Diabetes Autumn 2013

Diabetes Living well with diabetes

Autumn 2013

The Med diet

delicious & diabetes-friendly

CHILDREN AND DIABETES

Get the whole family involved

MINISTRY OF HEALTH WANTS YOUR FEEDBACK

GARETH MORGAN:

“Bariatric surgery isn't the answer” 10 vital diabetes checks + exercise safely + healthy heart tips

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DE NTAL AS S O CI A TI O N

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APPROVED

Diabetes: the national magazine of Diabetes New Zealand | Vol 25 no 1 Autumn 2013

INSIDE autumn 2013 4 5

From the Chief Executive From the President

Upfront

6

News, views and research

Research

8

Z Health Survey N – ten key diabetes findings

Focus

10 Bariatric surgery no silver bullet

Gardening

12 Cool weather vege garden

Living with diabetes

14 Student health

Care and prevention

16 Ministry of Health needs you

18 Ten essential

diabetes checks

22 Why am I more at risk of heart attack?

Families and children

20 Share the load

– getting the family involved

24 26 Recipes – Flavours of the Med Community

27 2013 Diabetes NZ

annual conference

33 Fundraising

Treatment

28 Steroids and diabetes Physical activity

Food The Mediterranean diet

20

22

– forging a new path

30 When to monitor your

blood sugar while exercising

Profile

32 The Beaven Papers – part two The last word

34 In praise of… the humble apple

EDITOR: Caroline Wood email: editor@diabetes.org.nz DESIGN AND PRINTING: Kraftwork, Wellington MAGAZINE DELIVERY ADDRESS CHANGES: Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 369 636 Email: membership@diabetes.org.nz ISSN: 1176-4406 Disclaimer: Every effort is made to ensure accuracy, but Diabetes New Zealand Inc. accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. If in doubt, check with your own doctor, nurse, dietitian, or health care professional. Editorial and advertising material does not necessarily reflect the views of the Editor or Diabetes New Zealand Inc. Advertising in Diabetes does not constitute endorsement of any product, and no advertiser may use publication of an advertisement in the magazine to support the marketing of any product. Copyright of all editorial is held by Diabetes New Zealand Inc. No article, in whole or in part, should be reprinted without permission of the Editor.

Not yet a member of Diabetes New Zealand?

Call 0800 369 636 now to join or visit www.diabetes.org.nz Membership includes a free subscription to Diabetes magazine

FRO M TH E CH I EF EXECUTIVE

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Our wonderful volunteers Over the past three years of changes at Diabetes New Zealand, I continue to be amazed by the commitment and dedication shown by the many people that volunteer and quietly support the organisation across the width and breadth of the country.

This unwavering support and dedication has not gone unnoticed.

Without our volunteers working to assist people with diabetes and their families, run support groups, organise branch and committee meetings, and fundraise locally, Diabetes NZ’s contribution would be that much the poorer. The knowledge, skills and expertise our volunteers bring is impressive – and hard to quantify.

So what of the future for our volunteers? The recent New Zealand

Health Survey shows a clear increase in obesity rates for adults and children – contributing to the ongoing growth of type 2 diabetes in New Zealand in young, middle-aged and older people. I believe people who understand diabetes – our volunteers among them – will be more in demand than ever before.

Volunteers help deliver our central pillars – peer support and selfcare assistance. These services are critical for people with diabetes, so it is important we deliver support and assistance consistently to a high standard across the country.

This doesn’t mean taking away the personal or unique way that information, education and support are offered by local branches. It does mean we provide volunteers with the necessary tools and skills to deliver what is needed locally.

This is where the knowledge platform comes in. I talked about the development of a knowledge platform in a previous column (see the Summer 2012 issue). It is

an online evidence-based support tool we are developing for people with diabetes and professionals.

This platform will also be useful for our volunteers and staff – giving them advice on how to deliver information and support locally.

This might include anything from understanding food labels, explaining the content of Diabetes NZ pamphlets, or how to present effectively to local groups.

Our volunteers, along with our members, staff and supporters, are the foundation stones of our organisation. A very big thank you to those of you already involved in giving time and effort. Of course if you would like to get involved with Diabetes NZ or one of our local branches, give us a call on 0800 369 636 to find out how you can help.

Joe Asghar Chief Executive

Welcome to Diabetes magazine Our mission is to help you live well with diabetes.

Every issue of Diabetes includes: • Trusted expert advice • Latest research and treatment options • Inspiring personal stories • Delicious diabetes-friendly recipes • Lifestyle advice on food, exercise, travel • Spotlight on children and diabetes

SUBSCRIBE today and have four issues of Diabetes delivered straight to your door for just $18 per annum.

Diabetes is published by Diabetes New Zealand.

Join today for just $35 waged (or $27.50 unwaged) and receive a free subscription to the magazine.

Email: admin@diabetes.org.nz or call 0800 369 636 to find out more.

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DIABETES | Spring 2012

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FROM TH E PRESIDE NT

The search for a cure That insulin was ‘discovered’ 90 years ago makes it relatively recent given diabetes has been around forever. I am thankful to have been born since as before then an awful death was certain.

Further developments to insulin now mean those with type 1 diabetes can live an almost normal life span.

That is an amazing achievement of science (plus a lot of hard work from us!).

Despite our gratitude for this, what we all really want is the cure. I try not to indulge in much hope of this happening in my lifetime, figuring it is better to get on and live with what I have got. But that doesn’t stop my heart lurching whenever I hear of any likely breakthrough in solving the incredibly complex puzzle that is type 1 diabetes.

This is why Diabetes NZ has research in its Six Pillars of Purpose

– to promote and support research for a cure for all types of diabetes.

The organisation has a research fund. However it is too small by several ‘zeros’ to be of any use, which is why the previous Board agreed to suspend further grants from it, to invest and let it grow. We named it in honour of arguably New Zealand’s greatest diabetes researcher and our late patron, Sir Don Beaven (see p32). Sir Don campaigned up until hours before his death for more money for research into diabetes – I know that because I was with him as he did it.

Let’s not let his lobbying go in vain and we encourage both branches and individuals to contribute to Diabetes NZ’s Sir Don Beaven Research Fund.

While we may not have the money yet to make decent contributions to research (a decent contribution probably starting at $500,000+), we do offer what support we can to appropriate projects by helping lobby for grant money, for example writing letters of endorsement or support, running articles in the magazine, and inviting researchers to speak at our annual conferences

to raise awareness of their work.

Who knows where the cure will lie or when it will come. History shows us that big breakthroughs are almost always the result of little pieces of the puzzle coming together from all round the world. Even in our small nation, exciting work goes on.

While I am not a scientist my hunch is that stem cells offer the greatest hope for type 1s. Work on myriad aspects of this happens everywhere including in Dunedin (see our story in the Winter 2012 issue). The fact there are people just like Dr Paul Turner in labs across the world who are so passionately committed to finding a cure gives me the hope to keep going. And the reason to grow a research fund.

Chris Baty National President

See our website for advice, tips and ideas on how to live well with diabetes: www.diabetes.org.nz

Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: Joe Asghar COMMUNICATIONS MANAGER: Lisa Woods DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 7, Classic House 15 Murphy Street Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145; Fax 04 499 7146 Email: admin@diabetes.org.nz

Diabetes New Zealand is a national organisation that acts for people affected by diabetes. We work to raise awareness, educate and inform people about diabetes, its treatment, management and control.

We offer local support to individuals with diabetes through a network of diabetes branches across the country. We also support research into the treatment, prevention and cure of diabetes.

Call now to make an instant $20 donation:

0900 DIABETES (0900 86369)

Spring 2012 | DIABETES

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UP FRO NT

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NEWS, VIEWS AND RESEARCH

Testosterone and diabetes study

First all-diabetic cycling team

Australian scientists are studying whether giving testosterone can help prevent the development of type 2 diabetes in men at high risk of the disease. The two-year study will involve up to 1,500 overweight men aged 50-74 years old, who have higher than normal blood glucose levels.

The world’s first professional cycling team made up entirely of riders with type 1 diabetes will take to the roads this year following the launch of a new partnership between Danish healthcare firm Novo Nordisk and the Team Type 1 sports team.

All participants will be put on a weight loss programme and receive injections of testosterone or a placebo every three months. They will be followed up two years later. Lead researcher Prof Gary Wittert, from Adelaide University’s School of Medicine, said low testosterone may lead to a higher risk of getting diabetes.

More US kids getting type 2 diabetes

Team Type 1, previously sponsored by Sanofi, will now be known as Team Novo Nordisk, a global team with more than 100 diabetic-only athletes, spearheaded by the world’s first all-diabetes pro-cycling team.

The ultimate aim is to take part in the prestigious Tour de France by 2021 – the 100th anniversary of the creation of insulin. Diabetes featured Team Type 1’s visit to New Zealand last year, when it included riders both with and without diabetes.

The American Academy of Pediatrics has issued its firstever guidelines for treating children with type 2 diabetes.

US doctors say there has been a jump in obesity-related illnesses in children, including type 2 diabetes, high blood pressure and high cholesterol levels.

Childhood obesity is a growing epidemic in America with 20 per cent of children aged between 6 and 11 being obese. Doctors, who say they never saw type 2 diabetes in children until 10 years ago, are recommending kids get at least 60 minutes of exercise a day and nonacademic ‘screen time’ including video games, television and computer usage should be limited to less than two hours a day.

Record-breaking T1 survivor New Zealand is home to one of the world’s longest survivors of type 1 diabetes. Great-grandmother Winsome Johnston, 84, from Auckland, has had type 1 diabetes for 78 years after being diagnosed at the age of six.

Winsome’s diabetes nurse Rab Burton says she is his number one patient, having never missed an appointment in eight years.

“I’ve learned so much from her,” he says. “And every day I tell her story to people.”

Mr Burton says the key to Winsome’s remarkable health is discipline. He says he’s never met someone as strict and determined. “She followed everything to the book.

I think that’s her secret, ” he added.

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DIABETES | Winter 2012

‘Artificial pancreas’ better than pump An ‘artificial pancreas’ that constantly monitors glucose levels to ensure timely delivery of insulin is more effective at managing type 1 diabetes than a traditional insulin pump, new Canadian research has found.

Researchers at the Institut de Recherches Cliniques de Montreal say their dual-hormone artificial pancreas improved glucose levels and lowered the risk of hypoglycaemia in 15 patients with type 1 diabetes.

Their study, published in the Canadian Medical Association Journal, found that glucose control had improved by 15 per cent over the study period, while an eight-fold reduction in the risk of hypoglycaemia was also noted.

The researchers note that the system can also deliver glucagon, which can raise glucose levels when they are too low. They are hoping to conduct clinical trials to test the system for longer periods of time and across a broader age group.

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NZ HEALTH SURVEY – 10 KEY FI NDI NGS

Diabetes rate slowly increasing over time More than five per cent of all adults in New Zealand have been diagnosed with diabetes, according to the latest New Zealand Health Survey. Here are 10 key findings of this important report.

The prevalence of diabetes has gradually increased in New Zealand over the past 15 years. The rate of diagnosed diabetes has slowly but steadily risen from 3.8 per cent of the adult population in 1996/97 to 5.5 per cent in 2012. Since 2006/07 there has been no change in the rate of diagnosed diabetes.

It is estimated that 193,000 adults (5.5 per cent) have the condition. “This measure is likely to underestimate the true number of people with diabetes, as some people may not be aware that they have this condition,” say the report’s authors.

Diabetes disproportionately affects Pacific adults – a worrying one in 10 has been diagnosed with the condition.

This is 3.4 times higher than the rate for non-Pacific adults.

Adjusting for age, men are more likely to be diagnosed with diabetes than women (six per cent for men, compared with five per cent for women).

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DIABETES | Autumn 2013

“These findings suggest there is considerable scope to improve the diagnosis and treatment of diabetes” NZ Health Survey 2012

Most people are thought to have type 2 diabetes – approximately 176,000 people – as they were diagnosed with diabetes when they were older than 25 years.

The Government does not keep figures on the number of people diagnosed with type 1 versus type 2 diabetes.

More than one in 10 adults aged 65 years and over have diabetes. You are more likely to be diagnosed with diabetes if you are 55 years and over than if you are 45 years or younger.

Māori adults are twice as likely to be diagnosed with diabetes than non-Māori, with seven per cent of the population diagnosed with the condition.

Asian men also had a higher rate of diagnosed diabetes (eight per cent) than other adults.

You are three times more likely to have diagnosed diabetes if you live in a deprived area. The rate of diabetes was 8.6 per cent for people living in the most deprived areas, compared with 2.7 per cent in the least deprived areas.

Undiagnosed diabetes is much more common among Pacific adults – half of all cases were undiagnosed. The authors note that for every three people with diagnosed diabetes, another person has undiagnosed diabetes – ie a quarter of all diabetes cases go undiagnosed (source: 2008/089 New Zealand Adult Nutrition Survey).

Of those with diagnosed diabetes, only half had good diabetes control.

All facts are from The Health of New Zealand Adults 2011/12: Key findings of the New Zealand Health Survey, published by the Ministry of Health, December 2012.

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FO CU S

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BA RIATRIC SURGERY WON'T WO RK

Stomach stapling no silver bullet New Zealand economists Gareth Morgan and Geoff Simmons have been researching the link between diet and the nation’s health for a controversial new book. In the following article they argue bariatric surgery is not the answer to the diabetes tsunami.

Nearly two-thirds of New Zealanders are overweight or obese.

Our burgeoning waistlines could burst more than just our trousers, they could bust the health budget too. With an estimated impact on the health budget of between two and six per cent (and growing), a tsunami of obesity and diabetes threatens to hit the health system at exactly the time the baby boomers are hoping to retire and have their customary hip and knee operations.

What can be done?

First up it is worth commenting on recent press reports suggesting we shouldn’t discriminate against fat people. This is a fair point. The prevailing view amongst the public is that fat people are either lazy, eat junk food or both. The latest science however suggests that things are a lot more complicated than we might think. Different people have different body shapes for different reasons. Genes play a part, as do our early experiences in the womb.

Some people are wired to eat more, others are wired to store more of what they eat as fat. So rather than judging others or even yourself, just focus on eating well and exercising.

Obesity is just one symptom of a much bigger problem – our poor diet. It is the most obvious warning sign, but it is not the only one. Thin

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DIABETES | Autumn 2013

people are getting crook from poor nutrition as well – some people don’t make as many fat cells as others, but they can still overeat and collect fat around their organs. That is why it is entirely possible for thin people to have heart attacks, and get diabetes too. Conversely some obese people are perfectly healthy, although on average obese people do have a higher risk of many diseases.

Bariatric surgery is a very expensive ambulance at the bottom of the cliff.

In short, while we can’t judge individuals, we should be worried by the trend. The rise in obesity is a sign that we as a population are eating too much crap food, and this is manifesting itself in many nasty ways. Food is now the top killer in this country, bigger than smoking.

The flavour of the month for tackling obesity and diabetes is bariatric surgery. A number of different procedures come under this heading, but they all share the same basic principle: to make the stomach smaller, so that the person cannot possibly eat as much food.

They get full quicker, and if they try to keep eating, will often vomit.

Bariatric surgery isn’t cheap –

usually $15,000–20,000 a pop – but there is little doubt it does the job.

People tend to lose between half and two-thirds of their excess weight (ie the amount above their ideal weight) following surgery. We don’t know why, but people are often cured of their diabetes too.

It isn’t all beer and skittles from then on. There are downsides, with around 20 per cent of people hospitalised with a complication during their first year, particularly if they continue to overeat. And in the long term there are risks – for example a diet of smoothies and tiny portions can cause nutrient deficiencies, particularly if the person isn’t eating the right foods.

Nevertheless, bariatric surgery greatly reduces the burden obese people put on the health system, and these savings mean the surgery generally pays for itself in reduced healthcare costs after about eight years.

But bariatric surgery can’t keep up with demand. At the behest of Associate Minister for Health Tariana Turia, who has reported personal benefits from a self-funded bariatric procedure, the government pumped more money into bariatric surgery in 2010, bringing the number of public bariatric surgery procedures to about 300350 per year. The government’s health experts think that around 900 operations are possible each year within current capacity. The problem is that this is just a drop in the bucket, given there are around 180,000 morbidly obese people in the country. Maybe we could eventually crank it up to 1,800 operations each year if we really made it a health system priority, but this would still not be enough even to treat the more than 5,000 new people that become morbidly

BA RI ATRI C S URG ERY WO N' T WO RK

Food is now the top killer in this country, bigger than smoking.

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FOCUS

Death By Diet Explosive new publication promises to be the most controversial book on food you will ever read Gareth Morgan and Geoff Simmons are writing a new book about diet and its impact on our nation’s health. They are looking at the key problems with our food and offering some ideas of what can be done about them.

A description of the book from Gareth Morgan’s website says:

obese each year. There just isn’t the money or the trained staff needed for bariatric surgery to be a serious answer to the diabetes and obesity epidemic. It is nothing more than a last resort for the most seriously affected.

Tackling diabetes and the other diseases of affluence will require making many changes, and there will be no silver bullet. The bizarre thing is the select few receiving bariatric surgery receive intensive diet coaching, whereas we haven’t

tried this elsewhere without the surgery. Patients are assessed for mental health issues which might contribute to overeating, and get coaching on sticking to their new diet. In fact they usually have to lose weight before the operation to show that they are committed to weight loss. Why don’t we try to use these tools much earlier to help people lose weight, before they need such expensive surgery? Bariatric surgery is a very expensive ambulance at the bottom of the cliff.

“We Kiwis are literally eating ourselves to death. In the move from cooking to convenience food we have given up control of what we eat. As a result our food is heavy on sugar, fat and salt, and light on the nutrients our body needs. This is causing a hidden health crisis that will swamp our hospitals just when the baby boomers want their hip operations. Gareth Morgan’s latest book cuts straight to the bone of what ails us, and what we can really do about it.”

Go online to get the first chapter of Gareth Morgan and Geoff Simmons’ new book as soon as it’s ready.

See www.garethsworld.com/appetitefor-destruction/

About the authors Gareth Morgan (far left) is a New Zealand businessman, economist, investment manager, motor cycle adventurer, public commentator and philanthropist. He is father of Sam Morgan (founder of TradeMe) and was an early TradeMe investor and director. When TradeMe sold to Fairfax Media, Gareth and his wife Joanne received NZ$50 million, which they donated to their charitable foundation, the Morgan Foundation. Gareth and Jo are UNICEF Goodwill Ambassadors. Earlier this year Morgan put the cat among the pigeons with his campaign to rid New Zealand of our favourite household pet.

Geoff Simmons (left) is an economist working for the Morgan Foundation. Geoff has an honours degree from Auckland University and over 10 years experience working for New Zealand Treasury and as a manager in the UK civil service. Geoff has co-authored three books with Gareth: Health Cheque: the truth we should all know about New Zealand’s public health system; Hook, Line & Blinkers: everything Kiwis never wanted to know about fishing; Ice, Mice & Men: the issues facing Our Far South.

Autumn 2013 | DIABETES

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GARD EN I N G

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COOL WEATHER HARVEST

Preparing for winter garden delights It is possible to enjoy tasty fresh vegetables and herbs in winter but you will need to start work now – in the autumn – to enjoy a cold weather harvest, as gardening expert Rachel Knight explains.

I enjoy my winter edible garden even more than my summer one. Things take life at a more leisurely pace in the cooler months. There’s plenty of rain, fewer weeds and you’ll have more flexibility about when to harvest crops. Many vegetables will continue growing all year round if you don’t get a frost. Some crops will taste much sweeter if you do get a freeze. It’s the perfect time to grow things that readily go to seed when things heat up. On a sunny day we can all find a sheltered spot from which to soak up the sights, sounds and smells that our garden sanctuary offers.

Crops that love the cold Leeks – succulent and flavoursome at any size.

Rocket – the nutty, decorative leaf that every salad-lover can grow.

Pak Choi – fast-growing, crispy, cupshaped greens.

Silverbeet – prolific and reliable back yard staple.

Red kale – a delicate, frilly appearance hides a delicious robust green.

Cos lettuce – the must-have upright leaf for a Caesar salad.

Cavalo Nero – black kale from Italy with distinctively dark, crinkly leaves.

Beetroot – earthy and sweet the red beets can’t be beat.

Carrots – round and orangey or purple and pointy they’ll taste carrotier than anything you buy.

Turnips – don’t turn up your nose at a turnip. Try roasting golfball-sized ones you’ve just dug.

Radishes – take your pick from red, round and crunchy or white, long and pointy.

Spring onions – multi-purpose onions in a bunch.

Fennel – liquorice bulb to serve raw thinly sliced or roasted chunky.

Parsley – flat leaved or curly. So much more than a garnish.

Coriander – if you love it you’ll use it with everything!

Celery – picked a stick at a time will mean your plants will last longer.

Mizuna – spiky, spicy leaf that doesn’t mind the cold.

Cabbage – steamed, coleslaw or sauerkraut. Great greens (and reds) to keep you healthy.

Parsnips – a slow grower but the pale, slender roots are worth the wait.

Chicory – bitter salad green beloved of the French.

Broccoli – green brains that give you brains.

Cauliflower – white brains longing for cheesey sprinkles.

Garlic – planted mid-year for a summer harvest.

Successful winter gardens begin in autumn to give crops a good start while there’s still enough warmth in the soil and before the days draw in. Some won’t be ready until early spring but you’ll be even more delighted to see them on your plate then. Try some or all of these cool weather varieties (see panel) for some tasty, fresh additions to your meals. Depending on where you live some or all of these will thrive in winter. Some protection will help move things along if it’s really cold.

A tunnel house, cold frame or cloche will raise temperatures, particularly on sunny days, and might be what you need to give seedlings a headstart. It’s a real treat to be able to appreciate the special taste of fresh winter vegetables in a stew, a salad or a soup.

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DIABETES | Autumn 2013

Winter planting plan Group compatible veges together for healthy plants.

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LIV ING W ITH D I A B E TE S

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STUD ENT H EA LTH

Forging a new path Going to university can be a stressful as well as exciting time for young people with diabetes. Caroline Wood meets the staff and students at what is thought to be the only university-based diabetes clinic in New Zealand.

Criminology and classics student Amanda Howes, 20, from Christchurch, was in her third year of study when I met up with her at one of the regular diabetes clinics held at at Victoria University’s Kelburn campus, in the heart of Wellington.

of whom are struggling to manage their diabetes on their own in a strange city.

She was one of a long line of students with type 1 diabetes waiting to see endocrinologist Dr Jeremy Krebs at the modern, wellequipped Student Health Service.

“My parents were very nervous about me leaving home, they worried about whether I would manage my diabetes well. At the time I had had a lot of hypos so it was understandable.

The clinic is held five times a year during term-time for students who are not from Wellington. It is staffed by Dr Krebs and two nurses who specialise in supporting young people with diabetes.

University's diabetes clinic popular with students: Patient Amanda Howes (left) with Kirsty Newton, Catherine Nelson, Dr Garry Brown and Dr Jeremy Krebs

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DIABETES | Autumn 2013

It is immediately clear the clinics and nurse-led follow up services offer an impressive and reassuring level of support for students, some

Amanda explained: “The clinic is great, it’s more convenient and easier than going to the doctor.

It’s organised for us, around our timetables.

“I said I would be fine, I gave them my friends’ phone numbers in case they couldn’t get hold of me and the university’s office administrator.

Three years on and I think my parents will always worry about me but they know I have got a really good HbA1c and I have never been to hospital.”

STUDENT H EA LTH

Victoria University’s diabetes clinic is thought to be the only one of its kind in the country and was the brainchild of the university’s health educator and long-term conditions nurse Catherine Nelson, who was concerned students with diabetes weren’t receiving the support they needed to help them manage their diabetes.

After a particularly stressful incident involving a student who had a hypo and fell through a glass door, Catherine decided action was needed.

The pair also organise a number of diabetes-related social and educational events during the year.

These include coffee meetings for new students with diabetes, carb counting classes, talks on alcohol, healthy eating and cooking in flats, women’s health and other topics.

Catherine said: “We love our students and we love our nursing.

We want to support them in every

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LI V I NG WITH DI ABE TES way we can. It’s hard enough for young people to make their way in the world even if they don’t have diabetes. We are trying to maximise their potential and make sure they are safe.

“We see students have a huge improvement in their diabetes control so it’s very encouraging.”

“We see students have a huge improvement in their diabetes control so it’s very encouraging.”

Nurse Catherine Nelson

“I said we need to do something.

We need to have clinics here at the university so students are more likely to come. I met (diabetes nurse specialist) Kirsty Newton and we hatched a plan to ask Dr Krebs to come here,” she said.

Dr Krebs agreed to hold his clinic at the university rather than have students trek across town to Wellington Hospital. The clinics are held at times convenient for students – for example before lectures and avoiding exam times – to ensure the maximum number attend. In four years, only two students have missed their appointment. The clinics are open to any student with type 1 diabetes.

Follow up appointments between the clinics are held by Kirsty and Catherine. Kirsty, who works for Capital and Coast DHB, specialises in helping teenagers and young adults manage their diabetes.

Catherine has encyclopaedic knowledge of university support services and the students know they can ring her direct if they need help.

Dr Jeremy Krebs starts his consultation with Kelly Gardner

Kelly Gardner, 20, from Hawke’s Bay, third year politics student Kelly was diagnosed with diabetes at the age of six. She says she didn’t have any problems as a child as her diabetes was well controlled. It became harder when she became a teenager and became more independent.

She still finds it quite hard to keep her HbA1c down and sometimes finds it frustrating when things aren’t on track. She says visits to the university’s diabetes clinic have helped her keep to her diabetes goals.

Kelly has also attended the university’s diabetes coffee club and carb-counting workshops, so she can share her experiences with other students.

“I felt fine about leaving home and living on my own because by that time I was doing everything myself.

“I have been coming to the clinic for three years and they take very good care of us. I get more support at university and see a diabetes specialist more frequently than I did at home.

“My advice to teenagers leaving home is to plan ahead so you can stand on your own two feet and take control of your diabetes because it is in your own interest.

“I talked to my friends about it and they understand it can be really hard to manage diabetes when you are way from home, you have to think about things like drinking and how that impacts on your diabetes.”

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ARE D HBs G ETTI NG IT RI G HT?

Ministry of Health needs you Are you happy with the diabetes care you receive?

Has it changed over the past nine months?

The Ministry of Health wants to hear about your experiences since the free annual Get Checked programme ended last July. Get in touch today and help shape the future of diabetes care in New Zealand, as Caroline Wood reports.

There is a slow-moving but profound change afoot in the way that patients with type 2 diabetes are cared for in New Zealand. The aim is to see a real and measurable improvement in patients’ health and a reduction in diabetes-related complications. It’s an honourable aim but how is it working in the real world?

The changes were implemented last July when the Get Checked programme of free annual diabetes checks came to an end. The Ministry of Health said Get Checked had plateaued and wasn't having the same level of impact as when it was first introduced. It said a new approach was needed to ensure patients who need it most, such as those with uncontrolled diabetes, receive the right care.

Every District Health Board was asked to draw up a Diabetes Care Improvement Package (DCIP) – explaining how they were going to build on core diabetes services to improve diabetes management in the community. They were allowed to localise the services they offered to patients to tailor them to local needs. In practice, this means patients in Auckland may be offered different kinds of tests, education and management than someone living in Dunedin. In fact, because there are three DHBs in Auckland, patients may find services differ depending on where they live.

Then there is the question of fees. Get Checked tests were free, but now some patients have to pay to get the same diabetes checks. How much patients pay depends on where they live and their DHB’s funding policy. It may be free for some people, for example, to get their eyes checked, others may have to pay on a sliding scale depending on individual factors, such as income or ethnicity.

One of the main aims of the new approach is to encourage patients with type 2 diabetes to be more proactive in looking after their own health. Every patient should have an individual diabetes care plan – and be

“We want to know what is working and what is not – and what we can do to fix it.”

Karen Evison, Ministry of Health

encouraged to set their own health targets, such as giving up smoking, losing weight, or lowering their HbA1c sugar levels. This requires some GPs and nurses to work differently with their patients – more proactively and holistically.

“It's about ensuring the person with diabetes has access to all the support and information they need to manage their situation more effectively,” says Karen Evison, the Ministry of Health’s National Programme Manager. “It is particularly important around goal setting. It should be a combination of what the nurse or doctor knows and understands and what you know and understand.”

The Ministry is keen to ensure the DCIP plans are well thought through and being delivered effectively. It says some DHBs are doing better than others. For example Northland, Southern and Whanganui have very innovative plans and their approaches are being used as a benchmark for others. Some DHBs need to seek more consumer input and partnership with different parts of the diabetes community.

The Ministry is monitoring outcomes – such as patient HbA1c levels and access to cholesterol and blood pressure medicines – every three months. It is also talking to healthcare practitioners and other stakeholders. As part of its evaluation, the Ministry of Health wants to know if the new approach is working at the grassroots level.

“We would like to hear from patients about their experiences. We want to know what is working and what is not – and what we can do to fix it,” added Ms Evison.

Case studies needed The Ministry of Health wants to talk to type 2 diabetes patients about their experiences of diabetes care in their area. Email your details to editor@diabetes.org.nz or call Diabetes New Zealand on 0800 369 636 and we will pass on your details to the Ministry so they can contact you directly.

10 essential diabetes checks – see p 18 16

DIABETES | Autumn 2013

By 1st March 2013 New Zealanders with diabetes should have changed their meters. Have you?

From 1st March 2013, CareSens will be the only fully funded option for both meters and test strips. Changing your meter is easy: if you’re taking medicines such as glibenclamide, glipizide, gliclazide or insulin, your pharmacist can help you change to a free CareSens meter (no patient co-payment).

www.caresens.co.nz or phone our toll-free helpline on 0800 GLUCOSE (0800 45 82 67). We’re here to help.

If you’re using diet and exercise to control your diabetes (or taking metformin alone), you are not eligible for a funded meter: however Pharmaco is offering you a free CareSens II meter through your medical or health centre.

Please discuss this with your doctor or diabetes nurse at your next visit.

There are three funded CareSens meters to choose from, all with different features. To find out which one is right for you, ask your health professional, visit

BLOOD GLUCOSE METERS

Pharmaco (NZ) Ltd, PO Box 4079, Auckland, New Zealand Toll-Free Phone: 0800 GLUCOSE (0800 45 82 67) Email: custserv@caresens.co.nz, Fax: 09 307 1307

Before using CareSens, please read the instructions in the Owner’s Manuals, Quick Guides and Package Inserts. Always read the pack insert/user manual, and follow the manufacturer’s instructions and the advice provided by your health professional/diabetes nurse.

People depicted in this ad are models and their images are used for illustrative purposes only. The use of a person’s image does not in any way imply or suggest that person’s endorsement or use of any product advertised or that they have any relationship or association with Pharmaco or its related entities.

TAPS: DA2512AY 0912CS04

1 February 2013

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10 ESSENTI A L DI A BETES CH ECKS

Are you getting the right diabetes care?

If you have type 2 diabetes you should see your doctor for a clinical review at least once a year, according to the Ministry of Health. Make sure you are asking for the diabetes checks and advice you need, as Caroline Wood reports.

We all know that people living with diabetes are at greater risk of heart disease, stroke, kidney failure, nerve damage and other serious health complications.

Everyone should see their doctor at least once a year to get a diabetes check up. This should include health tests for common diabetes-related complications plus medication, diet and lifestyle advice to help you manage your condition.

Every patient should have an individual diabetes care plan, which sets out the health targets you have agreed with your doctor or diabetes nurse. You should be able to ask for a hard copy of the plan or for it to be kept online by your health provider.

If you feel you aren’t getting the care you need, take the following checklist to your diabetes healthcare team and discuss it with them.

Ten diabetes essentials for good health Have your HbA1c level measured at least once a year. An HbA1c blood test will measure your overall blood glucose control and help you and your diabetes healthcare team set an individual target to aim for over the following year.

1

Get your blood pressure measured and recorded annually. Set a personal target and ask for advice on how to achieve it.

2

Measure your cholesterol (blood fats) once a year. Again ask for your own target that is realistic and achievable.

3

Ask for an eye screen for signs of retinopathy every year. The specialist will check your eyes for any diabetes-related damage to your retina.

4

Have your feet checked annually. Make sure they check the skin, circulation and nerves of your feet for signs of any damage and advise you on how to keep your feet healthy.

5

Have your kidney function measured every year. You should have a urine test for protein and a blood test to measure kidney function.

6

Get your weight checked and ask them to measure your waist to see if you need to lose weight.

7

Ask for help if you need to give up smoking or lose weight – both increase the risk of heart disease and stroke.

8

Attend an education course to help you understand and manage your diabetes.

Ask your local Diabetes NZ branch for advice and support.

9

Ask your doctor to refer you to a specialist diabetes healthcare professional if you think you need it, such as a dietitian, opthalmologist or podiatrist.

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Make sure it’s there when you need it*

Ask your Healthcare Professional about the importance of having the emergency hypoglycaemia medication, GlucaGen® HypoKit, at home, work or school. Make sure to check the expiry date and renew your GlucaGen® HypoKit as necessary.

New HypoHelp Website & App You and your family & friends can visit www.hypohelp.com.au or download the free HypoHelp app to your smart phone for education and support on hypoglycaemia.

HypoHelp also features a handy expiry date reminder service for your GlucaGen® HypoKit.

*Refer to full indications below

GlucaGen® HypoKit is a Pharmacist Only Medicine that is funded through the PHARMAC with a prescription, or available for purchase without a prescription (normal pharmacy charges apply). Ask your Healthcare Professional if GlucaGen® HypoKit is right for you.

Before prescribing, please review full Data Sheet available at www.medsafe.govt.nz GlucaGen® HypoKit. (glucagon [rys] hydrochloride). Presentation: Each pack consists of a vial containing lyophilised glucagon 1 mg (1 International Units) as hydrochloride and a glass syringe pre-filled with 1 mL water for injections. Indications: Therapeutic: Treatment of severe hypoglycaemic reactions in persons with diabetes mellitus treated with insulin or oral hypoglycaemic agents. To prevent secondary hypoglycaemia, oral carbohydrate should be given to restore hepatic glycogen following response to treatment. The treatment of sulfonylurea-induced hypoglycaemia differs from severe insulininduced hypoglycaemia due to the possibility of secondary hypoglycaemia - it is preferable to use intravenous glucose (see full Product Information (PI/Datasheet)). Medical consultation is required for all patients with severe hypoglycaemia. Contraindications: Hypersensitivity to glucagon or lactose, phaeocromocytoma, insulinoma or glucagonoma. Precautions: Glucagon will have little or no effect when the patient is fasting or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia. When used in endoscopy or radiography, caution should be observed in diabetic patients, or elderly patients with known cardiac disease. Glucagon should not be administered by intravenous infusion. Interactions: Glucagon is an insulin antagonist. When given in large doses, glucagon may potentiate the anticoagulant activity of warfarin. Glucagon can reverse cardiovascular depression of profound ß-blockade. With indomethacin, glucagon may lose its hyperglycaemic effect or even produce hypoglycaemia. Adverse Effects: Nausea; vomiting. Dosage and Administration: The glucagon solution should be prepared immediately before use. Dissolve powder in accompanying solvent and administer by subcutaneous or intramuscular injection. Therapeutic: Adults and children above 25 kg - administer 1 mg; Children below 25 kg - administer 0.5 mg.

Novo Nordisk Pharmaceuticals Ltd., G.S.T. 53 960 898. PO Box 51268 Pakuranga, Auckland, New Zealand. NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS: PP3317 Mck32230/Diabetes NZ

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Getting the family involved

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S H A RE TH E LOA D

Everyone in a family should be involved in caring for a child with diabetes.

Columnist Renata Porter explains the lesson she learned the hard way when she was suddently admitted to hospital.

I often get the opportunity to talk to families at events and I’ve noticed that when there seems to be a family that is under stress, or is having a hard time coping, it’s usually because there is one person trying to manage everything for the child with diabetes. It’s perfectly understandable, especially with the busy lives that we and our children lead nowadays.

However, I can’t help but feel for that parent because I know they feel isolated even though they are part of a larger family. Along with that isolation can come all kinds of other feelings like anger, stress, then guilt for possibly ignoring the other children, or maybe not saying something very nice due to the pressure they’re under. It happens and I am sure that anyone reading this article understands or has been there themselves.

I think the key is to understand that you are a part of a family and it would be good for everyone to be involved. Not only is there a safety issue when only one person understands the child’s food/insulin regimen, but it can also cause severe burnout for that parent. It can also make the other children think the child with diabetes gets more attention. And they may be right, but it’s more from a family imbalance rather than the parent

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choosing to give more attention to the child.

feel terribly guilty that he didn’t know what to do.

So, what can you do? Firstly, let’s talk about how it’s a safety issue if only one person understands the daily regimen of the child with diabetes.

My suggestion is to get the other parent involved and maybe even the older siblings. Teach them how to count carbs, teach them the daily regimen, teach them about what activity does to blood glucose levels.

Some of you might know that I was hospitalised a few years back. It was sudden and unexpected. Now, my kids weren’t little by any stretch of the imagination but I was always their double check person before shots were given.

Keep in mind that teaching them isn’t enough. They have to practise.

Maybe your spouse can take over for dinners or on the weekends. Maybe the older sibling can help out after school.

It’s also good to make a chart that you can put up on the kitchen cupboard that lists out regularly eaten foods and their values, has their latest regimen and emergency numbers. And keep that chart up to date!

When you bring the family together to help out, it can give everyone a sense of care and involvement. Talk about strengthening the family bond!

My husband, bless him, knows exactly what a low is and would be a star if there was an emergency – but had no clue how to verify if the kids made the right decision based on food, blood glucose and activity.

Face it, that’s a maths equation that can give even those of us who are masters some trouble!

Talk about throwing the family for a loop! Honestly, it scared everyone.

The situation made the kids feel vulnerable and made my husband

Secondly, when you bring the family together to help out it can give everyone a sense of care and involvement. Talk about strengthening the family bond! Your spouse will feel more connected and it’s an opportunity for you to get closer to the other children.

Thank or reward them for stepping up to help the child with diabetes.

Recognise them for helping you.

This will give them such a sense of pride and accomplishment. It will help to ease your burden, relieve some stress and bring the family closer together.

Lastly, it is possible you may get resistance from the family. Explain to them that you aren’t wanting them to take over, just help out.

Let them know that it’s safer for the child with diabetes if everyone has an understanding of how to manage.

Then explain that it’s important to you to be involved in everyone’s life and the only way that can happen is if everyone pitches in – for the family.

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A HEALTHY H EA RT

Why am I more at risk of heart attack?

It pays to look after your heart if you have diabetes, as Caroline Wood explains.

People with diabetes are two to four times more likely to have heart disease, according to the World Heart Federation. And cardiovascular disease is the leading cause of death for people with diabetes.

These are two sobering statistics but there are changes you can make to cut the risk of heart disease. Experts recommend regular exercise and a heart-healthy diet as ways to reduce your individual risk.

If you have diabetes your risk of cardiovascular disease rises for a number of reasons. You are more likely to have high blood pressure and high cholesterol – both risk factors in their own right for cardiovascular disease.

Uncontrolled diabetes causes damage to your body’s blood vessels making them more prone to damage from atherosclerosis and high blood pressure. People with diabetes develop atherosclerosis at a younger age and more severely than people without diabetes.

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High blood pressure is at least twice as common in people with diabetes as in people with normal blood glucose levels.

People with diabetes are more likely to suffer a heart attack or stroke than people who do not, and their prognosis is worse. If you have diabetes, you can have a heart attack without realising it. Diabetes can damage nerves as well as blood vessels so a heart attack can be ‘silent’, that is, lacking the typical chest pain.

Premenopausal women who have diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of oestrogen.

See your doctor regularly for a healthy heart check up and ask them to check your blood pressure and cholesterol regularly.

See our tips on the following page on how to eat for a healthy heart.

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Eating for a healthy heart You can significantly reduce your risk of having a heart attack or stroke by eating more healthily.

Making the right food choices is one of the keys to a healthy heart – and it will help your diabetes control too.

Luckily a healthy diabetes diet is also a healthy heart diet. The aim is to reduce cholesterol and high blood pressure, both associated with heart disease.

Here are our tips for a happy, stronger heart.

Banish salt from your diet Salt is added to make food taste good but it is bad for us because it can raise blood pressure to unhealthy levels and increases the risk of heart disease. The New Zealand Guidelines Group recommends that Kiwis reduce their sodium intake to less than 2,300mg a day. This is equal to 6g of salt a day, or just over 1 teaspoon of salt. Watch out for hidden salt – 75 per cent of our salt intake comes from processed and manufactured foods. And salty food doesn’t always taste salty! Foods high in salt include bread. There is also salt in cheese, biscuits and butter, soy sauce, stock cubes, yeast extract and processed meats like ham and bacon.

Know your good fat from your bad fat

Moderate your portions

Choose heart-healthy fats that contain omega-3, monounsaturated and polyunsaturated fats. These have been shown to reduce the risk of heart disease if eaten regularly.

Good sources include vegetable oils, such as olive, canola, rapeseed and safflower; oily fish such as salmon; avocados and walnuts.

Avoid saturated fats, found mostly in coconut and palm oils, as they can raise your LDL or ‘bad’ cholesterol levels. You may also know that transfats (artificial fats found in processed foods) are particularly bad for you as they lower your HDL ‘good’ cholesterol levels and raise your LDL ‘bad levels’ – a double whammy.

Make smart meat choices Red meat is high in saturated fat, which is why dietitians recommend choosing lean cuts of red meats, such as beef, lamb and venison, and not eating too much of it. You don’t need any more than a portion the size of your palm. The smartest meat choices are those that are lower in saturated fats, such as skinless chicken and lean cuts of pork.

If you visualise a healthy plate, only a quarter of it will be lean protein, such as lean meat, fish, beans or tofu. Think of your protein being the side dish, not the main attraction. The second quarter will be your carbs, preferably wholegrain, such as brown rice, pasta, potato, kumara, bread. And the other half will be non-starchy veges, such as broccoli, peas, green beans or salad.

Choose low-fat dairy Dairy foods, such as milk and cheese, are a valuable source of calcium and protein. However, they can also be a hidden source of salt and fat, especially saturated fat. Choosing low-fat milk, yoghurt and cheese will help reduce your risk of heart disease. It is recommended that we eat two to three servings of reduced or low-fat milk or milk products each day (see illustration for an example of what that means).

Eat fresh and cook your own Buying and cooking your own food from fresh ingredients gives you the control over how much salt, fat and sugar goes into your own meals. It also saves money. Changing habits is hard but eating healthily needn’t feel like a chore once you have experimented and found some recipes that you love and are good for you, your heart and your diabetes.

What do two to three servings of low-fat dairy look like?

+ 250mls low fat milk

3cm cube of Edam or Mozzarella

+

+ 1 pottle low fat, low sugar yoghurt

250mls low fat milk

+ 1/3 cup cottage cheese

2 tablespoons grated Parmesan cheese

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The Mediterranean diet – diabetes-friendly and delicious The Mediterranean diet is delicious and proven to be healthy. It is also good for people with diabetes, as Wellington dietitian Ann Gregory reveals.

A Mediterranean diet is regularly talked about as being healthy and good for people with heart disease but is it good for people with diabetes?

The Mediterranean diet became popular in the 1990s following two European research studies. The studies showed that men living in Mediterranean countries have a lower incidence of coronary heart disease compared to other countries and that replicating the Mediterranean diet reduced the incidence of heart disease.

Further studies since then have shown that a Mediterranean diet can reduce the risk of developing type 2 diabetes, and helps to improve blood glucose levels in people who already have type 2 diabetes.

So what is a Mediterranean diet and what changes do you need to make?

When I think of the Mediterranean I think of sun, the beach, seafood, fresh tomatoes with basil and olive oil. Best of all a Mediterranean diet gives you a delicious but healthy eating plan. Here are some tips to bring a bit of Mediterranean sunshine to your diet.

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Increase your veges and fruit to 10 a day We all aim for ‘five a day’ but it’s even better if you can find ways to increase it to seven to 10 servings a day. Try these tips: • chop some fruit into your breakfast cereal • raw vegetables and hummus make a great lunch • increase the vegetables on your plate for dinner • have a meal based on beans, lentils or chick peas instead of meat.

Switch to wholegrains Try different kinds of wholegrain bread, five grains, ancient grains… you are sure to find one that you like. Switch to wholegrain breakfast cereals – look for one with less than 15g sugar per 100g – 20g if it contains fruit.

Get fishy!

Include fish in your diet once or twice a week, with a serving of oily fish weekly. Try to grill, steam or bake it but do not fry. Tinned fish in spring water is a good choice.

Keep servings based on red meat small. Reduce the number of meals using red meat – use fish, chicken, beans and legumes instead. Avoid high fat meats such as sausages and bacon.

Check your fats Use olive oil-based spreads in place of butter and canola, rice bran oil or olive oil for stir frying and dressing. Use low-fat dairy products – green or yellow topped milk, low-fat yoghurts and cheese.

Avoid fried food.

Spice up your meals Use Mediterranean herbs and spices to flavour food and reduce the salt.

Try fresh basil, marjoram, thyme, parsley (you can grow your own herbs on the window sill or outside your back door), garlic, nutmeg, paprika and saffron.

Go a bit nuts Use nuts as a quick snack – best raw – but you can have them lightly roasted, plain or honey roasted (not salted) and keep to a handful not a whole packet!

Get physical Get some exercise each day. You don’t need to park next to the supermarket door. Use the stairs, get off the bus a stop earlier, put on some music and dance.

Relax at meal times Turn off the TV, sit at the table to eat, enjoy the company of your family and friends as they do in southern Europe. Take your time to enjoy your food.

Making changes to your diet can be difficult. Planning well before you start can help you stay on track and achieve your goals. Look for Mediterranean-inspired recipes and plan your meals in advance – write a shopping list and stick to it!

Keep some staples handy in the cupboard and freezer. At the weekend when you have time, cook double and freeze half – it makes a much better option than takeaways on a busy night.

For more information, and a downloadable Mediterranean food pyramid, visit the Oldways website at www.oldwayspt.org.

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Med diet helps patients control diabetes without drugs The classic Mediterranean diet became popular after it was introduced at a conference in Cambridge, MA, in 1993 by nutrition charity Oldways, the Harvard School of Public Health and the European Office of the World Health Organisation.

They said the diet would promote lifelong good health and presented a Mediterranean diet pyramid graphic to represent it visually.

The diet was based on the dietary traditions of Crete, Greece and southern Italy circa 1960 at a time when the rates of chronic disease among populations there were among the lowest in the world, and adult life expectancy was among the highest even though medical services were limited.

Studies have shown a Mediterranean diet rich in vegetables and wholegrains may help people control their type 2 diabetes without drugs – compared with those that followed a typical low fat diet.

a Mediterranean-style diet or a low-fat diet.

The Mediterranean diet was rich in vegetables and whole grains and low in red meat, which was replaced with fish or poultry. Overall, the diet consisted of no more than 50 per cent of daily calories from carbohydrates and no less than 30 per cent of calories from fat.

The low-fat diet was based on American Heart Association guidelines and was rich in wholegrains and limited in sweets with no more than 30 per cent of calories from fat and 10 per cent from saturated fats, such as animal fats.

The Med diet group had better blood sugar control, and was less likely to need diabetes drugs, than the control group.

They also had an improvement in cardiovascular risk factors. Weight loss was similar between the two groups.

In one of the longest studies of its kind, Italian researchers found that after four years only 44 per cent of people on a Mediterranean diet needed diabetes drugs to control their blood sugar, compared with 70 per cent who followed the low-fat diet.

Proponents say the key benefits of the Mediterranean diet include a longer life, healthier babies, improved brain function, decreased chronic disease and cancer risk. Also a decreased incidence of depression, Alzheimer’s, Parkinson’s, and dental disease. Rheumatoid arthritis, eye health, breathing, and fertility can also be improved.

In the 2009 study, researchers, including Katherine Esposito, of the Second University of Naples, randomly assigned 215 overweight people recently diagnosed with type 2 diabetes who had never been treated with diabetes medications to either

There are also diabetes-specific and related benefits including a decreased risk for type 2 diabetes and heart disease, better diabetes control, improved insulin sensitivity, decreased risk of macular degeneration and lower blood pressure.

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RECIPES

Flavours of the Med This is one of my favourite vegetable recipes, which can be eaten hot or cold, by itself or as a side dish with fish or chicken. It can be made the day before. The quantity of the vegetables is a guide, you can use more of each depending on what you have available.

Ratatouille INGREDIENTS 2 aubergines 3 medium zucchini 2 medium onions 2 red or green peppers 4 large tomatoes 2 cloves of garlic 3–4 tablespoons olive oil 1 tablespoon fresh basil Salt and black pepper to season Serves 4 NUTRITION: Energy 868kj; Fat 15g; Sat fat 2.2g; Carbohydrate 14g; Fibre 6.5g; Sodium 10mg

Wash and cut the aubergine and courgettes into thick slices about 2½ cm.

Place in a colander and sprinkle with a little salt, cover with a plate and weigh down and leave for 30–45 minutes. This helps draw out some of the moisture.

Chop the onions roughly, deseed the peppers and cut into 2½ cm chunks.

Skin the tomatoes by plunging in boiling water for 2 minutes, after which the skin will come off easily. Deseed them if you want and cut the flesh into chunks.

Heat the oil in a large pan, add the onions and garlic and cook gently for 10 minutes or until soft but not brown.

Add the pepper. Dry off the aubergine and courgette and add to the pan.

Add the basil, season with black pepper and a little salt, stir well, cover and simmer gently for 30 minutes.

Add the chopped tomatoes, check the seasoning and cook for 15 minutes with the lid off.

Hummus is quick and easy to make. It is great for lunch with wholegrain bread or crackers. Serve with vegetable sticks for a snack. The recipe below can be adapted by using different spices, adding orange juice, diced cucumber, pureed pumpkin or pureed kumara for variety.

Hummus

Drain the chick peas and rinse.

INGREDIENTS 200g drained tinned chick peas 2 tablespoons lemon juice 2 cloves garlic crushed 1 teaspoon ground cumin Pinch of salt 100mls tahini (sesame paste) 4 tablespoons of water 2 tablespoons of olive oil 1 teaspoon of paprika to garnish

Combine the chick peas, lemon juice, garlic, cumin, salt, tahini and water in a food processor and blend to a creamy puree.

Serves 6 NUTRITION: Energy 1,175Kj; Fat 25g; Sat fat 4g; Carbohydrate 5.6g; Fibre 16g; Sodium 515mg

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Add more lemon juice, garlic or cumin to taste.

Place in a bowl and sprinkle with paprika.

D IABETES NEW ZEA L A ND 2 013 A NNUA L CO NFERENCE

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COM MUNITY

All of us together Plans are well under way for this September’s Diabetes New Zealand annual conference and organisers are making sure they build on the success of last year’s conference.

It’s going to be hard to top the success of last year’s annual conference and AGM, which coincided with celebrations to mark Diabetes New Zealand’s Golden Anniversary and the birth of a new unified organisation.

This year’s conference and AGM will be held in September rather than May because Diabetes New Zealand has moved to a new financial year.

The theme of this year’s conference is ‘All of us together’, which reflects the new unified organisation and the efforts of every member of the diabetes community to help people live well with the condition.

We depend heavily on donations, legacies and membership fees to help us do our work.

Please help us educate and support people with diabetes so they can live well with it.

There will be a particular emphasis on the use of evolving technology to help manage diabetes, for instance the use of smart phones and computers to shift and record information or to link blood glucose meters to pumps.

Organisers are planning involve local iwi in some sessions this year.

They are talking to representatives from Wellington’s Pipitea Marae on some exciting potential new features at the conference.

Conference organiser Russ Finnerty says: “We want to convince members that there is a very good reason to be at the conference. There will be a strong educational focus this year, lots of experts and great practical advice for everyone on how to manage their diabetes and live well.”

The programme will include something for everyone. There will be more educational workshops as they proved to be particularly popular last year.

Ways to give

There will be sessions on cooking, exercise, young people and the latest advice for diabetes management.

All sessions will be led by experts in their field and the conference will include some thought-provoking panel discussions, another popular feature of last year’s conference.

Further details about the annual conference will be in the Winter issue of Diabetes. You can log on to www. diabetes.org.nz from May to register.

Practical details Venue: James Cook Hotel Grand Chancellor, The Terrace, Wellington.

Date: From noon Friday 20 September to lunch Sunday 22 September (the AGM is on Friday afternoon).

Registrations: Open in May. Prices: Expected to be similar to last year Accommodation: James Cook is providing special accommodation rates.

How can you help?

• • • • •

You can make a regular donation or a one-off donation.

You can call 0900 86369 to make an instant $20 donation.

You can sponsor a special event such as Diabetes Awareness Week.

You can sign up to payroll giving.

You can leave us a bequest in your will.

A third of money donated can be claimed back as a tax refund.

Donations are tax-deductible up to the donor’s full annual income.

Visit www.ird.govt.nz for more information.

Please talk to us to discuss your donation options.

Call Freephone 0800 369 636 or email admin@diabetes.org.nz

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STEROIDS AND D IABETES

Watch out for steroids Taking steroids can raise blood glucose levels in patients with diabetes. Many people are unaware that this can happen, as Caroline Wood explains.

Barry, 65, controls his type 2 diabetes with a healthy diet and regular exercise. He doesn’t take medication. Last winter he got a bad cold so he went to his doctor and was prescribed a short-term dose of the steroid prednisone to help with his symptoms. After starting treatment, he was shocked to find his blood glucose reading shot up. It took him three weeks using medication to bring it down.

Doctors should help patients determine what adjustments are needed to keep blood glucose levels within the target range. If you are taking large doses of steroids, you may need to temporarily start or increase diabetes tablets or insulin injections.

Like many people, Barry didn’t realise taking some kinds of steroids can cause a temporary rise in blood glucose levels in people with type 1 and type 2 diabetes. Had he known, he would have taken steps to mitigate the impact.

Steroids are useful antiinflammatory medications that are commonly used to treat asthma, dermatitis and to prevent nausea during medical procedures, such as chemotherapy.

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Prednisone, hydrocortisone and dexamethasone are some of the kinds of steroids in common use. These are not in the same class as the anabolic steroids used to build muscle mass.

Steroids are hormones, similar to those that naturally occur in the body, that are produced to fight stress, injury and disease. They are part of a group of medications called corticosteroids (steroids for short). They are also known as glucocorticoids because of their impact on glucose metabolism.

Steroids raise blood glucose in three ways, according to the Australian Diabetes Council: • They block the action of insulin,

which causes insulin resistance.

• Less glucose is able to be removed from the bloodstream to be taken up by muscles. This raises blood glucose.

• They cause the liver to start releasing extra glucose into the bloodstream.

Inhaled steroids for asthma have not been found to raise blood glucose.

Oral steroids can start raising blood glucose within a few days and this will change according to the time, dose and type of steroid being taken.

A steroid injection into a joint or muscle may cause blood glucose to rise soon after it is given and its effects may last three to 10 days.

How to manage diabetes and steroid therapy • If you are prescribed any medication, tell your doctor you have diabetes and ask him whether the steroid will impact on your blood glucose.

• Increase the number of times you test your blood glucose and record all results to identify patterns.

• Contact your diabetes team if you have any concerns.

• Continue exercising and follow a healthy eating plan.

• Never stop taking your steroid medication abruptly.

• The effects normally subside within 48 hours of stopping the medication.

STERO I DS A ND DI A BETES

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TREATMENT

Doctors should help patients determine what adjustments are needed to keep blood glucose levels within the target range. If you are taking large doses of steroids, you may need to temporarily start or increase diabetes tablets or insulin injections.

If your blood glucose starts to rise, ask your doctor or diabetes nurse for advice on how to adjust your insulin or tablets accordingly.

The Australian Diabetes Council has published a useful leaflet on Steroids and Diabetes (Talking Diabetes No 45). See www.australiandiabetescouncil.com.

What is steroid-induced diabetes?

Steroids can sometimes cause temporary diabetes in people never diagnosed with the condition.

Steroid diabetes (also ‘steroid-induced diabetes’) is a medical term for prolonged hyperglycaemia (high blood glucose) due to steroid use. It is usually, but not always, a temporary condition. However it can sometimes be a marker of future type 2 diabetes.

Most people can produce enough extra insulin to compensate for this effect and maintain normal glucose levels. Those who cannot develop steroid diabetes.

The most common glucocorticoids that cause steroid diabetes are prednisone and dexamethasone given systemically in high doses for days or weeks.

Typical medical conditions in which steroid diabetes arises during high-dose glucocorticoid treatment include severe asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease, and induction chemotherapy for leukemia or other cancers. Short courses of steroids can also be given for gout, emphysema or chronic bronchitis.

Treatment depends on the severity of the hyperglycaemia and the estimated duration of the steroid treatment.

Mild hyperglycaemia may not require treatment if the steroids will be discontinued in a week or two. Moderate hyperglycaemia carries an increased risk of infection (especially fungal) in people with other risk factors, such as those who are immunocompromised or have central intravenous lines. Insulin is the most common treatment.

It is not always possible to determine whether apparent steroid diabetes will be permanent or will go away when the steroids are finished. This is because it is not unusual for steroid treatment to result in type 1 or type 2 diabetes in a person that is already in the process of developing it. Sometimes undiagnosed cases of type 2 diabetes are brought to clinical attention with corticosteroid treatment because their condition becomes symptomatic. Generally, steroid diabetes without pre-existing type 2 diabetes will resolve on stopping corticosteroid administration.

Source: Wikipedia

Autumn 2013 | DIABETES

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P HYS I CA L A CTI VITY

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HOW TO EXE RCI S E S A FELY

When to monitor your blood sugar Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.

Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.

But diabetes and exercise pose unique challenges, too.

Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations.

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H OW TO EXERCI S E S A FELY

Before exercise: Check your blood sugar Before jumping into a fitness programme, get your doctor’s OK to exercise — especially if you’ve been inactive. Discuss with your doctor which activities you’re contemplating and the best time to exercise, as well as the potential impact of medications on your blood sugar as you become more active.

For the best health benefits, experts recommend 150 minutes a week of moderately intense physical activities such as: • fast walking • lap swimming • bicycling.

If you’re taking insulin or medications that can cause low blood sugar (hypoglycaemia), test your blood sugar 30 minutes before exercising and again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it’s safe to exercise.

Consider these general guidelines relative to your blood sugar level (measured in millimoles per litre – mmol/L): • lower than 5.6 mmol/L – your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.

• 5.6 to 13.9 mmol/L – you’re good to go. For most people, this is a safe pre-exercise blood sugar range.

• 13.9 mmol/L or higher – this is a caution zone. Before exercising, test your urine or blood for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate that your body doesn’t have enough insulin to control your blood sugar. If you exercise when you have a high level of

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P H YS I CAL A C TIVITY

ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment.

Instead, wait to exercise until your test kit indicates a low level of ketones in your urine.

• 16.7 mmol/L or higher – your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

During exercise: Watch for symptoms of low blood sugar During exercise, low blood sugar is sometimes a concern. If you’re planning a long workout, check your blood sugar every 30 minutes — especially if you’re trying a new activity or increasing the intensity or duration of your workout.

This may be difficult if you’re participating in outdoor activities or sports. However, this precaution is necessary until you know how your blood sugar responds to changes in your exercise habits.

Stop exercising if: • your blood sugar is 3.9 mmol/Ln or lower • you feel shaky, nervous or confused.

Eat or drink something to raise your blood sugar level, such as: • two to five glucose tablets, or • 1/2 cup (118 millilitres) of fruit juice, or • 1/2 cup (118 millilitres) of regular (not diet) sweet fizzy drink, or • five or six pieces of hard candy.

Recheck your blood sugar 15 minutes later. If it’s still too low, have another serving and test again 15 minutes later. Repeat as needed until your blood sugar reaches at least 3.9 mmol/L. If you haven’t finished your workout, continue once your blood sugar returns to a safe range.

After exercise: Check your blood sugar again Check your blood sugar right away after exercise and again several times during the next few hours.

Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood. The more strenuous your workout, the longer your blood sugar will be affected. Low blood sugar is possible even hours after exercise.

If you do have low blood sugar after exercise, eat a small carbohydratecontaining snack, such as fruit or crackers, or drink a small glass of fruit juice.

Exercise can be beneficial to your health in many ways, but if you have diabetes, testing your blood sugar before, during and after exercise may be just as important as the exercise itself.

Reprinted with kind permission of MayoClinic.com. All rights reserved.

Mayo Clinic is a not-for-profit medical practice and medical research group based in Rochester, Minnesota, which specialises in treating difficult cases. Patients are referred to Mayo Clinic from across the US and the world. It is known for innovative and effective treatments.

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P RO FI LE

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TH E BEAVEN PAPERS PART TWO

Beaven predicted diabetes epidemic 30 years ago In the early 1980s, Professor Sir Don Beaven was one of the first doctors to warn about the rising social and economic costs of diabetes in New Zealand society. He also viewed nutrition education as vital to correct our ‘outdated and unhealthy’ relationship with food. Courtney Harper, of the University of Auckland, was given access to the Beaven papers archive as part of her PhD thesis. This is her second article about Sir Don Beaven for Diabetes.

Thirty years ago Professor Sir Don Beaven was warning anyone who would listen about the rising cost of diabetes in New Zealand society. Former Patron and lifelong supporter of Diabetes New Zealand, Beaven was a world-class researcher and one of the first medical experts to publicise the looming epidemic of diabetes, obesity and its potential cost to the healthcare system in this country.

During the 1980s Beaven made regular contributions about the political and cultural aspects of health in popular media. He fostered relationships with the journalists who frequently solicited his opinions on topical health policy issues.

In 1980 he was in talks with the Star about doing a ‘provocative’ column on health. Rival paper the Press sought Beaven’s professional opinion on how it could improve its health articles. It had already contracted another columnist (who Beaven considered to be “very 1 2 3 4

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orthodox [and] very conservative”), and the Press relegated Beaven to a fortnightly nutrition column for the women’s pages. This he saw as a telling indictment on male New Zealanders’ attitudes to health.1 Beaven viewed nutrition education as vitally important to correct New Zealanders’ “outdated and unhealthy relationship with food”. He scribbled on a notepad: “Pavlovas are as unsuitable as the beer, racing and football philosophy in New Zealand and as appropriate as dinosaurs… They epitomise the ‘kill your man early’ high fat and sugar gourmand attitudes which should have been as extinct as dinosaurs 10 years ago.” 2 In various public forums Beaven proposed taxes on beer, televisions and sugar to fund health care for obesity, diabetes and the other problems they caused.3 He railed against New Zealand’s culture of pubs, rugby and male aggression, relishing opportunities

to evoke controversy and discussion.

Beaven frequently wrote to Members of Parliament of both major parties on health issues he felt he could offer advice on, particularly the rising social and economic costs of diabetes in New Zealand society.

He also took his increasing distaste for the Government straight to the airwaves. In September 1983, Beaven made a thinly veiled attack on Prime Minister Rob Muldoon’s regime in a radio talk, where he argued New Zealanders’ “frustrated aggression and widespread unhappiness” was manifesting itself in high rates of “overweight” (ie obesity).

He suggested the solution to overweight was ‘non-political’: “The return of decentralised decisionmaking to citizens and the reversal of unhealthy power aggregation.” 4 Beaven received numerous letters from the general public supporting his comments.

Beaven to M. Forbes, 17 January 1980, D. W. Beaven Papers, Accession #195, 36660, Macmillan Brown Library, Canterbury.

Draft speech notes, D. W. Beaven Papers, Accession #195, 36760, Macmillan Brown Library, Canterbury.

Example newspaper clippings are in D. W. Beaven Papers, Accession #195, 36821, Macmillan Brown Library, Canterbury.

Beaven, ‘Return to an overweight country’, Script for radio talk, 11 September 1983, D. W. Beaven Papers, Accession #195, 36855, Macmillan Brown Library, Canterbury.

DIABETES | Autumn 2013

FUNDRA I S I NG

Sir Don Beaven Research Fund

COM MUNITY

New fundraising drives launched

Diabetes New Zealand is urging members and branches to donate to a new fund dedicated to diabetes research. The Sir Don Beaven Research Fund is named in memory of its former Patron, one of the world’s greatest diabetes researchers and campaigners.

Diabetes New Zealand wanted to honour Sir Don, who passed away in 2009, for all the work he did for the organisation and for people with diabetes. It will replace Diabetes NZ’s Education and Research Fund.

Details of the fund are still being finalised. More information will be posted on www.diabetes.org.nz later this year.

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Diabetes New Zealand has been chosen as a nominated charity for two exciting new fundraising opportunities.

Donate your Desktop: Diabetes NZ has been selected to take part in Donate your Desktop. All you have to do is download a simple application that renews your desktop background daily with an advertisement. A generous 75 per cent of the revenue collected from the advertiser goes to one of the Donate your Desktop’s partner charities, and you can nominate which charity receives the funds. To find out more, or to download the application go to: www. donateyourdesktop.co.nz. When you download the application you will be given the option of selecting Diabetes NZ as the recipient charity.

Just Energy: Diabetes NZ has just been made one of Just Energy’s community partners. For every Diabetes NZ supporter that signs up to Just Energy under its community support programme, Just Energy will make a payment to Diabetes NZ. When a person signs up to Just Energy under the community support programme, they receive a 19 per cent prompt payment discount when they pay on time and Just Energy will pay three per cent of this discount to one of the community support programme charities the person nominates (Diabetes NZ is one). To find out more, or to sign up to Just Energy go to: www.justenergy.co.nz/content/about-community-support-programme.

You will be given the option of selecting Diabetes NZ as the recipient charity.

Join Diabetes New Zealand today!

Join Diabetes New Zealand today. Membership includes access to services from your local branch and a free annual subscription to Diabetes magazine (four issues per year).

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Membership includes free home delivery of four issues of Diabetes (worth $18) straight to your door. If you do not want to join Diabetes New Zealand, you can subscribe to the magazine for $18 per year (four issues), simply choose this option in the payment box below.

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Post to (no stamp required): Freepost Diabetes NZ, Diabetes New Zealand, PO Box 12-441, Wellington 6144

Autumn 2013 | DIABETES

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THE L AS T WORD

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A IS FOR APPLE

In praise of... the humble apple

Missionary Samuel Marsden sent the first apples to New Zealand with the first missionaries, who planted them in 1819 at their new mission settlement at Kerikeri. Our climate provided perfect growing conditions and over the years those first few trees have developed into a multimillion dollar export business.

New Zealand has a unique combination of warm summer sunshine, crisp winter frosts and clean pure waters, according to the 100% Pure Apples NZ website.

Apples ripen slowly, naturally, with the absolute minimum of human intervention – and develop a naturally crisp texture and intense flavour.

Should you eat apples if you have diabetes? Yes, apples are a nutritious food and you can still eat them even if you have diabetes, according to the American Diabetes Association.

Apples are high in fibre and are a source of vitamins and minerals.

They don’t have any fat, saturated fat, cholesterol, or sodium. To get the maximum benefit from an apple, eat it with the peel on – this part of the apple is packed with nutrients that you don’t want to miss out on!

Apples are a perfect fruit for people with diabetes, according to the Joslin Diabetes Center, in the US. The fibre and antioxidants they contain can help ward off heart disease and lower cholesterol.

They are a low glycaemic index

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DIABETES | Autumn 2013

carbohydrate, which means they are less likely to spike your blood glucose if eaten in reasonable portions.

Enjoy a Kiwi apple this autumn!

NZ home to world class apple growers

New Zealand has grown and exported apples to the world for over 100 years. Over that time our growers have earned a reputation for developing new apple varieties that have become favourites with apple lovers the world over. Jazz, Braeburn, Royal Gala and Pacific Rose to name a few.

Braeburn is our largest volume variety and developed in New Zealand. Much sought after in Europe and North America, Braeburn has excellent storage qualities. It has a clean, semi-sweet flavour and crisp, juicy flesh.

Royal Gala was developed in New Zealand and is a red sport of the Gala variety. Sweet and crisp, it is one of the world's premium apple varieties and New Zealand's second largest volume variety.

PHOTOS: TURNERS AND GROWERS LTD

We export about 300,000 tonnes of apples per year with earnings ranging from $350 million to $400 million, according to the Ministry of Primary Industries. The variety mix is moving away from the mainstay commodity varieties of Braeburn and Royal Gala towards new and more marketable varieties such as the Pacific series, Fuji, Jazz™, Envy™ and Pink Lady®.

ALEXANDER TURNBULL LIBRARY, WELLINGTON, NEW ZEALAND

Autumn is here and with it comes apple picking season – yummy! Apples are delicious and healthy especially if you have diabetes – but how much do you know about the humble origins of the Kiwi apple?

Jazz is our fastest growing export variety already sold in 20 countries. A tangy-sweet apple with incomparable crunch and juice content. It is the progeny of Braeburn and Royal Gala.

Pacific Rose is another New Zealand variety, with a unique rose pink skin colour. It has a rich sweet flavour and crisp juicy flesh.

IMPORTANT MESSAGE To all People who Test for Blood Glucose and/or Blood Ketones

Optium / FreeStyle Optium

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g

ne o t ke

FreeStyle Optium Blood Glucose Test Strips: An agreement with Pharmac has been agreed to continue funding FreeStyle Optium Blood Glucose Test Strips for eligible users. Funding will continue after 1st March 2013 for those who received both Optium Blood Glucose and Optium Blood Ketone test strips on prescription prior to 1st June 2012.* FreeStyle Optium Blood Ketone Test Strips: Prescription access remains available and continues for all people with diabetes, maximum of 20 strips per prescription, regardless of which meter they use for glucose testing.* FreeStyle Optium Meter: is able to be prescribed for ketone diagnostics where the patient has had one or more episodes of ketoacidosis and is at risk of future episodes. One meter per patient will be subsidised every 5 years.*

M E D I C A

L I M I T E D

www.medica.co.nz www medica co nz 0800 106 100 PO Box 303205 North Harbour 0751 TAPS NA6142

*www.pharmac.govt.nz

Always read the label and follow the manufacturer’s instructions. MSE120820011031

A 24-hour insulin that I can take once a day? 2

“Sweet...!”

Lantus® (insulin glargine) is now fully funded for Type 2 diabetes mellitus patients requiring insulin.1,2 For thousands of Kiwis, this will be something to smile about.

Lantus® is a long-acting basal insulin. ‘Basal’ is a term used to describe the slow, steady release of insulin needed to control your blood glucose between meals and overnight. Lantus® provides a continuous level of insulin over 24 hours, similar to the slow, steady (basal) secretion of insulin provided by the normally functioning pancreas.

This means that only one dose of Lantus®, given at the same time each day, is needed for 24-hour basal control. 2,3 How is Lantus used in people with Type 2 diabetes?

In Type 2 diabetes, Lantus is given by subcutaneous injection once daily and can be used in combination with oral diabetes medications and/or with short or rapid acting insulin as instructed by your doctor. 2,4,5 Talk to your doctor about whether Lantus® could be right for you.

References: 1. February 2012 Pharmaceutical Schedule Update, Pharmac. 2. Lantus Data Sheet, August 2010. 3. Goykham S, et al. Expert Opin. PharmacoTher 2009; 10(4):705-718. 4. Fulcher G, et al. AMJ 2010; 3(12):808-813. 5. Nathan D, et al. Diabetes Care, 2009; 32:193-203.

Lantus® is a Prescription Medicine that is part of the daily treatment of Type 1 & Type 2 diabetes mellitus. Do not use if allergic to insulin glargine or any of its ingredients.

Precautions: for subcutaneous (under the skin) injections only, do not mix or dilute. Close monitoring required during pregnancy, kidney or liver disease, intercurrent illness or stress. Tell your doctor if you are taking any other medicines, including those you can get from a pharmacy, supermarket or health food shop. Interactions with other medicine may increase or decrease blood glucose.

Side Effects: hyper or hypo glycaemia, injection site reactions, lipodystrophy (local disturbance of fat metabolism). Contains insulin glargine 100U/ml.

Use strictly as directed and if there is inadequate control or you have side effects see your doctor, diabetes nurse or educator. For further information please refer to the Lantus® Consumer Medicine Information on the Medsafe website (www.medsafe.govt.nz). Sanofi, Auckland, freephone 0800 283 684. Lantus® is fully reimbursed when prescribed by a medical practitioner. Pharmacy charges and doctors fees apply.

TAPS PP1903

GLA 12.02.001