visits also include a podiatrist and the chronic disease nurse, to provide a multidisciplinary team.

Kathy Lemon, Diabetes WA Aboriginal Health Coordinator, came along as part of our team and worked with the chronic disease nurse to deliver some our culturally appropriate diabetes education programs, including DESY and Feltman™

FUN FACTS

The Giles Weather Station is a short distance from the Warakurna community.

Some of the communities in the Ngaanyatjarra Lands are on central Australian time, even though geographically they reside within the WA border!

In 1984, the last known group of traditional Indigenous Australians to make contact with Western society, entered Kiwirrkurra. Up until that point, this family of nine, known as the Pintubi Nine, had been living a traditional nomadic life in the desert.

This September, diabetes educator NYAREE LAWLER visited the Ngaanyatjarra Lands to offer support and information about diabetes to some of WA’s most remote Communities.

TAKING ACTION

and management of diabetes in Aboriginal and Torres Strait Islander peoples.

We are committed to a journey of reconciliation for our organisation and our sphere of influence.

As an organisation, we are committed to our role and contribution in addressing the five dimensions of reconciliation race relations: equality, equity, institutional integrity, unity and historical acceptance.

Diabetes WA has long provided support for Aboriginal and Torres Strait Islander people living with diabetes on traditional Country across Western Australia. We pay our respects to all Elders, both past and present, as it is their knowledge and experiences that holds the key to addressing the burden of diabetes in the future.

Diabetes WA recognises the impact that a just, equitable and reconciled Australia will have in the future development

The Reconciliation Action Plan we presented this year is our commitment to advancing reconciliation within the sphere of our influence. We have already taken some significant actions to develop strong relationships and improve staff knowledge and understanding of Aboriginal and Torres Strait Islander cultures.

By formally engaging in a Reconciliation Action Plan, we acknowledge that we still have a long way to go and commit to continuing to move forward with open hearts and minds on our reconciliation journey.

KEY ACTIONS FROM OUR RECONCILIATION ACTION PLAN.

1. Establish and strengthen mutually beneficial relationships with Aboriginal and Torres Strait Islander stakeholders and organisations.

2. Increase knowledge and understanding of the National Agreement on Closing the Gap and the Priority Reforms.

3. Build relationships through celebrating National Reconciliation Week (NRW).

4. Promote reconciliation through our sphere of influence.

5. Promote positive race relations through anti-discrimination strategies.

6. Increase understanding, value and recognition of Aboriginal and Torres Strait Islander cultures, histories, knowledge and rights through cultural learning.

7. Demonstrate respect to Aboriginal and Torres Strait Islander peoples by observing cultural protocols.

8. Build respect for Aboriginal and Torres Strait Islander cultures and histories by celebrating NAIDOC Week.

9. Improve employment outcomes by increasing Aboriginal and Torres Strait Islander recruitment, retention and professional development.

10. Increase Aboriginal and Torres Strait Islander supplier diversity to support improved economic and social outcomes.

11. Establish and maintain an effective RAP Working Group (RAWG) to drive governance of the RAP.

12. Provide appropriate support for effective implementation of RAP commitments.

13. Build accountability and transparency through reporting RAP achievements, challenges and lessons both internally and externally.

14. Continue our reconciliation journey by developing our next RAP.

What is a Reconciliation Action Plan?

Reconciliation Action Plans (RAP) assist businesses to embed the principles and purpose of reconciliation. Since 2006, Reconciliation Action Plans (RAPs) have enabled organisations to sustainably and strategically take meaningful action to advance reconciliation.

Based around the core pillars of relationships, respect and opportunities, RAPs provide tangible and substantive benefits for Aboriginal and Torres Strait Islander peoples, increasing economic equity and supporting First Nations self-determination.

(From reconciliation.org.au)

Our Reconciliation Action Plan shows that Diabetes WA is committed to collaborating with Communities across our state to address the increased risk of diabetes affecting Aboriginal and Torres Strait Islander Communities.

PERSON WHOLE THE

Born in England, raised in Kenya and educated in Scotland, Rural Health GP of the Year Seema Basil has found her place in WA’s remote Communities, writes MYKE BARTLETT.

When Seema Basil was awarded GP of the Year in October’s WA Rural Health Excellence Awards, it was welldeserved recognition for nine years of work at Mawarnkarra Health Service (MHS). Based in Roebourne, MHS offers a unique holistic approach for families living in the area, giving them access to three full-time doctors and a host of specialists, alongside Allied Health Services including diabetes education.

This approach has had a profound and positive impact upon Aboriginal Communities in the Pilbara region, which tend to have high prevalence of diabetes and heart disease.

Seema says receiving the award was a lovely, if humbling, experience.

“I was talking to my husband just on the weekend, and I said, you know, you win an award like that, and everyone

thinks so highly of you,” Seema says. “And I still feel I just don’t know enough about the human body. You can never know it all!”

This modesty and willingness to keep learning might explain why Seema has been so highly valued since joining the MHS in 2013. Born in England, raised in Kenya and educated in Scotland, she hadn’t been to Australia before her husband lured her down under.

“I really feel like it was a calling. I’d never had any experience of working with Aboriginal people but I’d just had this intense desire to work in Aboriginal Health, for a few years. It was handy to have somebody who was willing to come with me somewhere so remote.”

The plan was to come for a year, but Seema says she soon realised that wouldn’t be possible.

“We both knew very quickly, that a year was not going to be enough for us. The work was really challenging, but also really rewarding and very meaningful. I hadn’t really experienced that intensely before. Also, I could see the potential to make a real difference, but that could not be achieved in one year. This is a community that has a lot of transient staff passing through, so it is really hard to develop respect and rapport if people don’t get to know you really well.”

That connection makes all the difference when it comes to providing holistic care.

“You get to know not just the patient, but also their family, and you really get to understand what’s going on in their lives that could be driving their health problems. The other thing you find is when patients know there’s a familiar face to come back to, every time they come to the clinic, over time, they start trusting you. And that’s when you start noticing people wanting to make changes, to come back and report to their doctor or their nurse about how they’ve adjusted their lifestyle.”

In other words, trust in their medical practitioner makes patients more likely to take a greater ownership of their health journey. Seema says, over the time she has been at the clinic, she’s seen a great increase in people booking their own three month review, rather than having to be reminded. This improved sense of trust has allowed the MHS to change the way they operate from being a predominantly walk-in clinic to one where patients are happy to book a slot with their regular doctor. Patients have

also been happy to take up telehealth options, particularly in the wake of the pandemic, which allows health practitioners to offer wider support to people in remote Communities.

“There have been some initial teething challenges – just annoying little tech things like your printer doesn’t work or where do you send the prescription? Probably the biggest challenge is that often, people’s phones might be taken by another family member, so you can’t get hold of them. But that’s when it becomes really handy that we have staff who have been here for a while and know who the family connections are.”

Over her nine years, Seema has seen firsthand the rapid increase in diabetes diagnoses in Aboriginal and remote Communities. Thankfully, that rise in numbers has been matched by a greater understanding of how to help patients self-manage their health journey.

“First of all, the pickup rate of type 2 diabetes had increased exponentially, which is worrying, but our percentage of diabetic patients with a HBa1C of less than 6.5% was far greater than it was back in 2010. Even though we have way more patients, I think we have about 45% of them who had a HbA1c of less than 6.5.”

Seema puts this improvement in management down to not having to wait three months to see a specialist or educator, onsite services including podiatry and optometry, the introduction of better treatments (notably GLP-1 agonists) and the

clinic’s point of care machines, which can deliver an HbA1c in seven minutes. But, in the end, Seema says it’s the broad interpretation of person-focused care that makes all the difference to her patients from Aboriginal Communities.

“We try to help with anything and everything. Whether it’s your physical health, whether you’ve got some financial struggles, whether you’ve got housing issues, whether you’ve got domestic violence problems, it’s about the holistic support we provide, not just pharmaceutical-based medicine. Even if we can’t help fix your financial issues, we know who to send you to, to support you. We want to address the whole person, not just their body.”

“You get to know not just the patient, but also their family, and you really get to understand what’s going on in their lives that could be driving their health problems.”

PLANTING THE SEED FOR HEALTHY GROWTH

While a lot of focus tends to be given to good food choices, what can be missed is how difficult it is for some people, particularly those living in regional or remote Communities, to access the nutrition-rich food they need. EON Foundation is a Western Australian organisation determined to break this cycle of insecurity, malnutrition and disease. Established in 2005 in response to a landmark investigation into Aboriginal child health, EON helps build edible gardens in remote Aboriginal schools and Communities to provide a secure supply of fresh fruit and vegetables.

CEO Caroline de Mori says the program’s hands-on approach to gardening and nutrition education

gives kids the knowledge and motivation they need to bring about important lifestyle changes.

“Within six weeks of building our first community garden, we saw children eating corn off the cob, tomatoes, green beans, you name it,” Caroline says. “They love it because they’ve grown it and they’re just having a feast. They become very confident and competent gardeners and cooks, and their knowledge of the link between nutrition and health, which is the whole point of all of this, is very high.”

That knowledge sits at the heart of EON’s Thriving Communities Program, an invitation-only program that seeks to addresses two of the main underlying causes of poor health: food

insecurity and a lack of education around good health and nutrition. The program has three complementary components. The establishment of a large garden in the community school, lessons for children and their families about nutrition and cooking (using produce from the edible garden), and education for the broader community. Once the program is established, EON project managers maintain a regular presence, visiting the Community every fortnight for up to five years.

Caroline says, given this long-term investment, there are a lot of factors to consider when inviting a Community to take part. These include the size of the community, how many children are in the school and how close the Community is to other communities involved with the program.

The availability of housing can also be an issue, as Community need to be able to provide EON staff — who are predominantly women — with safe accommodation.

The link between food insecurity and health conditions such as diabetes can be overlooked. But one organisation is growing edible gardens to make a big difference in remote communities, writes MYKE BARTLETT.

ABORIGINAL HEALTH + diabetes

“They need to provide somewhere for us to stay, they need to give us the land for the plots, they need to give us some water and they need to build us into the school curriculum,” Caroline says. “But the program is always tailormade to the Community and school’s particular needs and wants. It’s a generational change game, really.”

Although she trained as a journalist, Caroline was inspired to found EON after travelling around the Pilbara and seeing firsthand the impact that poor access to food was having on Aboriginal Children.

“I wasn’t born with a silver spoon in my mouth, but I could see that my children were going to have a lot better chances than the children I was seeing in remote regional areas.”

It was clear that a big chunk of the difference between outcomes for those living in Aboriginal Communities was down to nutrition, but that education alone wasn’t enough to turn the tide.

Caroline began working with Ernie Bridge — famously Australia’s first Aboriginal cabinet minister — and going into remote Communities to find out more about a diabetes prevention and management program he had started.

“While they were doing a fantastic job, what I noticed was people were being told to eat less sugar, less fat, and eat more fruit and veg, but they couldn’t get the fruit and veg. Children couldn’t get the food they needed to prevent or manage their type 2 diabetes, because they lived on highly processed food.”

This aspect of life in remote Communities is often misunderstood by the rest of Australia, Caroline says.

“It’s absolutely inconceivable to most Australians that people in these Communities can’t just go down the road and buy whatever they want. But the answer is not to bring them all down to the ‘burbs and plop them down here. Moving people off their country was not the solution when we colonised and it still isn’t the solution.”

This legacy of disastrous intervention means it’s important that the program is led by the Communities EON works with.

“We’re just giving them the bridge, but the kids do all the work. We’re not free gardeners, we’re not free cooks, free anything. It’s all an understanding between us and the schools, and the Community elders who have invited us to come in.”

Caroline says that, while the success of the program is clear to all involved, she wishes there was a broader understanding of how much easier — and cheaper — it is to prevent conditions such as diabetes, rather than treat them. She also hopes that raising the issue of food insecurity in remote Communities will help fight a tendency to blame people for being sick.

“Nobody wants to be sick. Nobody wants their children to be sick. Nobody wants their grandma to be sick. They’re all having a go. They’re all doing their best. They’re trying their hardest. And what we do is so loved and it is making a very big change in their lives.”

CEO Caroline de Mori

CEO Caroline de Mori says the program’s hands-on approach to gardening and nutrition education gives kids the knowledge and motivation they need to bring about important lifestyle changes.

DESY workshops involve sharing stories about living with diabetes and yarning about:

What is diabetes?

How diabetes can affect you

How you can take care of your diabetes, your way

Who else can help you take care of your diabetes

WHAT IS DESY?

DESY (Diabetes Education and Self-Management Yarning) is the adapted face-to-face DESMOND program for Aboriginal and Torres Strait Islander people living with type 2 diabetes. The program teaches skills, behaviours and practices to self-manage their diabetes and has been developed in collaboration with Aboriginal Communities.

The DESY program is based on yarning about our experience living with diabetes. The program teaches skills and practices to self-manage diabetes.

Because Diabetes WA is training and mentoring Aboriginal Health Workers across the state to deliver the DESY program in their Communities, each DESY program is personalised to the Community and their needs.

“I’ve learned more today than I’ve learned in six years about diabetes. I reckon DESY is wicked.”

— DESY participant

DESY is where we learn from you and you learn from us.

AN EDUCATION

When Pejar man RAPHAEL MANNEL was diagnosed with type 2 diabetes at the young age of 15, he knew he had to get some help.

I had struggled throughout my teens with my weight and I was diagnosed with type 2 diabetes when I was 15. I didn’t expect to have diabetes at such a young age. The doctor said I had to do something about my sugars, so put me on a tablet to manage that.

I was really shocked. I couldn’t believe that young people get diabetes. People who are supposed to be in the peak of good health. And I just thought, “I’ve got do something about this.”

I made changes straight away. I exercise now and I watch what I eat. I try to be positive about things. I attend the diabetes sessions when they’re on at Diabetes WA. That all really does help. It just makes me feel better.

I mean, I enjoy sugar. Of course I do. But I’m trying to find ways to reduce the intake of sugar from sweet drinks. That was probably the hardest thing for me. That and trying to eat healthy food and avoiding KFC and all the other fast food places.

It’s not easy. It’s something I have to work on every day. It can be really tough. But being active helps, as does just taking each day as it comes. Getting more active and going out to the gym, and going walking, all of that just changes your life when you have diabetes. It really does.

I’m not on medication anymore. I’m managing my diabetes with just diet and exercise control, which is probably the best outcome, because it can be difficult. I’m glad that I was diagnosed when I was younger, before it got much worse.

I really want other people like me to know about the risk factors for diabetes. If you look at the Indigenous population versus the rest of the Australia, diabetes is far more prevalent. People need to know about the complications that go along with

that, you know, eyes and kidneys and so on.

It’s like any other condition. It’s real. it’s something that affects a lot of people in many different ways. You can be skinny, you can be big, you can be any type of person. People shouldn’t resign themselves to getting it — it shouldn’t just be something you think you might get when you’re older. You can do something about it now, while you’re young.

I still struggle with weight myself, it’s something I have to work on, but being educated about all that when I was young has made a difference. Since I have been involved in the education sessions run by Diabetes WA here at Ngulla Mia, I have been able to keep on top of the management, monitoring and control of my diabetes and I encourage those in the community,

especially Aboriginal and Torres Strait Islander people, to commit to getting their diabetes checked as frequently as possible.

I hope that by sharing my experience, I will inspire other people to do the same and to take an active approach in the care of their diabetes so they can be the best they can be.

What else would I tell people like me? It’s not the end of the world. It’s never too late. Just do things gradually. Not all at once. Be proud of yourself that you’re making small steps, because those steps will get you there. And check Diabetes WA, of course.

Ngulla Mia (Noongar for ‘’Our Place’’) is a safe and secure residence for adults experiencing mental health issues who are homeless or at risk of being homeless.

GIVING A HAND

At Diabetes WA, we are here to support all West Australians living with diabetes. We are always on the look out for new opportunities to connect with the broader community and to pay our respects to the Traditional Custodians of our great state. Wherever there is a chance to talk diabetes, we’ll be there, often with our Feltman™ in tow!

This year, we were proud to take a part in a range of activities for National NAIDOC week (3-10 July), including the NAIDOC Netball Carnival (pictured).

The NAIDOC theme this year was ‘Get Up! Stand Up! Show Up!’, highlighting the commitment that we all need to make to commit to systemic change in the nation. We all must continue to Get Up! Stand Up! Show Up! and support Aboriginal and Torres Strait Islander communities, and push for institutional reforms and community understanding.

As part of this year’s NAIDOC Week, Diabetes WA developed a colourful art project to celebrate the launch of our Reconciliation Action Plan (see p11). Our Pledge for Reconcilation artwork (pictured) saw every member of staff leaving green and purple handprints on a canvas that will take pride of place in our office.

WORKSHOPS

DESMOND

CarbSmart

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. 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.

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.

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.

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

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

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.

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.

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

When should I check my glucose levels?

Nyaree Lawler

Nyaree is a registered nurse and has been working as a diabetes educator for 20 years. Nyaree has a passion for working in Aboriginal health and rural health. Even though she has worked at Diabetes WA for five years, she still lives in Toodyay and continues to provide diabetes services in the Wheatbelt. During her nursing career, Nyaree has worked overseas in England, Ireland and Angola. As a diabetes educator, she has worked in the Gascoyne, Wheatbelt and Perth, as well as providing some diabetes group sessions in various remote Aboriginal communities. Nyaree enjoys jogging and hiking. Competing in an ultramarathon and completing the Cape-to-Cape hike are among her personal highlights.

One question that we get asked a lot on our Helpline is ‘when should I check my glucose levels?’ Like most things related to diabetes management, no one size fits all. When and how often you check your glucose level is going to depend on your type of diabetes, what you want to find out, what medications you are taking and how you are feeling.

So let’s start with what you want to find out. This is thinking about what information you think is going to help you to manage your diabetes. Here are some common reasons why people with diabetes check their glucose levels:

 Want to know what effect exercise is having on your glucose levels? When could you check your levels to help work this out? Potentially before, during and after exercise. You may also need to check your glucose level before exercising to make sure it is at a safe level for you to do the exercise. This will depend on the type of diabetes you have and what diabetes medications you are taking, so check with your GP or Diabetes Educator.

 How could you see what effect certain foods/drinks/meals/portion sizes has had on your glucose level? Check your levels before you eat or drink and then two hours later to see the difference in the two levels. If your glucose level has increased by more than 2.0mmol/L then you might think about how much carbohydrate you had, what type of carbohydrate you had (low or high glycaemic index) and, if you take insulin with your meals, did you have enough insulin and did you take it at the right time.

 What effect does stress have on your glucose levels? You might check your levels more regularly when you are feeling stressed to see if they increase.

 Started a new medication for diabetes? You might like to ask your GP, diabetes educator or pharmacist how the medication works and then decide an appropriate time to check your glucose levels to determine the effect of the medication.

 Not sure how much insulin you need to be taking? Discuss with your GP or diabetes educator when to check your glucose levels to help determine the right amount of insulin for you. This will vary depending on the type of diabetes you have and the type of insulin you are using.

 What is happening overnight? Your liver releases stored glucose during the night to make sure there is enough glucose circulating in the blood. A morning fasting glucose check can help you to determine how this process may be affecting your glucose levels. In some people with type 2 diabetes or gestational diabetes the liver releases too much glucose overnight, causing the morning reading to be high. In type 1 diabetes a fasting glucose check helps to determine how much insulin is needed overnight to match the liver production.

 Am I safe to drive? The recommendation is for your glucose level to be above 5.0mmol/L before and during driving.

 I’m not feeling well. Is it my diabetes? High or low glucose levels can make you feel unwell but being unwell can also affect your glucose levels. Checking your glucose level when you are unwell or have symptoms can help you to determine if your glucose is too low (hypoglycaemia), or too high (hyperglycaemia). Talk to your GP or diabetes educator about how to manage your individualised glucose levels if your are unwell or if you are at risk of having hypoglycaemia.

 What about medications? Steroid injections or tablets can increase glucose levels so it is often recommended to check them more regularly during this time.

As a summary, the usual times that people check their glucose levels are before breakfast (fasting), before meals, two hours after a meal, before driving and before exercise. This may not be every day for every person. How often you check your glucose level will depend on your individual circumstances. You can find out more information about glucose monitoring by talking to your diabetes educator, ringing the Diabetes WA Helpline on 1300 001 880, or check out this NDSS fact sheet Blood glucose monitoring fact sheet (ndss.com.au) .

Blood glucose monitoring

HOW YOU ARE?

With all the activities, skills and knowledge required to manage diabetes, it is not surprising that the condition can negatively impact emotional wellbeing and quality of life.

One in three people living with diabetes experience impaired emotional wellbeing, and one in five experience diabetes distress.

Diabetes distress is a term used to describe the emotional toll of

living with diabetes – the relentless burden of daily self-management and the prospect of long-term health complications. Diabetes distress can present itself as anxiety, depression, diabetes burnout, diabetes-specific fears and eating problems or eating disorders. It is important not to ignore these if they start to present.

Why is diabetes distress so common?

The American Association of Diabetes

Educators (AADE) has identified seven critical self-care behaviours for optimal health and effective management of diabetes. These include problemsolving, reducing risk, monitoring (for example, checking blood glucose levels), taking medication, healthy eating, being active and healthy coping.

Although these steps might appear relatively straightforward, statistics reflect how challenging it can be to

Managing diabetes can be overwhelming and complex, leading to emotional distress for many people, but there are ways of improving your emotional health write NELINE GOOSEN and JANICE POWELL.

When was the last time you asked yourself

manage diabetes. According to an Australian Government audit in 2021, only 18.3% of people with type 1 diabetes and 27.4% of people living with type 2 diabetes in a national audit met the HbA1c target of < 7%.

Living with diabetes is demanding and self-management is complex. If you have ever felt overwhelmed with managing diabetes, you are not alone! That is why it is important to ask yourself, “how are you?”

Healthy coping is at the centre of the AADE7 framework (see graphic) because this behaviour is essential if the other six self-care behaviours are to follow.

To help cope with the continual demands of self-management, it is important to be equipped with a toolkit of knowledge and skills to help you cope and to be aware of the tell-tale signs of not coping.

Problem solving is a learned behaviour and it is essential for successful selfcare management because it is needed to overcome barriers. At its most basic level, problem solving should identify what the problem is, how to address the problem with strategies, and then select, implement, and evaluate the

success of the strategies selected.

Effective problem solving can increase a person’s self-confidence in their ability to handle future challenges. Problem solving can also be used to help you set goals.

Goal setting is a useful strategy to help you cope because it provides a sense of purpose and increases positive solution-based thinking. Diabetes distress may be reduced if you focus on specific, measurable, achievable, realistic, and timely goals.

Coping strategies can be quite personal and different from person to person. One common concern for many people living with diabetes is the lack of understanding and acknowledgment from others about how difficult selfmanagement can be.

Diabetes is a condition that requires attention 24 hours a day, 365 days of the year. Too often, people feel they are dealing with it alone.

This may be a reason why many people living with diabetes have found it so helpful to socialise with others who understand diabetes management. Social support networks not only help with emotional coping through someone providing empathetic listening, encouragement, and acknowledgment of the impact of diabetes, but also provide an opportunity to learn about valuable resources and practical tips from others with similar experiences.

Observing and learning from others also helps to reinforce certain behaviours and the importance of these behaviours. Being motivated, supported, and seeing peers model the behaviours of self-management can be very useful for healthy coping when dealing with a long-term condition such as diabetes.

Now that you know the importance of healthy coping, and how common diabetes distress and impaired emotional well-being can be, how are you really?

Diabetes is a condition that requires attention 24 hours a day, 365 days of the year. Too often, people feel they are dealing with it alone.

HAVE YOURSELF A VERY ACTIVE CHRISTMAS!

Although it can be easy to get caught up in the hype of exercise fads (and pay a bomb in the process), there are plenty of low-cost activities that will keep you fit, healthy and social, writes MARIAN BRENNAN.

Around Christmastime, we often find ourselves navigating endless parties, free-flowing food and booze, while juggling increased family commitments. No wonder some of us end up feeling a bit stressed and exercise routines often go out the window.

Of course, Christmas only comes around once a year, so if you want to take a day or two off from the daily grind, do it! We may not get many

opportunities to spend time with family and friends, so it is completely reasonable to want to have some downtime with loved ones during this period. But if you would rather keep the ball rolling a bit and are looking for ways to keep up the activity over the festive period, there are plenty of options.

Christmas day is often full of family tradition, so why not add a new one?

A few years ago, I started a new Christmas tradition and now it wouldn’t feel like Christmas without it. I get up early before all the family activities begin, meet a group of friends down at the beach for a run and a frolic in the water (we may even have a sneaky fruit mince pie and a glass of champers), before heading back home before most people have started their day. For those with some extra time on their hands

on Christmas morning, getting out for a bike ride is a great idea. The roads are usually very quiet on Christmas morning, making for a very peaceful start to the day.

There are some great festive fun runs and walks that you can get involved with too! On the Parkrun website, you will find a number of local runs on Christmas and New Year’s Day mornings. These are not too time consuming and can be a great thing to do as a family – you might even like to dress up in your best festive attire! The WA Marathon Club (the club welcomes everyone of any ability) host a fun New Year’s Eve run and walk, with many participants hanging around for a picnic afterwards on the river – just lovely!

If it’s simply not possible to fit something in before the festivities start, why not try stretching your legs later in the day? Take the whole family for a post-Christmas lunch stroll! Or get out the cricket set and have a game of backyard cricket! Remember, you don’t have to meet your daily exercise quota of 30 minutes all in one hit. Try fitting in a few 10 minute blocks of activity. A quick game with the kids, grandkids, nieces or nephews, a quick 10 minute walk before guests arrive, or maybe 10 minutes of some last minute cleaning!

There are plenty of ways to fit activity into the festive season without it feeling like a chore. That said, if you would rather just take a few days off to relax and take a break from the usual routine, allow yourself some downtime!

Links

• www.parkrun.com.au/ special-events/

• www.wamc.org.au/event/ new-years-eve-run

• If you would like to speak to our dual qualified accredited exercise physiologist and credentialled diabetes educator, Dr Marian Brennan PhD about starting or increasing your physical activity, visit Perth Physical Activity and Diabetes Institute (www.perthpadi.com).

There are plenty of ways to fit activity into the festive season without it feeling like a chore.

GOING MEAT FREE

In her new book ELLA MILLS, founder of Deliciously Ella, makes it easy for families to adopt a plant-based diet. In this excerpt from How to Go PlantBased, Ella gives her take on a few key questions.

What does a balanced plant-based diet include? I want to start but I don’t feel I have the knowledge or the confidence. A plant-based diet focuses on fresh, wholefood, plantbased ingredients: fruits, vegetables, nuts, seeds, whole grains, beans and legumes. This list may sound a little boring when you first read it, but the reality couldn’t be further from the case. In terms of ensuring it’s balanced, it’s the same as any diet, each meal should have a mix of complex carbohydrates, protein and healthy fats – the three together support stable blood sugar, which stops

DISCLAIMER: This is an extract from How to Go Plant-Based by Ella Mills. Diabetes WA dietitians say that plant-based diets are likely to meet your nutrition requirements if you eat a variety, unlike other diets such as vegan, carnivore or paleo, all of which completely cut out specific foods or food groups, increasing your risk of deficiency. Please consult your health professional before making changes to your diet.

you having the spikes and crashes that leave you lethargic and craving more sweet food. To meet the vitamin and mineral needs, those meals should contain a rainbow and vary a lot throughout the week.

GIVEAWAY:

Thanks to Hachette Australia, we have FIVE copies of How to Go Plant-Based to be won. Email media@diabeteswa.

The biggest take-home is that you just need a diverse diet: by eating a wide array of different ingredients you’ll be able to look after yourself much better than eating the same few recipes day in, day out. In a nutshell: vitamin C, the B vitamins (bar B12), vitamin E, folate, potassium and magnesium are plentiful in a plant-based diet. It’s important to be mindful of calcium, iron, zinc, iodine, selenium, omega-3 fatty acids, which are slightly less abundant, but nonetheless easy to get into the diet. B12 and vitamin D need to be supplemented.

What are the best protein sources?

Not being able to get enough protein on a plant-based diet is a real myth. Almost no one in the Western world is deficient in protein and numerous studies show vegans consistently meet, if not surpass, the recommended daily allowance of protein. Great plant-based sources of protein are: tofu, tempeh, edamame, peas, quinoa, all nuts/seeds/ nut butters/tahini (including chia seeds, hemp seeds etc.), beans and legumes. Think about adding at least one source to each meal, e.g. porridge with hemp seeds and almond butter for breakfast, a roast veggie salad with lentils and a tahini dressing for lunch, and a tofu curry for dinner. It’s really simple, but important to be mindful of.

Flexitarian versus plantbased: which is healthier?

Ultimately the benefits come from eating lots of fibre and fresh, wholefood ingredients instead of ultra-processed foods, which make up more than half of most people’s diets now. In my view,

what you add to all that fresh food is up to you. If your diet is rooted in fruit, veg, beans, nuts, seeds and legumes, you’ll likely feel much better.

more we eat together the less stressful I find it (it also means that you’re not going through the trouble of making a whole meal just for them, which they then refuse) and the more varied their diet is.

How do I get my partner to try it?

It is. A range of professional organisations including the NHS, British Dietetic Association, the Academy of Nutrition and Dietetics, the American Academy of Paediatrics, the Canadian Paediatric Society, Dietitians of Canada all agree that appropriately planned vegetarian and vegan diets are not only safe but may provide certain health advantages. The important note here is ‘appropriately planned’. Being truly aware of meeting your nutritional needs is essential in any diet, and it’s really important in a plant-based diet.

Do you and your children eat the same meals?

Whenever we can. It doesn’t always line up with work as getting out of the office on time is difficult, but it makes a world of difference to how much they eat and what they’re willing to try when we do. During the UK’s coronavirus lockdown we ate dinner together every night and it was heaven. Lots of the recipes in this book are based on those meals, recipes that are equally delicious for adults and children, because none of us have time to consistently make everyone separate meals. Our children certainly aren’t perfect eaters, they have fussy periods and will absolutely say ‘I don’t like it’ without even trying it, but the

They’re very sceptical and it’s holding me back.

This is a big barrier for so many people who want to change their diets. Sharing food is such a huge part of our culture and I found the idea of always eating something different very lonely, so I was really committed to finding a way to get my friends and family to try more plant-based food and drop the misconceptions that it was bland and restrictive. They were all completely new to the concept of a plant-based diet 10 years ago, no-one had tried a vegetarian diet, let alone a plant-based one. I knew they were sceptical and like so many, they worried it would be bland and unsatisfying. From day one I wanted to show that it wasn’t, instead that it was abundant, colourful and rich in flavour. I let the food do the talking, I’d explain what was in the dish and how I’d cooked it, but never why it was healthy or imply that it was superior in any way. With some groups I’d also serve the plant-based option as the main initially, and some chicken, fish or cheese on the side, to make it feel more familiar, and that was highly effective in opening people’s minds. Over time I dropped the sides, once they realised the plant-based option was more than enough in and of itself.

Extract printed courtesy of Hachette Australia.

How do I know that I’m getting enough of everything I need? Do I need supplements?

Is it safe for both me and my family – smaller children and teenagers included?

com.au with the subject line GIVEWAY and your address to be in the running.

PAPRIKA PORK & POTATO CRUSH

Prep: 10 mins

Cook: 15 mins Serves: 2 (as a main)

300g Zerella Spud Lite Baby Potatoes, unpeeled 100g frozen peas

4 green shallots, finely chopped 25g light margarine, plus 1 tsp extra, for the potatoes Freshly ground black pepper

2 x 125g lean pork cutlets, trimmed of fat ½ tsp smoked paprika

1 carrot, sliced, steamed, to serve 50g snow peas, steamed, to serve

1 Cook the potatoes in a medium saucepan of boiling water, adding the peas for the last 2 minutes of cooking. Drain the potatoes and tip into a large bowl. Add the green shallots and 1 teaspoon extra margarine. Season with pepper. Crush gently with a fork to just break open the potatoes.

2 Meanwhile, heat a large non-stick frying pan over medium heat. Add the pork cutlets to the pan and cook for 3 minutes each side. Add the margarine and paprika and cook for a further minute, brushing often with the margarine. Transfer pork to a plate, cover loosely foil and set aside for 5 minutes to rest.

3 Divide the potatoes between 2 serving plates. Top with the pork cutlets and any juices. Serve with the carrot and snow peas.

Nutritional Information

PER SERVE 1430kJ (342Cal), protein 31g, total fat 11g (sat. fat 5g), carbs 23g, fibre 8g, sodium 205mg • Carb exchanges 1½ • GI estimate high • Gluten free • Lower carb

BARBECUED BREAM WITH GREEN SHALLOTS, LEMON & CHILLI

Prep: 20 mins

Cook: 30 mins

Serves: 4 (as a main)

1.5-2kg whole sea bream, cleaned and descaled (or use 2 smaller breams)

Freshly ground black pepper

½ brown onion, thinly sliced

2 lemons, 1 sliced, 1 halved

2 green shallots, trimmed

1 large clove garlic, unpeeled

2 long red chillies

3 Tbsp olive oil

500g Zerella Spud Lite Baby Potatoes, halved, steamed, to serve

2 cups mixed salad leaves, to serve

1 Preheat a barbecue plate on medium. Season the inside of the bream with pepper and stuff with the onion and lemon slices.

2 Put the green shallots, garlic, whole chillies and lemon halves, cut-side down, onto the grill. Cook for 10-12 minutes, turning halfway through, or until the vegetables starts to colour and soften.

3 Rub 1 tablespoon of the olive oil over the outside of the fish and place on the grill. Do this carefully, as the oil on the fish skin may start to catch and burn.

4 Remove the vegetables and lemons from the grill. Finely chop the green shallots and chillies (remove the seeds if you don’t want it to be too hot) and place into a bowl. Squeeze the garlic from its skin into the bowl. Squeeze over the barbecued lemon and drizzle with the remaining oil. Toss to combine.

5 After 8-10 minutes, carefully turn the fish using tongs and a fish slice, if needed to prevent it breaking apart. Cook for another 8 minutes, then check the fish is cooked through by pulling a piece of skin away – the flesh should be opaque.

6 When the fish is ready, transfer to a serving plate and pour over the vegetable topping. Serve with the potatoes and salad leaves.

Nutritional Information

PER SERVE 2450kJ (586Cal), protein 62g, total fat 29g (sat. fat 7g), carbs 14g, fibre 5g, sodium 271mg • Carb exchanges 1 • GI estimate medium • Gluten free • Lower carb

Diabetes WA dietitians suggest dividing this dish into six serves, instead of four, and adding some non-starch vegetables to bulk it up, to reduce the calorie count

SUMMER READS

Fiction

If you’re after something more literary, William Boyd’s The Romantic is a globe-trotting adventure in which an Irish traveller stumbles across borders and through some of the great historical moments of the 19th century. In a similar vein, Ian McEwan’s Lessons uses its protagonist to examine key events from the second half of last century. Both offer beautiful character portraits across an epic canvas.

Crime

It’s the time of year when everyone’s thoughts turn to… murder? Crime thrillers are a staple when it comes to beach reads, guaranteed to keep you turning the page between swims. British author Richard Osman’s Thursday Murder Club series has been a runaway success, with each new volume perfectly balancing the criminal, the comic and a cast of unusual but loveable characters. Latest entry The Bullet That Missed is just as twisty, funny and addictive as the previous two.

From the other side of the pond, American Pip Drysdale’s The Next Girl sees a burned lawyer attempt to find a dangerous kind of justice by posing as a villain’s next victim. Closer to home, Jane Harper’s Exiles returns us to the world of Aaron Falk (star of The Dry), who finds himself investigating two unsolved murders in a small South Australian town. Musician Holly Throsby’s Clarke also concerns small town mysteries, but offers something more human and illuminating than the standard crime novel.

Perth writer Michelle Johnston’s Tiny Uncertain Miracles is a surprising and tender novel about a hospital chaplain looking for meaning in the hidden depths of a public hospital. Seeing Other People by Diana Reid has a similar dark humour, telling the story of two very different sisters and the summer that nearly tears them apart. Also pulled apart and stuck back together are the divorced couple at the heart of Elizabeth Strout’s Lucy By The Sea As the world goes into lockdown, Lucy and William are isolated in a small town in Maine, where they have to navigate a complex past.

Nothing makes a summer break better than a good book to share it with. MYKE BARTLETT chooses some of the best reads to keep you company after Christmas.

Memoir

True stories? We’re in a boom for biographies right now, with this year’s stash featuring everyone from Hollywood stars to Australian activists. If sport is your bag, check out Ash Barty’s My Dream Time, which covers her brilliant career from first tennis match to her surprise retirement after winning Wimbledon. Comedy? Try Shaun Micallef’s new memoir Tripping Over Myself. Something more political? Try Grace Tame’s The Ninth Life of a Diamond Miner

Rock star Bono’s Surrender is as raw as it is weighty, using 40 of U2’s songs to pull apart his fame, music and personal life. Paul Newman’s The Extraordinary Life of an Ordinary Man is no less frank, with the Hollywood icon examining his inner life and failings in forensic detail. British actor Richard E Grant was recently touring Australia (not Perth, sadly) with his new heartfelt memoir A Pocketful of Happiness in which he writes honestly and beautifully about the death of his much-loved wife. Fellow thespian and Harry Potter star Alan Rickman has had his diaries published — Madly, Deeply: The Alan Rickman Diaries — and they’re wonderfully gossipy about all his starry chums, if only providing small sketches of the man himself.

If you’d rather read about someone more down to earth, try Raynor Winn’s Landlines. It’s the third volume in a series that began with The Salt Path, in which Winn and her gravely ill partner Moth decide to walk the length of a famous British coastal path (rough camping all the way) after suddenly becoming homeless in middle-age. Things have improved in the new book, but what hasn’t changed is the lyrical way Winn evokes the power of nature and landscape.

Children’s

Kids will be delighted to see David Walliams has Spaceboy out in time for the summer holidays. The British comedian and author has become a kid lit giant, pumping out at a couple of volumes a year that can be reliably grotesque to keep young readers enthralled and disgusted. After something more cerebral? Alan Garner’s Treacle Walker is strange, short and powerful reading. The latest volume of the illustrated Harry Potter series is also on shelves — Harry Potter and the Order of the Phoenix is probably too heavy for a beach read, but these volumes are beautifully constructed and worth treasuring as keepsakes. Cressida Cowell of How To Train Your Dragon fame has a different kind of wizarding treat on offer, as a young team of magical explorers voyage through weird and wonderful worlds in Which Way to Anywhere Younger readers will delight to Real Pigeons Stay Coo by Andrew McDonald and Ben Wood. These absurd, comic crime tales featuring a cast of clever pigeons have been a smash hit — and are Australian too!

We’re in a boom for biographies right now, with this year’s stash featuring everyone from Hollywood stars to Australian activists.

NEW CHALLENGES

A new start means a chance to rethink what’s important and what changes can be made, writes DENISE BROWNSDON.

As we say goodbye to 2022, I feel it’s time for me to start thinking about what my goals are and what I need to do to achieve them. Right now, my goals include strength building, weight loss and continuing to improve my fitness.

Each winter I play on a women’s softball team where I spend a couple hours on a Saturday on the field with a team of amazing women of all ages and abilities. I played the sport in Canada as a child and when I turned 40, I decided I needed to do something I enjoyed and that provided me with a social outlet. Four years on, I consider my fellow players to be some of my closest friends. When I first joined, I was literally shaking with nerves each time I got on the field but over time I learned to just get out and have fun. I love the social and fun aspect of the division I play in but I’d also like to improve my batting skills which means focusing on strength training and lots of practice.

Part of the strengthening component will be to change up my workouts – it’s time to push myself a bit harder. I am going to switch things up for myself

and aim to do three weight training sessions each week along with two cardio sessions and a Sunday batting practice. I like to keep the cardio sessions in so that I can improve my speed and endurance. I’m still working through on the niggling issue with my knee, but we are making good progress and the strength training will definitely help.

As part of this process, I’m also going to focus on losing some more weight. I use “diabetic friendly” recipes and portion control to help me lose weight. Thankfully with the many amazing recipes out there, a calorie deficit diet doesn’t have to be full of boring, flavourless foods. Between full time work, the gym and everyday life, I don’t have a lot of spare time to spend in the kitchen so I like to find quick and easy meals or ones I can prepare in advance. I find that meal prepping on a Sunday helps my family from overindulging or boredom eating during the week. We also like to have healthy snacks on hand for after work or school – Greek yogurt parfaits are always a winner in our house, topped with strawberries, chia pudding, oats,

hemp seeds and pepitas, they are filling and nutritious and can be used as breakfast or a snack. I even found some protein-rich biscuit recipes that are made with lentils or chickpeas which I can store in the freezer and pop into our lunches.

It can be daunting to take on a new challenge and hard to stay motivated because we all know change doesn’t happen overnight. If you’re someone who is looking to lose weight, it can be disheartening when the scales don’t go down but try to take note of other things like: are you able to do an exercise for longer or with a bit heavier of a weight than before? Maybe your body shape has started to change? I find the fitness app that I use helps me stay motivated. I share mine with a small group of my friends so they can see when I’ve done a workout, when I’ve lost weight (but hides my actual weight from them) or if I have achieved a personal best.

So, now the weather has warmed up, maybe you can look at setting a goal or two for yourself and see where it takes you?

Festivals

Perth Festival (10 February to 5 March 2023)

The 2023 Perth Festival is packed with alluring arty treats from home and abroad. The big news is Icelandic pop sensation Björk (pictured above) is playing four super-rare and Australian exclusive gigs in March. But there’s something for everyone, be it classical concert Music of the Spheres, a selection of foreign films or a new theatrical production of Strange Case of Dr Jekyll and Mr Hyde

HERE ARE A FEW OF OUR FAVOURITE THINGS RIGHT NOW.

TV

The Avengers: The Emma Peel Collection (Blu-ray)

With more TV to choose from than ever, it’s amazing what’s still missing from Netflix et al. Australian label Imprint have released this beautifully restored collection of episodes starring Diana Rigg as secret agent extraordinaire Emma Peel. They don’t make telly like this any more — the adventures witty, fun and fantastically colourful. Just the thing to hide inside with when it’s hot.

Film

TÁR (out 26 January 2023)

Cate Blanchett is extraordinary in this tense and acclaimed drama, playing a great composer and conductor whose outspoken views and questionable behaviour lead to a dramatic downfall. Expect plaudits aplenty when awards season rolls around next year.

& STAY