Accu-Chek Extra Newsletter by Hallowed Ground

F o r p e o p le w ith T yp e 2 d iab etes

The exclusive bulletin for Accu-Chek Extra members Freephone 0800 80 22 99 | Web www.accu-chek.co.nz

New technology keeps getting better and better Remember the days when testing your blood glucose was done with urine samples. And remember how big and slow the first blood glucose meters were?

echnology has come a long way over the years, and continues to develop, making life easier for people with diabetes. Right now there are quite a few developments in the pipeline that have exciting prospects, including new ideas around insulin delivery and entirely new ways of testing blood glucose. But it will probably be a while before they reach the public.

news march 2007

Another happy winner Congratulations to Ruth Forlong of Mount Maungauni who won the Kenwood blender in the recent competition on our website. The website is full of useful information, the latest news and, from time to time, a chance to win fabulous prizes like the whizzo Kenwood blender Ruth is now enjoying.

the improvement in the temperature range where tests can be done. Anyone who has been through a cold South Island winter would welcome that development. Roche Diagnostics is a leader in the development of this technology, and although the latest developments are not yet available in New Zealand, we are working with Pharmac to see what can be made available here. In the next few months we hope to have good news on this front.

However, around the world right now there are some handy new developments in blood glucose testing that are available. These With that in include faster mind, do make testing – as fast as sure that the 5 seconds – and Faster, smarter testing devices details we have give more freedom to roam devices that have about you are correct so alarms and reminders to we can let you know as test, as well as needing much smaller soon as we have any news. Check your blood samples. For New Zealanders, one details on the Talkback form and, if of the recent developments of interest is they’re not exactly correct, let us know.

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So make sure you add our web address to your internet favourites and regularly check out what’s happening online at www.accu-chek.co.nz. Get your email address to us so you can receive our e-newsletter.

IN THIS ISSUE Hidden dangers you need to know Preventing & dealing with hypos when driving New faces on our team Advice for women: managing menopause Helping to save the black rhino Hamilton artist wins global award

What you can’t see can hurt you What you need to know about the hidden dangers of diabetes.

ne of the most challenging things about having diabetes is that, at first, there’s no visible evidence that anything’s wrong. There are no spotty lumps, no particular pain, no bits sticking out and no strange shudders or shakes. Most of the time a person with diabetes looks fine. But looks can be deceiving. All the while with diabetes, things are happening inside the body, especially during those times when blood glucose levels are too high. Excess blood glucose interferes with blood vessels and nerve endings, and quietly, furtively causes damage. Over time, the damage from all those episodes of high blood glucose levels will start to show up in what’s called

complications. That’s a polite way of summarising all the things that can happen as a result of diabetes. Complications range from mild nerve damage that causes numbness or tingling in feet and hands, gum disease, and skin problems all the way up to blindness, heart disease, and major nerve damage that can end up destroying tissues and limbs. Once complications start to develop, sadly diabetes is no longer invisible. But testing can help keep those complications at bay. How? Because testing tells you what your blood glucose level is at different times. Armed with that information you can adjust what you’re eating or doing, and you can adjust your medication or insulin, to help keep

your blood glucose levels in the right range where they can’t do as much damage to your nerve endings and blood vessels. As international studies such as The Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS), prove, keeping blood glucose levels under control significantly reduces the risk of long-term complications due to blood vessel damage. So the point of testing isn’t just to look at your reading and log it. It’s about using that reading to learn and adjust what you’re doing so the things you can’t see have less chance of hurting you.

Smart tool shows doctors the whole picture hundreds of tests stored in a meter. Many pharmacies installed these programmes, and provide customers with a printout of all the charts and graphs.

An individual blood glucose test tells you what’s happening there and then. But to get the whole picture you need to look at all your tests over a period of time. For years, a hand-written log book served the purpose. Then computer programmes such as Accu-Chek Compass were introduced, and they gave a fast, in-depth picture of

Now a smart new device is available. Called Accu-Chek SmartPix, it analyses the information stored in an Accu-Chek meter in much the same way as the Compass computer programme. But the big difference is that the brains are all in the device. There’s no programme to be

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downloaded, and no cables or wiring between the device and the meter. The device simply uses infra-red technology to read the meter and, in an instant, all your tests are analysed and translated into graphs and charts that show exactly when and where you’re going well and where you need to make a change. Sales of the SmartPix devices are currently underway with doctors around the country, so ask yours if they have it yet.

Top tips for drivers How to avoid becoming a hazard on the road.

here are enough hazards on the roads these days, with heavy traffic, heavy trucks, and hairraising driving all around the place, without adding a hypo to the list. But the stress and the time on the road between meals and medication can sneak up on you and, next thing, you’re a hazard not just to yourself but to others on the road too. Low blood glucose levels, or hypoglycaemia (a hypo), can make you feel sleepy or dizzy, blur your vision, or even cause you to lose consciousness. That’s why it’s critical to make sure your blood glucose level is within your target range when you’re on the road. To help keep you safe on the road here are a few important reminders before you next get behind the wheel.

• Test before you go, especially for long trips. • Take your meter and testing supplies with you when you drive. • Don’t store or leave them in the car, though, as test strips, insulin, and meters can be damaged by the extreme heat and cold that can occur in vehicles when they’re parked. • Keep a supply of plain muesli bars, biscuits, glucose tablets, dried fruit and long-lasting fruit juice in the car. • If you feel a low while driving, pull over immediately and test your blood glucose level. • If your blood glucose level is low, eat a snack containing a fast-acting carbohydrate, such as juice, a non-diet fizzy drink, lollies, or glucose tablets. Wait 15 minutes and test again. Repeat as needed, and don’t start driving until your blood glucose level has stabilised. • Talk to your doctor about how often you should test while driving an extended amount of time, especially if you have a history of not feeling the symptoms of hypoglyceamia. • Try to plan your trips so you won’t miss or delay a meal.

• Wear a medical ID bracelet or tag, just in case. • Remember that changing a car tyre or pushing a car could result in low blood glucose levels. Be prepared!

Advice from the authorities The Land Transport Safety Authority advises that, in some situations, you may need to refrain from driving. If you have a mild hypoglycaemic episode, they recommend that you don’t drive for at least an hour, to give your brain time to recover. If you have a severe hypoglycaemic episode (for instance, when you need someone else’s help to deal with it), the LTSA says you shouldn’t drive for 24 hours. If you have several hypoglycaemic episodes, you should talk to your doctor before you return to driving. If you have a severe hypoglycaemic episode while you’re driving, the LTSA advises that you shouldn’t drive for at least a month – whether you’re involved in a crash or not. It’s likely you’ll need to see a specialist before you can safely return to driving, and you’ll need to talk to your doctor.

Licence conditions The LTSA may sometimes issue a driver with diabetes a licence that has certain conditions attached. The conditions will depend on: • the type of licence (classes and endorsements) • how the diabetes is controlled • whether the driver has any history of hypoglycaemia • how carefully the driver follows their medication schedule The details of those considerations are covered in a booklet called Medical Aspects of Fitness to Drive, and all doctors have a copy of this booklet. You can see it online at www.landtransport.govt.nz.

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Focus groups show Kiwis are quick to learn A big thank you to all the people who took part in our focus group sessions in Auckland, Wellington and Christchurch at the end of last year. As always when we meet our readers and Accu-Chek Extra members, we came away inspired by the positive attitudes people have when it comes to getting on with life, even with the many challenges of diabetes. “I don’t know if it is just the kiwi spirit, but New Zealanders with diabetes tend to be really active in their healthcare and more willing to learn how to take better care of themselves, and we saw plenty of that spirit at our focus groups” says Roz Vickerman, Manager Diabetes Care at Roche Diagnostics. Roz was also impressed with the willingness of participants to try something new, and this was best seen in the way people picked up the Multiclix lancing device which was provided at each focus group. On average, it took less than a minute for each person to have figured out how the device works. “We didn’t provide any instructions or help at first, we just wanted to see what people would do with it, and it was amazing how quickly they got on to it,” says Roz. Not only did people find the Multiclix fast and easy to use first time round, even the most doubtful participants were surprised at how gentle it was. “I never even felt that,” laughed one woman who avoided doing tests because of the discomfort of lancing. “I’ll be much happier now,” she said. Add your name for future focus groups If you would like to join us for future focus groups, just let us know and we will keep your name on the list of people to contact next time we are arranging a group. Just call the helpline on 0800 80 22 99.

Meet the new team The start of the year was a busy time at Roche Diagnostics with several new people joining the team in preparation for a busy year ahead. We managed to pin down three of the newcomers for a quick chat and here’s what they told us. Amy Kedian

Lisette Jacob

Anna Cook

Marketing Co-ordinator

Account Manager

Amy has joined the team in place of Naomi Letica who is on maternity leave having recently given birth to a wee girl. Amy is busy organising the annual Diabetes Nurse symposium in Rotorua and will be responsible for organising this newsletter and the e-newsletter which is becoming very popular. (Register online at www. extracare.co.nz/services/index.html)

Lisette will become a familiar face for pharmacies, GPs, and Diabetes Nurses as she moves around her territory, which goes from Hawkes Bay to New Plymouth and down to Wellington and sunny Nelson, promoting Roche Diagnostics Accu-Chek diabetes products.

South Islanders will already be getting to know Anna who joined our team earlier this year. Anna will be taking care of our South Island customers and says one of her main priorities will be to ensure that patients and healthcare professionals get maximum benefit from the Accu-Chek products.

Although this is her first experience in the field of diabetes care, Amy has already discovered one of the most important things we know: that people who work in diabetes care and people who have diabetes tend to be so bright and friendly. “I’m looking forward to meeting lots more people once I get my desk organised,” she laughs. Amy comes to Auckland from the Waikato and has lived in Tokoroa and Twizel. She is an avid reader and admits she is addicted to Grey’s Anatomy on TV. She also enjoys the bush and beach when she’s out of the office, and has represented Waikato in rowing and waka ama. Her job now is to keep the Accu-Chek Extra team rowing in a straight line so we get our newsletters and information out to everyone on time and with no last minute rush, which is easier said than done.

Before joining our team, Lisette worked as a Fertility Nurse “for ages” and says her new role is a very exciting change. But there’s one big similarity. “It’s all about being able to help make people’s lives a little easier and assist them to manage their health, and that’s what I really enjoy most,” Lisette explains. Outside work Lisette enjoys making jewellery and scuba diving, and she bravely admits that she loves fresh chillis, the hotter the better. We think that might stem from the best advice Lisette says she ever received. “It’s good to do something that scares you once a day” she was told. Right now, she does admit to being a little nervous about navigating her way around the country as she admits to being “geographically challenged”. We’re sure she’ll find her way just fine, especially with a little help from the locals and our customers along the way.

“I’ll just try and stay relaxed and keep smiling,” says the upbeat Amy. Are you the lucky reader? Is there a $100 Mystery Voucher hidden in this newletter? We give away 4 of these vouchers every issue, with each winner getting $100 to be spent in a pharmacy on whatever you choose. So remember to look out for it!

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Working in diabetes healthcare is a new area for Anna, but she has valuable experience in customer service, having been Facilities & Services Manager at ING Investment Bank headquarters, London, in her last job. She says she is learning quickly about diabetes care and looks forward to learning more from the people she meets along the way. Learning quickly and getting on with the job are characteristics she says she learned from very good advice she once received. “I was told: ‘And what are you waiting for, get on with it!’ so that’s what I’ve been doing ever since,” she says. When she’s not at work, Anna enjoys socialising and, she says, most importantly, shopping, especially for shoes, bags and jewellery. “Oh and there is that gym thing that I must try to fit in more often,” she laughs. So if you come across Anna somewhere around the South Island looking longingly at the nearest shoe shop, just tell her to “get on with it” and point her to the nearest gym!

Kids have a brilliant time at camps The sounds of kids shrieking and squealing as they were making their way through the waves in sailing boats was one of the highlights of a week spent by Nisha Taylor from Roche Diagnostics at the annual camp for children held by Diabetes Auckland.

Chef’s Choice Roasted mediterranean style tomatoes Most of us probably eat our tomatoes uncooked. Try cooking them for a change.

“

t was just brilliant to see these kids tearing around, having the fun that every kid should have in the summer,” says Nisha. Nisha and Roche Diagnostics colleagues Teresa, Julia and Sharon all attended the camp to lend support to the Diabetes Societies, volunteers and Diabetes Nurses who make the camps possible. While the emphasis was on having fun, the healthcare needs of the children weren’t forgotten.

These slowly roasted tomatoes are simple to make – don’t overcook them as they will split.

Mastering a challenge at the annual camp

Dietitians helped prepare healthy, delicious meals and snacks, while diabetes nurse educators and other healthcare professionals helped the children learn more about diabetes and how to take better care of themselves.

2 serves

4 serves

tomatoes

2 medium 4 medium

basil pesto

1 tspn

2 tspns

feta cheese 1 slice

2 slices

black olives 2

Step 1: Preheat the oven to 150˚C (130˚C fan). Step 2: Slice the tomatoes in half. Place the sliced side up in an ovenproof dish. Step 3: Spread the pesto on top of the tomatoes.

“The camps are really an opportunity for children with diabetes to mix with others their own age and learn from each other, all mixed up with good healthy fun,’ says Nisha, adding that the adults attending were probably

Step 4: Chop the feta cheese into small triangles. Place a triangle on top of each tomato. Step 5: Cut the olives in half. Place a halved olive on top of the feta cheese. Step 6: Bake for 20-30 minutes until cooked.

more exhausted than the kids by the end of camp.

Kids at camp messing about in boats

Ingredient

“But it’s totally worth it to see these kids grow in confidence and see that having diabetes doesn’t mean they have to miss out on life.”

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Nutritional Information (per serve): energy: 181 kj (43 cal); carbohydrate: 4 g; fibre: 1.6 g; total fat: 2.4 g; saturated fat: 0.6 g; sodium: 113 mg; GI: low; GF: use GF pesto Recipe from NOSH, the new cookbook NZ Registered Dietitian, Julie Leeper. To purchase this book contact Julie by email at julie@nosh.net.nz or by phone on 0800 69 6674 (0800 NZ NOSH)

Easy to mix up menopause and diabetes For women of, shall we say, ‘a certain age’, life with diabetes gets a whole lot more challenging as menopause kicks in.

he average age for most women to have their last period is 51, although the menopause process can start at any time from age 40 to the late fifties. During menopause, and in the years leading up to it, the body gradually produces less of the hormones oestrogen and progesterone. Those hormonal changes can affect blood glucose levels, and many women with diabetes notice more variations in their blood sugar levels than before. Also, blood glucose levels may not be as predictable as they were previously.

supply of food – glucose. Keeping blood glucose levels down can help reduce this annoying problem. Interestingly, some of the symptoms of menopause and low blood sugar are similar, and it’s easy to mistake menopausal symptoms such as hot flushes, moodiness and short-term memory loss for symptoms of low blood sugar. Treating the symptoms as though they are caused by low blood sugar instead of menopausal could result in a spike in blood glucose levels. On the other hand, thinking it’s menopause, not low blood glucose, could lead to a hypo. Clearly, if you’re going through menopause you need to take care to avoid treating your diabetes incorrectly, and there are several things you can do.

Test more often

For women with diabetes, menopause can also bring an increase in vaginal infections. As oestrogen levels decrease, yeast and bacteria have an easier time growing, especially if blood glucose levels are frequently too high. That’s because yeast thrives in warm, moist places with a good

A quick test will tell you if the symptoms are coming from a change in blood glucose or are menopause. But for the bigger picture, you may need to do more frequent tests during the day and occasionally at night, and keep a log of your results and symptoms which can help your doctor make any necessary adjustments in your treatment.

Work with your doctor to adjust diabetes medications Your doctor may need to adjust your diabetes medication or start you on new medication if your blood glucose level increases consistently. This is more likely to happen if you gain weight or have less physical activity. On the other hand, if your blood

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glucose level goes down, you may need to reduce your dosages. The amount of insulin you need may go down. But, if you put on some weight or stop exercising, you may get some resistance to insulin and your dosages may remain the same. It’s something you need to keep an eye on and discuss with your doctor.

Watch your cholesterol At this time of life your doctor is likely to be checking your cholesterol levels, especially because with diabetes you have a higher risk of heart disease. High cholesterol levels also increase your risk and your doctor may want you to have cholesterol levels that are lower than what’s acceptable for someone without diabetes. To help keep those levels down, your doctor may recommend that you take a cholesterol-lowering medication.

Get help for menopausal symptoms Ask your doctor for help if you’re having especially intense hot flushes, or if you notice vaginal dryness or thinning. If you’re putting on weight, a dietitian can help review your meal plans.

Breathing technique can help Slow, controlled deep rhythmic breathing — known as paced respiration — done twice a day can help decrease hot flushes. Take a slow, deep breath, hold it for a few seconds, and breathe out just as slowly. This breathing technique may also help if you do it just as a hot flush starts.

Blood glucose test helps save black rhino The same blood glucose testing kit currently used by most of our 100,000 readers – the Accu-Chek Advantage – is playing a key role in New Zealand-led research to save the endangered black rhinoceros from extinction. Dr Wayne Linklater, from Victoria University in Wellington, is leading an international research project to test a theory that high sugar levels in female black rhinos are leading to a disproportionate number of male black rhinos being born. Dr Linklater says about 73 per cent of black rhinos born in zoos are male and research suggests there are also more male black rhinos born in game reserves than female black rhinos. Unless the sex imbalance can be fixed the species could be extinct in 10 to 15 years. Dr Linklater believes the imbalance is related to blood glucose levels and he turned to Roche Diagnostics New Zealand to see if our expertise in diabetes testing could help.

prick and glucose levels are measured by glucometer which is exactly the same way people with diabetes monitor their blood glucose levels. The research being led by Dr Linklater is truly international. While he is based at Victoria University in Wellington, Dr Linklater is an adjunct researcher at Nelson Mandela University in Cape Town and his interest in rhinos began when he was working at San Diego University. The first black rhinos to be blood glucose tested are at Western Plains Zoo in Dubbo, Australia.

Says Dr Linklater: “We expect to provide evidence for the role of excess glucose in calf sex determination. If so we will recommend the provision of low-fat Roche and glucose Diagnostics foods, New Zealand reduction in marketing body fat and manager Nick minimisation Tunnicliff Elizabeth Berkeley, PHD Student to of stress for was intrigued Dr Linklater, makes a new friend mothers by the unusual request. during the “Obviously we wanted critical period around conception for to help and it’s great the Accu-Chek reducing the number of male calves testing strips we use for humans may born in captivity.” work just as well for animals. Helping out also fits in well with Roche DiagnosDr Linklater says the research could tics’ corporate social responsibility.” benefit other endangered species. Roche Diagnostics has supplied the study with the Accu-Chek testing strips which have proved ideal given the need to avoid agitating the rhinos as much as possible. A drop of blood is collected from the rhino’s ear or lip by needle

“Advances in managing birth sex ratios have widespread importance not just for rhinoceros but conservation management generally. Extremely male-biased birth sex ratios in captivity are common in many species.”

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Global art winner comes from Hamilton We’ve been saying for years that Kiwi kids are talented, and now we have the proof. Budding young Hamilton artist Qiliang Liu (16) has won the top prize in the 2006 Accu-Chek Global Art Contest for children and teens with diabetes. Qiliang’s artwork was chosen from finalists from around the world to win the overall award and receive a $5000 holiday package to the destination of her choice. Qiliang, a student at Hamilton Girls High School, has had diabetes for four years. With help from her diabetes nurse educator Vikki Lowe-Reid she is able to participate in all the activities other teenagers enjoy – sports, socialising and even competing in English and maths competitions. Her winning artwork in this year’s contest theme, “diabetes in school”, includes a depiction of the Junior Dux trophy she won last year. Qiliang was presented with her prize at Diabetes Waikato in Hamilton on World Diabetes Day, 14th November.

The contest was initiated to recognise children with diabetes and enhance their self-confidence as well as to help families and healthcare professionals better understand the emotional effect of diabetes on children. Since its inauguration in 2002, the popular Art Contest has received a staggering 6,500 entries from over 30 countries around the world. “We are thrilled that a New Zealand entrant has gone on to win the main prize,” says Roz Vickerman, Manager Diabetes Care, Roche Diagnostics NZ.

Christchurch study confirms link between tubby waistline and diabetes We are probably all familiar with the suggestion that being overweight is a risk factor for developing type 2 diabetes. However, until recently it wasn’t clear exactly why.

ecent studies have confirmed and identified a protein called adiponectin, made by fat cells, that provides a connection between being overweight and the increased risk of type 2 diabetes.

he asserts. Losing weight is the only way we know of producing more adiponectin in the body and therefore the clear message is to lose weight around the middle, from the tummy and ‘muffintop’ regions of the body.

Adiponectin is helpful in making insulin more effective, and also helps protect the body from heart disease by stopping blood cells attaching to vessel walls which causes arteriosclerosis or narrowing of the arteries.

There is a lot of research going into finding out if drugs can help increase the amount of adiponectin but that’s likely to take some time, so meanwhile Brett’s advice to lose weight around the middle is a good place to start.

As Dr Brett Shand, Scientist at the Lipid and Diabetes Research Group in Christchurch explains, the more adiponectin you have, the better. But the bigger you are around the middle, the less adiponectin you make.

Volunteers wanted for studies on new therapies for type 2 diabetes

Taking part in a clinical study can be a fascinating and informative experience. People taking part will often have greater access to a wide range of Brett and his team in Bigger tummy could indicate healthcare professionals, Christchurch have just bigger risk for diabetes and are closely monitored completed a three year throughout the study. study into the importance So, as well as helping scientists learn of adiponectin, looking at whether low more about diabetes, it can also be an levels of the protein lead to people excellent opportunity to have more getting diabetes. They have also looked intense healthcare than usual. at the differences of adiponectin in The research team at the Lipid and different ethnic groups, especially the Diabetes Research Group in Christchurch differences in Maori and Europeans. is always keen to hear from people The results of their studies are due to willing to take part in studies, especially be published later this year, and Brett people who have just been diagnosed says it carries a clear message. with diabetes. If you live in the Christch“Basically, adiponectin provides urch region and would like to take part the link between being overweight and in the group’s clinical studies, send an the increased risk of type 2 diabetes,” email to brett.shand@cdhb.govt.nz Accu-Chek is a trademark of the Roche Group. Roche Diagnostics (NZ) Ltd, 15 Rakino Way, PO Box 62 089, Mt Wellington, Auckland, New Zealand. Free Phone 0800 80 22 99, www.accu-chek.co.nz

Test after eating for best results testing tips Want to know how to get better results on those HbA1c tests your doctor does from time to time? Do your own tests after breakfast, lunch and dinner, that’s how. Testing after meals is called postprandial testing and, according to a number of studies, it’s the trick to keeping control over letting your blood glucose levels go too high after eating. By testing, you can see what impact different foods have on your blood glucose levels and adjust your meal plan accordingly. And the big advantage in doing that is to keep your HbA1c levels where your doctor wants them to be. HbA1c is a measurement of your overall exposure to high glucose over a period of several months. A number of studies conclude that having high blood glucose levels after meals is an important contributor to HbA1c. And, not to be too gloomy, having high blood glucose levels after meals also increases your risk of kidney disease, eye damage and heart disease. On the bright side though, doing a test after meals to make sure your blood glucose level hasn’t gone high is a practical, simple way of keeping things under control. In fact, post-prandial testing is now part of the treatment guidelines issued by major international diabetes organisations including the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and ACCE, the American College of Clinical Endocrinologists. So, take their advice and do a test after meals and see if you too start to get better results.