Diabetes Spring 2013

Diabetes Spring 2013

Living well with diabetes

Going into bat

Sophie Devine’s diabetes journey LESSONS FROM THE WOMB ‘Early years’ diabetes research

What did Ancient Egypt know about diabetes?

DON’T RISK BLINDNESS

Dr Peter Hadden on retinopathy

Spring clean

your diabetes care

Grow tomatoes + entertaining recipes + 7-day fitness plan

Don’t brush it off – use Colgate

®

Did you know that people with diabetes may be more at risk of gum disease?

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Visit your dentist regularly and protect your gums with Colgate Total.

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Always read the label and use as directed. If symptoms persist see your Dental professional. Colgate-Palmolive Ltd., Lower Hutt. TAPSPP1101. * Fine, et al. (2006). Journal of the American Dental Association, 137: 1406-1413 CPL MW42186

Diabetes: the national magazine of Diabetes New Zealand | Vol 25 no 3 Spring 2013

INSIDE spring 2013 4 5

From the Chief Executive From the President

Families and children

30 Cure kids: the trip of a lifetime

30

Diabetes Youth

Upfront

6

31 The National Walk

News, views and research

The last word

Care and prevention

8

34 Bus poster campaign

Spring clean your diabetes care

Focus

10 Lessons from the womb: Is

26

diabetes risk predetermined?

Interview

12 Professor Rebecca Simmons Profile

Food

22 Entertaining recipes Let's get active

14 Sophie Devine

24 Green prescriptions 25 7-day exercise plan

Gardening

Research

16 Tantalising tomatoes Treatment

18 Retinopathy signs,

symptoms and treatment

Living with diabetes

20 World Diabetes Day duo

27 CareSens meter study Community

26 Advice on meter concerns 28 Diabetes in antiquity 32 Obituaries 33 Diabetes NZ Conference 2013

COVER PHOTO: MIKE LEWIS

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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Another diabetes landmark Government leaders at the 66th World Health Assembly in Geneva earlier this year unanimously adopted a resolution to prevent, and improve the treatment of patients with non-communicable diseases (NCDs), including diabetes. The resolution marks a milestone in the struggle to improve health outcomes for those with diabetes around the world. It also shows a civil society can move governments to introduce real change to meet the global health goals and challenges.

Part of the resolution is to introduce a global action plan and global monitoring framework. The action plan aims to reduce preventable deaths, illness and disability due to diabetes and other NCDs. Effectively, it moves the process from the political to the practical

– delivering something meaningful for those living with and at risk of diabetes.

The global monitoring framework has nine voluntary targets and 25 indicators, including an overarching goal to reduce NCD deaths by 25 per cent by 2025. All nine targets are important for diabetes, but three are major wins for the global diabetes community. They are: halt the rise in diabetes and obesity; ensure 80 per cent of patients have access to affordable basic technologies and essential medicines; and ensure 50 per cent of people at risk of heart disease and stroke (including people with diabetes) receive drug therapy and counselling.

There is no doubt the World Health Assembly has adopted an ambitious agenda for responding to diabetes and other NCDs. There will need to be determination, leadership and commitment to deliver these objectives at a national and global level. This is where Diabetes NZ plays a role, working with the

government, the Ministry of Health, health providers and others. We want to ensure the prevention and control of NCDs is seen as a priority and that action is accelerated and monitored to show we are making progress.

As a first step, New Zealand needs to identify and implement specific health goals that focus on halting the rise in diabetes and other NCDs. To this end, Diabetes NZ recently met with the Director General for Health to discuss the World Health Assembly resolution and next steps.

There is a long road ahead, but we are optimistic we can get there, and we stand ready to help meet these ambitious targets.

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 2013

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FROM TH E PRESIDE NT

Is type 1 diabetes a problem or an opportunity?

Certainly the question is provocative – some might even say completely unnecessary.

After all diabetes in any form is a problem and not something anyone in their right mind would ever choose. So how come many truly inspirational people I know also have type 1 diabetes? And is it a mere coincidence or is there a more causal relationship? I would wager on the latter.

I think of the youngsters who have type 1 and are stand-out successes in their fields of sport, academia, cultural activity or leadership. There are adults in the same category. All developed their diabetes young.

Some of them I know personally and many of them, I now realise, have the same things in common.

It helps that diabetes diagnosed young means good habits are developed that yield a healthier

work/life balance – like healthy eating and exercising regularly with a good amount of sleep.

Living well with diabetes demands discipline, and discipline is a powerful ingredient in success and achievement.

But the thing most common to them all is that those very close to them (usually parents or partner), no matter what, have urged them on, supported and helped them, affirming ‘they can do it.’

Unspoken is the belief that the world is their oyster regardless of diabetes.

They are not sick, disabled or somehow lessened; they do not have a limited or grim future. Instead they are believed in and perceived as a whole person rather than as ‘the diabetic kid’. Sure, diabetes is a factor in their lives but it is simply something to be dealt with in their quest for happiness and wellbeing.

If the youngster with diabetes sees they are accepted and loved for who they are, this in turn enhances their perception of themselves. Such an environment feeds their confidence and stokes their self esteem so that they can go out and realise their

dreams. If, on the other hand, they are surrounded by negative messages about the grimness of their life with diabetes, it is likely in turn that they will struggle.

I was interested to note what outstanding sportswoman Sophie Devine (see p 14) says about her diabetes. If anything, she claims, it has driven her to achieve greater things. She believes nothing should hold you back, you should give everything a go and have supportive people around you. For her diabetes is no barrier to success.

Diabetes cannot lessen a person when it provides an opportunity to enhance existing potential. And we all have attributes and potential.

Best wishes for realising them.

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 2013 | DIABETES

5

UP FRO NT

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NEWS, VIEWS AND RESEARCH

Promising new T1 vaccine

Artificial pancreas trial

An experimental vaccine that may reverse type 1 diabetes has shown promising results in a clinical trial involving 80 people. The TOL-302 vaccine is genetically engineered to switch off immune cells that attack and destroy insulin-producing cells in the pancreas. The research, published in Science Translational Medicine, shows some of the patients’ remaining beta cells were preserved, while markers of pancreatic function improved. Scientists from Leiden University in the Netherlands and Stanford University say they are excited by the results because they show it may be possible to shut down rogue immune cells without damaging the rest of the immune system.

Five people with type 1 diabetes in the UK have become the first to successfully use an ‘artificial pancreas’ in their own home. The closed loop device, created by researchers at the University of Cambridge, monitors blood glucose levels minute by minute and relays the information to an insulin pump, which delivers the correct amount of insulin into the bloodstream. It eliminates the need for daily insulin injections and means patients may no longer have to manually monitor their blood sugars.

Birth order and diabetes risk First-born children may be at higher risk of developing type 2 diabetes or higher blood pressure in later life, according to research conducted by the Liggins Institute at the University of Auckland and published in the Journal of Clinical Endocrinology and Metabolism.

The findings showed first-born children have greater difficulty absorbing sugars into the blood and higher daytime blood pressure than children who have older siblings.

The study of 85 healthy children, between four and 11 years, was the first to document a 21 per cent drop in insulin effectiveness among first-born children, said research leader Prof Wayne Cutfield.

Diabetes UK, which is funding the research, says the trial is a landmark in diabetes research and could ‘within years’ be offered as a routine treatment.

Research director Dr Alasdair Rankin said: “As the technology progresses, we expect to make type 1 diabetes an increasingly manageable condition.”

Fasting may prevent T2 Intermittent fasting may be as effective as bariatric surgery for treating obesity and lowering the risk of developing type 2 diabetes, say researchers in the British Journal of Diabetes and Vascular Disease. They believe fasting (restricting calorie intake) every other day, or for two days a week, will result in weight loss and is an easier diet to stick to than a general calorie-limiting diet.

“We think people who are pre-diabetic, or at risk of getting diabetes or heart disease, would benefit from this diet,” says Dr James Brown, of Aston University, which is now planning a clinical trial to investigate the impact of fasting on type 2 diabetes.

Low HbA1c cuts complications

Diabetes breathalyser test

Good diabetes control dramatically cuts the risk of patients developing long-term complications, according to a 30-year trial. The Diabetes Control and Complications Trial started in the UK in 1982 to investigate whether achieving good blood glucose control would reduce complications in type 1 diabetes.

Patients from the original trial continued to be monitored and in 2013 they have been reviewed again.

Researchers found that patients who maintained lower HbA1c readings of 53 mmol/mol or below had significantly lower risk of kidney damage, retinopathy, heart disease and stroke.

Chemists at the University of Pittsburgh are working on a non-invasive, inexpensive method of diagnosing and monitoring diabetes using breath analysis alone.

They have demonstrated a sensor technology that could in the future replace the need for blood glucose tests. The idea was inspired by breath acetone – the characteristic ‘fruity’ odour that increases significantly with high glucose levels. The Pitt team is interested in this biomarker as a possible diagnostic tool. It is currently working on a prototype of the sensor, dubbed ‘titanium oxide on a stick’, which it plans to test on human breath samples.

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DIABETES | Spring 2013

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Please note CGM consumables are not currently funded.

Always read the manufacturer’s instructions and use strictly as directed. NZMS, Auckland. TAPS NA6067

C ARE A N D PRE VE NTI O N

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REVIEW YO UR DI A BETES M A NAG EM ENT

Spring clean your diabetes care Spring is a good time to review your diabetes care and take steps to improve any areas you feel are lacking, says nurse specialist Kate Smallman, of Diabetes Projects Trust.

It’s a good idea to review your diabetes care at least once a year to make sure you are on track and in control. It can sometimes be a bit daunting to ask yourself the hard questions about your diabetes, so here are some simple ideas to get you started this spring.

Diabetes spring clean checklist Do you know if your diabetes is under control?

No Yes

Are you happy with your diabetes care and general health?

No

Yes

Have you checked all your equipment is in date?

No

Yes

Have you thought about how you look after your diabetes?

No

Yes

Have you had an annual check-up in the past 12 months?

No

Yes

If you answered no to one or more questions, it’s time for a diabetes spring clean!

Check your insulin pen

Check your insulin pen – give P it a clean with a damp cloth.

book about diabetes? Read up on your type of diabetes.

Look at websites and ask your P diabetes team for trusted sources of information.

Clean your meter

P

Do you have a CareSens meter?

Give it a good clean – use a damp cloth – and wash the case.

Check expiry dates for strips P – throw away all out of date strips.

P

Finger pickers – when did you last change the lancet? Wash the device.

What do you do with the P

results of your blood tests?

Get a record book.

exercise a day?

Meet up with a friend and P

Check all medication for P

Keep a diary.

P

expiry dates- take dated medication back to the pharmacy.

When did you last read a P

Do you do 30 minutes of P

Wash the wallet that you keep P your pen in.

Knowledge is power

Review your physical activity

Get a new sharps bin from the P pharmacy.

Review your diet

Consider whether your diet P is healthy – do you need to change anything?

Do you want to try and lose P weight – how might you do this?

Clean out your fridge and P

pantry for old out-of-date food.

exercise together.

Talk about your diabetes To your family.

P Friends.

P Work mates.

P

Book your annual check up Get tested – HbA1c, P

cholesterol, renal function.

Eye screening every two years.

P Foot check.

P Mental stress – talk about it.

P Make a list of anything else you P want to talk about.

How are you doing?

If you have diabetes, you should be aiming for: • HbA1c – 50-55 mmol/l – or as individually agreed with your doctor • Blood pressure – 130/80 or less • Total cholesterol – less than 4.0 mmol/l If you are not meeting your goals, have a chat with your diabetes team.

They will be able to help.

Expert speakers, educational workshops and more at Diabetes NZ’s Conference, see p33.

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DIABETES | Spring 2013

Dexcom G4TM Platinum - The Latest Technology in Continuous Glucose Measurement Now Available in New Zealand Do you use insulin? Do you want to improve your glucose control?

The Dexcom G4TM updates your glucose level every 5 minutes so you can track your glucose continuously day and night. Monitor your highs, lows and target ranges and how fast you are getting there to help you take the guesswork out of your diabetes management and enable better treatment decisions.

• Fully waterproof sensor and transmitter • Full colour screen makes it easier to read • Sensors approved for up to 7 days continuous use • Exceptional accuracy1,2 • Simple calibration rules • Discrete transmitter beams results wirelessly to your receiver up to 6 metres away1 • 24/7 support provided by our NZ team

For more information or to arrange a trial to see the benefits for yourself, please contact us on 0508 634 103 W www.nzms.co.nz P 09 259 4062 E nzms@nzms.co.nz Dexcom G4TM Platinum is not indicated for children under 2 years of age. Always read the manufacturer’s instructions and use strictly as directed.

1 Dexcom G4™ User Guide, May 2012. LBL-011277 Rev 04, LBL-011346 Rev 02. 2 Freckmann G, Baumstark A, Jendrike N, Zschornack E, Kocher S, Tshiananga J, Heister F, Haug C. System Accuracy Evaluation of 27 Blood Glucose Monitoring Systems According to DIN EN ISO 15197. Diab Tech & Thera, Vol 12, No 3, 2010.

FO CU S

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CH ILD 'S EARLY YEARS KEY TO G O O D H EA LTH

Lessons from the womb Some of the world’s most exciting diabetes research is taking place right here in New Zealand.

Aimee Brock, of the Gravida National Centre for Growth and Development, explains why scientists increasingly believe the early years of a child’s life are critical to good health.

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DIABETES | Spring 2013

CH I LD' S EA RLY YEA RS KEY TO G O O D H EA LTH

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FOCUS

I

S LIFELONG HEALTH preprogrammed in the womb or even before conception? Increasingly scientists believe this crucial period is the key to understanding, treating and preventing conditions like type 2 diabetes and obesity.

Globally it is becoming accepted that environmental factors, such as diet, obesity and smoking, contribute to this critical in-utero and early years’ time period.

Gravida’s researchers look at things that contribute to a healthy pregnancy, and healthy babies and children. These include environmental and biomedical factors that may influence good health as a child grows – or conversely increase the risk of ill health in later life.

As diabetes, heart disease and obesity continue to rise in New Zealand and overseas, more emphasis is being placed on research in this ‘early years’ window to try to find out how to prevent disease before genetics are ‘influenced’ or ‘programmed’.

Our scientists are searching for preventative measures we can take in these early days to stop our children suffering ill health in adulthood, as well as effective treatments for diseases such as type 1 and type 2 diabetes.

We are also focusing on how to treat pregnancy and birth complications, such as pre-eclampsia, inter-uterine growth restriction, premature birth and brain injury to ensure the best lifelong outcome for a baby. Our researchers are also looking at the importance of nutrition and lifestyle advice in a child’s formative years to prevent ill health and metabolic conditions, such as diabetes, in adulthood.

One of the most important aspects of our researchers’ work is translating our findings into practical new guidelines and improvements in clinical practice. For example in

October 2012 Gravida’s Prof Paul Hofman, from the Liggins Institute, published a major piece of work in the international journal Diabetes showing adults who are born prematurely, and their children, have an increased risk of diabetes and other diseases.

Prof Hofman advises clinicians and GPs to keep a close watch on any adult patients who were born prematurely, and their children, and this advice has now become routine practice. Quietly behind the scenes, our researchers are trying to find ways to prevent and pre-empt type 2 diabetes, treat and care for New Zealand families.

What is Gravida?

Gravida is a government-funded Centre of Research Excellence (CoRE) that brings together leading biomedical, clinical and animal scientists from across New Zealand and around the world. Based at the University of Auckland, Gravida’s researchers seek to reveal how conditions encountered in early life affect the way an individual grows and develops throughout life.

They support the application of their findings in the clinical, public policy and education sectors to help bring economic and social benefits to all New Zealanders.

Current Gravida research Studies being carried out by Gravida researchers include: •

A study looking at how early life nutrition can ‘pre-programme’ obesity, type 2 diabetes and heart disease (Prof Mark Vickers, University of Auckland).

•

A community action project in Auckland Counties Manukau studying how the use of probiotics and nutrition advice in pregnant obese women might result in better outcomes and reduce gestational diabetes (Prof Lesley McCowan, University of Auckland).

•

Whether increasing protein intake at birth can help extremely low birth weight babies avoid metabolic disease like diabetes later in life (Prof Frank Bloomfield, University of Auckland).

•

The impact of ‘oxidative stress’ (lack of oxygen in the placenta) during pregnancy and how it may affect embryonic growth, altering gene pathways, and leading to metabolic or other disease (Prof Mark Hampton, University of Otago).

•

Whether nutritional ecology modelling (looking at several generations of diets/energy intakes) can prove relationships between the level of human protein consumption, obesity and other metabolic syndromes (Prof David Raubenheimer, Massey University).

•

How to encourage ‘behaviour change’ in children about nutrition (through specific teaching courses) with a view to reducing future obesity and diabetes (LENScience programme, University of Auckland Liggins).

*New Zealand’s diabetes research is world class. See p12

Spring 2013 | DIABETES

11

INTERV I EW

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PROFESSOR REBECCA SI M M O NS

New Zealand’s ‘early years’ research is world class Top US diabetes expert and awardwinning researcher Professor Rebecca Simmons believes Kiwi scientists are world-class. She explains why her work and that of her NZ counterparts could lead to a breakthrough in treating diabetes and obesity. Caroline Wood reports.

“You should be very proud of the science that is going on in New Zealand,” says Professor Rebecca Simmons. “The quality of diabetes research in the area of developmental programming is really outstanding. I think there has been a long tradition of excellence in biomedical research in New Zealand.”

Professor Simmons is a leading US expert in ‘early programming’ – the causal links between an infant’s early life in the womb and diabetes and obesity in later life.

An award-winning researcher, she is also Professor of Pediatrics and Obstetrics and Gynecology at the Perelman School of Medicine, University of Pennsylvania. Prof Simmons is also an ad hoc reviewer for multiple granting agencies including the Wellcome Trust, the Medical Research Council, New Zealand Foundation for Research Science and Technology, and

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DIABETES | Spring 2013

the Canadian Institute of Health Research.

She regularly visits New Zealand to advise the government on research grant applications and is one of the independent experts on the Gravida National Centre for Growth and Development’s Scientific Advisory Board. I caught up with her during a whistle-stop visit to New Zealand, where she met with some of Gravida’s scientists to advise on their research, as well as meeting with government scientific officials.

Talking about her area of research, Prof Simmons explains that she is interested in finding ways to prevent the development of type 2 diabetes in later life by making interventions very early in life.

Factors that impact on an individual’s risk of developing type 2 diabetes include low birth weight, big babies, obesity in mothers, nutrition in pregnancy and nutrition in the early years of a child’s life.

“It’s too late when you have diabetes, we want to prevent the development of diabetes. We’re trying to

understand the basic mechanisms that lead to diabetes and how interventions may prevent it,” Prof Simmons explains.

“We’re trying to understand the effect of too much, or too little, nutrition in utero or very early in life, so we can intervene to prevent ill health. We need to know when and how to do that.

“New Zealand has some leading proponents – Peter Gluckman and Mark Vickers are at the forefront of this kind of research.

Her advice is simple. Most mums get it right, she says: eat well in pregnancy, don’t over eat, have a healthy balanced diet and don’t smoke. Feed kids well and don’t let them get overweight.

“We have known for many years about the impact of the mother’s nutrition but perhaps not told the world enough. Children who are overweight have a higher risk of developing diabetes and heart disease in later life. It’s important to make sure your children are not overweight.”

Make sure it’s there when you need it*

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HypoHelp also features a handy expiry date Reminder Service for your GlucaGen® HypoKit. To register please enter barcode number 000276 to login and when requested.

*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.

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NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS (DA):5913RB McK32349/Diabetes NZ

P RO FI LE

k S O PHIE D EVINE

First class innings Sophie Devine is a rare sporting talent – she has represented her country in two different sports. As the 24-year-old says on her website ‘I have played hockey and cricket since I was four and have jumped between the two sports ever since’. Sophie has played for the Black Sticks and is recognised as being one of the best all rounders on the White Ferns cricket side. She recently accepted a 12-month contract to become a full-time cricket professional – training, playing, coaching and promoting women’s cricket. Sophie was diagnosed with type 1 diabetes at 15 and is an ambassador for Diabetes Youth NZ. She explains how she manages to keep on top of her diabetes while playing sport professionally.

PHOTO: MIKE LEWIS

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DIABETES | Spring 2013

S O PH I E DEVI NE

Sport has always been a major part of my life. From the tender age of four I can remember going to the local hockey club every Saturday morning and chasing a small ball around the pitch. Come summer it was a cricket bat instead of a hockey stick – with hours spent on my family’s homemade cricket pitch in the front yard. Like most Kiwi kids I wanted to try every sport possible and was encouraged by my parents to give everything a go. Cricket and hockey seemed to stick and it is these two sports that I remain very much involved with now.

I was diagnosed with type 1 diabetes in 2005 and I thought my sporting career was over before it ever really began. With a national under-21 tournament just a few weeks away, my main concern was whether I would be able to play – not what sort of insulin regime I would be on.

But it’s amazing what can happen in the space of 24 hours. I was in Wellington Hospital straight after being diagnosed at my local GP surgery. Over the next 12 hours I was taught almost everything I needed to know about diabetes.

The team of doctors and nurses who worked with me at Wellington Hospital continued to support me long after I left the hospital room – I thought that was fantastic!

I am both honoured and privileged to have represented my country in two sports and have had so many amazing experiences that I will always hold close to my heart. It’s not very often you get to go to places like India, Sri Lanka and the West Indies. Jumping time zones, upset sleep patterns and having no clue whether you should be eating breakfast or dinner can make things tricky, and requires smart planning when it comes to managing diabetes.

Whenever I travel long haul I make sure to pack a few essentials. I have plenty of snacks – a cup of noodles,

muesli bars and dry fruit are really handy snacks that store well and can fill me up. My medication always stays with me and I am sure to pack two to three times more insulin, testing strips and needles than I would normally need, just in case something should happen while I’m overseas. Also, a letter from my doctor confirming my diabetes is really helpful for getting through customs. I’ve had some pretty confused looking customs officers trying to figure out what my insulin was!

I’ve had to play around with what foods I am eating, what times I am eating them and how they impact on my blood glucose levels. What works for me can be different to what works for another person with diabetes but I believe it is all about trial and error when it comes to food.

Although playing sport for my country is great fun and provides me with awesome opportunities, there is a lot of hard work, time and commitment that takes place behind closed doors. Training is a major part of any athlete’s life, whether it’s on the pitch, in the gym or getting outside. Equally crucial is making sure your body has sufficient fuel to push you through the long hours

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PROFILE

of training. I’ve had to play around with what foods I am eating, what times I am eating them and how they impact on my blood glucose levels. What works for me can be different to what works for another person with diabetes but I believe it is all about trial and error when it comes to food. For me bananas are perfect! They provide me with a quick boost of energy, as well as giving me a bit of substance. I’m not a big fan of sports drinks as they really spike my sugar levels but a couple of jelly beans never go amiss!

Having good support is crucial for anyone, but I believe even more important for those with diabetes.

With all the travel, training and competing I do, having people around me who know how I operate and are aware of my diabetes can take a lot of pressure off my shoulders. I make sure everyone (team physio, management or my team mates) is on the lookout for any cues that I may be having a hypo. Equally significant is the fact that I feel comfortable injecting and checking my blood glucose levels around the team. I realised the team was confident when they wanted to do my injections for me! I’m really lucky to have a great support network of people that care about my health and wellbeing first. It’s not just family and friends but the support of organisations such as Novo Nordisk and Diabetes Youth New Zealand. These two organisations have given me the platform to bring greater awareness to society about type 1 diabetes and I am sincerely grateful for their ongoing encouragement and support.

Sophie is an ambassador for Diabetes Youth New Zealand. If you would like to have Sophie speak at your next event email contact@diabetesyouth.org.nz

Spring 2013 | DIABETES

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GARD EN I N G

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HERE COMES SUMMER

Tantalising tomatoes Tomatoes are one of the most rewarding summer crops.

Once you’ve grown your own tomatoes, you’ll appreciate the sublime taste and texture of a freshly picked fruit, writes Rachel Knight.

Tomatoes allowed to ripen on the vine and stored without chilling retain a scent and flavour all of their own. The home gardener’s varieties are selected for their eating qualities, rather than uniformity and yield. You’ll also find they’ll be thin skinned, as they don’t have to withstand transport and storage. The diversity of shape, colour and size is truly tempting. From tiny yellow pears to giant black beefsteaks. If you can’t decide which to chooose and grow too many tomato plants, you can preserve the surplus for winter in sauces and soups to enjoy the taste all year round.

Tomatoes are a tender crop, originally from South America.

They’ll need a warm, sunny and sheltered spot to thrive. They grow poorly below 10°C so in cooler parts of the country they will benefit from protection in a tunnel house. You’ll get the biggest choice of tomatoes by growing from seed and if you raise more plants than you need you can swap, sell or donate your extra seedlings to help others share the tomato experience. Start seeds inside in pots to get them to germinate well.

Otherwise choose strong, healthy plants from the garden centre. Don’t buy anything with yellowing leaves, roots hanging out of the bottom of the pot or looking long and lanky from lack of light. If it’s too cold to put the seedlings outside, move them to bigger pots for a while, topped up with good potting mix and keep them somewhere bright indoors until it warms up.

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DIABETES | Spring 2013

Recommended varieties Cherry – Sweet 100 (red), Sungold (orange), White Cherry (very pale yellow).

Large coloured – Green Zebra (green striped), Jaune Flamme (orange), Black from Tula (mahogany red).

For container – Minibelle for Pots (red cherry), Container Choice (red beefsteak).

Tomatoes grow tall so put in good support for them when you plant them out. Dig a big hole and put in plenty of compost to feed and keep them moist through summer.

I support my tomatoes on thick string, tied to a support of bamboo canes. When they first go out I put a ‘bottomless flowerpot’ over them to keep out the wind and birds.

The plants won’t need much watering and feeding until they start to form fruit. They say that limiting water and feed makes for a tastier tomato, even if you get a smaller crop. When they start to fruit I water weekly with a weak seaweed or worm farm ‘tea’. Dad reckoned that misting with seaweed tea also kept blight away – just do it when the sun’s not out.

Pinch out side shoots to keep the plants open and support the central stem as it grows. Daily tomato picking is a real pleasure and a couple of plants will keep you well supplied during the summer. Tiny tomatoes take time to harvest but you can store some of them in your tummy to sustain you while you pick. Enjoy your crop fresh, give them away to friends and family or preserve them for winter. Tomato growing is a healthy passion to enjoy and share.

*Rachel runs gardening courses from her Wellington home. She can be contacted via her website: www.thekitchengarden.co.nz

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TREATM ENT

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D IABETIC RETINOPATHY

Don’t risk losing your sight to diabetes Diabetes can result in damage to the blood vessels in your retina. Specialist eye surgeon Dr Peter Hadden explains diabetic retinopathy and looks at the latest treatment options.

Diabetic retinopathy occurs when the blood vessels in your retina (the focusing surface at the back of your eye) are damaged due to high blood sugar levels. In its later stages, diabetic retinopathy can seriously affect your sight, and may even cause blindness.

If you’ve been diagnosed with diabetes, you’re at risk of developing diabetic retinopathy, and you should take action immediately to prevent it.

Detecting diabetic retinopathy Your optometrist or ophthalmologist can tell you if you have diabetic retinopathy by using a special camera to take a photograph of the back of your eye. You should have this test as soon as you’re diagnosed with diabetes, and at least every two years after that.

Causes of diabetic retinopathy High blood sugar levels can cause damage to the blood vessels in your retina. These blood vessels can leak fluid or bleed, which causes the retina to swell with deposition of hard deposits, resulting in blurred vision.

People with diabetes are at most risk from retinopathy, and the longer you have diabetes, the higher the risk.

High blood pressure, smoking and pregnancy can also increase your risk of developing diabetic retinopathy.

Preventing diabetic retinopathy The best way to prevent diabetic retinopathy is to keep your blood sugar and blood pressure under control. Maintaining a healthy diet and exercising regularly are essential, as is following any specific instructions your doctor gives you.

Treatment for diabetic retinopathy Treating diabetic retinopathy early can yield fantastic results, with as many as 95 per cent of patients

Dr Peter Hadden examines a patient

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DIABETES | Spring 2013

DI A BETI C RETI NO PATHY

avoiding substantial vision loss if they are treated in time. However, it is a case of treating it before it becomes a problem rather than after problems develop.

That’s why it’s so important to have regular eye exams to check for diabetic retinopathy.

Laser treatment Patients who have reached the proliferative retinopathy stage – where abnormal blood vessels grow on the retina – can be treated with a procedure called laser photocoagulation. A laser is used to seal off leaking blood vessels and prevent further growth of blood vessels that lead to loss of vision.

Medication Two drugs called Lucentis and Avastin have shown promising results in trials, and may be able to stop and even reverse vision loss in patients with early stages of diabetic retinopathy.

Retinopathy symptoms In its early stages, diabetic retinopathy may not affect your vision, and you may not even be aware that you have it.

But this is when early treatment is most effective and can prevent vision loss. So even if you don’t have any symptoms, it’s important to have regular check-ups from an eye health professional if you suffer from diabetes.

When diabetic retinopathy starts to affect your vision, you may notice you have difficulty with reading and close-up work. Floaters in your vision, and double vision, may also be symptoms of diabetic retinopathy, although they can have other causes too. In some severe cases, diabetic retinopathy may also lead to glaucoma.

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TREATMENT

Vitrectomy If you have blurred vision because of a retinal detachment or vitreous haemorrhage – where blood leaks into the ‘gel’ that fills the eye – you may need vitrectomy surgery, which usually results in a good improvement in vision. As with all diabetic eye disease, the earlier these problems are caught and treated the better the results.

Cataract and glaucoma treatment Sometimes diabetic retinopathy and its treatment can also cause cataract or glaucoma, in which case you may need a cataract operation or glaucoma treatment as well.

Dr Peter Hadden is a Clinical Senior Lecturer in Ophthalmology (University of Auckland), a Consultant Ophthalmologist at Auckland District Health Board, and an examiner for the Royal Australian and New Zealand College of Ophthalmologists.

He is a specialist cataract and retinal eye surgeon and also has a private practice in Auckland. For more details go to www.eyeinstitute.co.nz.

Retinopathy stages Diabetic retinopathy has a number of stages:

Non-proliferative The early or ‘non-proliferative’ stages are characterised by damage to the blood vessels in the retina, but vision tends not to be affected.

Proliferative Once the disease reaches the more advanced ‘proliferative’ stage, abnormal and fragile blood vessels begin to grow on the retina; these vessels can bleed and also cause retinal detachment and blurred vision, requiring laser and vitrectomy surgery.

Macular oedema In this stage, abnormal blood vessels leak fluid into the macula – the centre of the retina – causing blurred vision.

Spring 2013 | DIABETES

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LIV ING W ITH D I A B E TE S

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WORLD DI A BETES DAY DUO

A tale of two toddlers

OGRAPHY IONS PHOT LUSIONS) DER ILLUS M/IL FFANY WIN (FACEBOOK.CO CREDIT: TI

Addison McEwan and Jaylen-Blaze Daane have never met but both were diagnosed with diabetes in the same month last year, when they were just two years old. They also share a very special birthday – November 14 – World Diabetes Day. Caroline Wood finds out more.

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DIABETES | Spring 2013

WORLD DI A BETES DAY DUO

J

Toni says it has been a tough road since Jaylen-Blaze was first diagnosed last June.

Jaylen-Blaze, from Invercargill, and Addison McEwan, from Auckland, share a very special birthday – November 14, which also happens to be World Diabetes Day. And the coincidences don’t end there. They were both diagnosed with type 1 diabetes in the same month, of the same year, at the same age.

“We thought he had glandular fever, he was very tired and started wetting the bed even though he was potty trained. We took him to the GP and they did a urine test.

The nurse asked me if it was mine because the reading was so high.

Then they did a fingerprick test. My family has type 2 diabetes so I knew the numbers were too high, I knew what they were going to tell me.

The pair, now aged three, have never met and live at opposite ends of the country. Their mums made contact online after Addison’s granny met diabetes campaigner Sandra Grant, who realised the two youngsters were the same age when they were diagnosed and put them in touch via Facebook.

“I was in shock for two days. I was very strong and I didn’t cry, but one day I was sleep-deprived and exhausted and I cried and cried, I realised it was forever. Then I got angry. I’d done everything right, I’d eaten really healthily while I was pregnant, I breastfed him for a long time and then this happens.

AYLEN-BLAZE AND ADDISON are typical preschoolers – gorgeous little bombs of energy, full of life and, as one of their mums says, ‘pretty cool’.

Toni Daane still can’t believe the coincidences that have brought her family and the McEwans together.

“We realised they were diagnosed in the same month, the same year and both were born on World Diabetes Day. That’s really massive. So on Jaylen-Blaze’s birthday we had a little party and the kids dressed up in blue to acknowledge that World Diabetes Day is a special day for us.

“I can’t wait to meet Addison and Melisa, we are planning to go to Auckland at Christmas and hope to meet up there.”

World Diabetes Day is the biggest global awareness diabetes campaign in the world and is held on November 14 each year. It was introduced in 1991 in response to the alarming rise of diabetes around the world.

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“But one year on and everything is really good. Jaylen-Blaze has awesome numbers and in April he started on an insulin pump. It’s made a big difference, it can make the corrections and it’s a lot less tiring for us.

“We’ve just celebrated our one year diabetes anniversary in June and we bought him a present, we celebrated the fact that we have got a really strong son. We’re going to do it every year, we are not celebrating diabetes but the fact that our son is pretty cool!”

World Diabetes Day features a new theme chosen by the International Diabetes Federation each year to address issues facing the global diabetes community.

While the campaign lasts the whole year, the day itself marks the birthday of Frederick Banting who, along with Charles Best, first conceived the idea that led to the discovery of insulin in 1922.

This year’s theme is diabetes education and prevention and the International Diabetes Federation is asking people

LI V I NG WITH DI ABE TES Melisa McEwan can’t wait for daughter Addison to start her pump later this year – the same model as Jaylen-Blaze’s – of course! She remembers finding out a week before Addison’s birthday (and five months after she was diagnosed) that she was born on World Diabetes Day. At the time it seemed a cruel coincidence, she says.

The family marked November 14 by asking friends and family to wear blue and Melisa made a poster for her desk with Addison on it to raise awareness of diabetes. She plans to do the same this year.

“I thought it was unbelievable that Addison was born on World Diabetes Day and then to find out someone else was in the same boat, it was a real surprise. We are going to meet them at Christmas, their tickets are booked. I’m looking forward to it, there are only 23 preschoolers with diabetes in Auckland and even fewer in Invercargill, so it’s good to have the support.”

Melisa and Toni communicate on Facebook and hope Addison and Jaylen-Blaze will become friends as they get older. “Who knows what the future holds,” says Melisa, “it’s up to us to encourage them to be friends and make the effort to stay in touch.” to show the world how they are taking a step for diabetes – to raise awareness and promote prevention.

The campaign’s goal is to reach 317 million steps, in support of the number of people with diabetes. You can take part in World Diabetes Day by organising a special event, lighting a prominent building blue or joining the Take a Step campaign.

For more details see www.idf.org/worlddiabetesday/activities.

Spring 2013 | DIABETES

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FO O D

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E NTERTAINING RECIPES

At my table: Recipes from 60 celebrated chefs At my Table is a special occasion recipe book for those with diabetes, their families and friends. It contains a collection of sophisticated recipes from 60 famous Australasian chefs, such as Maggie Beer’s Haloumi and Citrus Lentils and Stephanie Alexander’s Mushroom Soup with Porcini. Kiwi chefs Jacob Brown and David Pugh also have recipes featured.

Beautifully illustrated with over 50 colour photographs, At my Table is edited by Amanda Bilson, wife of renowned Australian chef Tony Bilson, who has had type 1 diabetes for 45 years, and Janni Kyritsis, who has type 2 diabetes. Each recipe was reviewed by a senior dietitian from the Diabetes Centre at St Vincent’s Hospital, Sydney, and includes nutritional information. Each purchase will help raise funds for patients and their families attending the hospital’s diabetes centre.

LUCA BRASI SLEEPS WITH THE FISHES This recipe by Aaron Harvie was inspired by a famous line from Francis Ford Coppola’s 1972 movie The Godfather ‘Luca Brasi sleeps with the fishes’. This is Aaron’s take on the classic Italian-American cioppino (seafood stew). Aaron was an Australian Masterchef finalist in 2010 and went on to host his own cooking show and develop a line of food products.

4 cups (1 litre/35 fl oz) fish stock (homemade or salt-reduced storebought stock) 12 raw prawns (shrimp), peeled and deveined, heads and shells cleaned and reserved 12 mussels, scrubbed and debearded 12 clams (vongole), scrubbed 12 × 20 g (¾ oz) pieces snapper fillet TOMATO BASE 1 tbsp olive oil, plus extra for drizzling 2 garlic cloves, roughly chopped ½ onion, roughly chopped 2 carrots, roughly chopped ½ green capsicum (pepper), roughly chopped

For tomato base, heat a heavy-based saucepan over medium heat, add olive oil and vegetables and sauté till soft.

Add basil, oregano, parsley, pepper, chilli powder, white wine, Tabasco, vinegar and worcestershire sauce and cook until liquid has reduced by half. Finally add tomatoes.

Cover, and simmer over low heat for 45 minutes, stirring every 10 minutes, until reduced and thick. Cool in fridge, then blend until puréed.

Strain, pressing pulp through sieve, and reserve.

For homemade or store-bought fish stock, heat till almost boiling, reduce to a simmer, add prawn heads and shells. Infuse for 20 minutes. Strain into large saucepan and mix in tomato base.

1 celery stalk and some leaves, roughly chopped

Bring soup to the boil, reduce heat a little and add mussels, clams and fish. After 4 minutes add prawns, cooking until mussels and clams open.

1 tbsp chopped basil

Discard any that do not. Season to taste.

1 tsp chopped oregano

Divide seafood between serving bowls so everyone gets two pieces of everything and ladle soup over. Garnish with some parsley and a drizzle of olive oil.

2 tbsp chopped flat-leaf (Italian) parsley, reserve some to garnish freshly ground pepper 1 tsp chipotle chilli powder (or normal chilli powder) 2 tbsp white wine 1 tsp Tabasco sauce 1 tbsp red wine vinegar 1 tbsp worcestershire sauce 3 × 400 g (14 oz) tins chopped tomatoes Serves 6

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DIABETES | Spring 2013

NIP Includes drizzled olive oil when served Energy 1036 kJ (248 Cal) Total fat 10g Saturated fat 2g Carbohydrate 13g

ENTERTA I NI NG RECI PES

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FOOD

DARK CHOCOLATE MOUSSE WITH ORANGE Janni Kyritsis, co-author of At My Table, offers this delicious light and simple chocolate mousse recipe. Janni was diagnosed with type 2 diabetes four years ago and considers it a wake up call that allowed him to improve his health. Janni learned his culinary skills with Stephanie Alexander in Melbourne, going on to cook at the Sydney Opera House before opening MG Garage, which earned Three Chef Hats.

125 g (4½ oz) dark chocolate (70 per cent cocoa solids), broken into pieces finely grated zest of 1 orange 2 tbsp orange juice 4 extra large eggs (67 g/2½ oz each), at room temperature, separated Serves 6

NOTE: For a rich chocolate mousse, you can add 1 cup (250 ml/9 fl oz) whipped cream. Instead of the orange flavour, you can try adding 1 tablespoon water plus 1 tablespoon coffee, rum, orange liqueur, brandy, Poire William, or spices such as cinnamon or chilli.

NIP

Combine chocolate pieces and orange zest and juice in a heatproof bowl. Place bowl on top of a saucepan of simmering water and turn off heat. Let chocolate melt undisturbed for about 10 minutes.

Energy 673 kJ (161 Cal) Total fat 9g Saturated fat 5g Carbohydrate 14g

Whisk egg whites to very soft peaks.

In a separate bowl, whisk egg yolks for a moment and fold them into chocolate and orange mixture. Fold egg whites into mixture and stop folding as soon as egg white is incorporated. Place in six glasses or cups and refrigerate until cold, about a couple of hours.

The carbohydrate content remains modest because, of all the chocolates, dark chocolate contains the least sugar.

DIETITIAN TIP

Extracted from At My Table: Delicious recipes from 60 celebrated chefs for people with diabetes.

Published by Allen & Unwin. RRP $49.99.

Spring 2013 | DIABETES

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LE T ’S G E T A CTI VE

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D OCTOR ’ S ORD ERS

Green prescriptions go global The number of green prescriptions issued to patients in New Zealand is set to double over the next four years. Caroline Wood looks at how the homegrown Kiwi health initiative is inspiring Canadian doctors to follow suit.

he needed to start exercising. And he’s very happy with the results – his diabetes is now under control, he’s lost over five kilograms and got his mobility back.

A year ago things were getting a bit difficult for 72-year-old Brian Kelly from the West Coast. He had type 2 diabetes, needed to lose a little weight and was struggling with his mobility.

Anyone can ask their doctor for a green prescription – written advice to support patients to have a more active and healthier lifestyle. The ‘prescription’ is forwarded to a provider, often a regional sports trust, which encourages the patient to become more active through phone calls, face-to-face meetings or support groups and provides information on local activities, such as aqua aerobics and walking groups.

Brian said the green prescription from his doctor was the motivation

More than 250,000 green prescriptions have been issued to

New Zealanders by their GP or practice nurses since the scheme was launched in 1998, according to the government. Last year a record 36,000 adults were issued a green prescription and that figure is set to double over the next four years, with the Minister of Health Tony Ryall announcing extra funding for the scheme in the 2013 budget.

Now the initiative is going global with Canadian doctors writing green prescriptions for their patients – inspired by the results seen in New Zealand.

“Canadian doctors have been prescribing exercise to patients at risk for obesity and chronic diseases such as diabetes for the past year and are starting to see the same positive results we see in New Zealand,” said Mr Ryall.

CBC News reported this month that Canadian doctors are now writing prescriptions for exercise to patients as a means to prevent and treat a host of illnesses.

Dr Justin Balko, a Canadian GP and president of the Leduc Beaumont Devon Primary Care Network said he was inspired by the New Zealand experience. Research has shown that green prescriptions can increase physical activity in adults by 10 per cent.

“There is a sense of tangibility and authoritativeness to a prescription.

People understand what a prescription is. They know it's not just a good idea. It's a health expert telling them that they want to do this for their own health,” said Dr Balko.

Green prescriptions set to double in New Zealand

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DIABETES | Spring 2013

You can ask your doctor or diabetes nurse for a green prescription, which is available to adults and also to children and families. For more information see www.health.govt.nz.

7- DAY EXERCI S E PL A N

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LE T ’ S GE T ACTIVE

Seven days to a new you It can be hard to get started on an exercise programme.

If you are new to exercise, or haven’t been active for a while, try this oneweek exercise plan developed by personal trainer Malcolm Tester. As you get fitter you can build on this foundation.

Remember it’s all based on your own ability, so go at your own pace. I don’t want this to be too hard for you – you shouldn’t be so sore you can’t move the next day. It’s all about getting out there and getting moving.

After building a foundation for your exercise journey you can look at introducing some body weight circuits that can be done at home in the lounge or down at a park. This will be a great way to put some variation into your training and a good way to see improvements and start to build muscle mass.

Always remember to get checked out by your doctor or diabetes nurse before you start training.

Don’t be worried about asking for help and add in variety. Mix up your routine, walk different streets, get out there and have fun and try different forms of exercising. * Malcolm Tester is a personal trainer at the Results Room gym in Wellington.

MONDAY

Move day Ok it’s go time. Put on those shoes and head out for a 15-minute walk. Start with five minutes at a slower pace to warm up and then pick up the pace for the next 10 minutes. Spend another couple of minutes at a slower pace to cool down.

TUESDAY

Rest day WEDNESDAY

Intense day Still nothing to worry about. We are out walking again but this time we’re going for longer. Still start with a five-minute warm up. Walk at your fast pace for one minute then slow it down and walk at a slow pace for one minute.

Repeat this six times.

THURSDAY

Rest day FRIDAY

Fun day Find a friend and do something active together. Some ideas to try: - go for a bike ride or swim - go bowling, play tennis or head down to the park and kick a ball around.

- try a fitness class together.

Make sure whatever you do is fun and enjoyable.

The aim is just to be active.

SATURDAY

Get out there day Time to get walking again. Follow Monday’s plan but aim to pick up the pace for an extra couple of minutes.

SUNDAY

Rest day

Spring 2013 | DIABETES

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CO M M U N IT Y

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UPDATE ON NEW METERS

Advice on meter concerns Some people are concerned about the accuracy of the new CareSens blood glucose meter. Here is Diabetes New Zealand’s advice on what to do if you are worried.

Blood glucose meters are critical to the health and management of people with diabetes who need to self-monitor their blood glucose levels. Some people have contacted Diabetes New Zealand to express their concerns about the accuracy of the new Pharmac-funded CareSens meter. They are worried it is reading differently to their old meter and want to know what to do about it.

If you are worried about your meter, contact your doctor or diabetes specialist to discuss your concerns.

We believe it’s important everyone has access to accurate information, so we are sharing the facts that we know so people affected by diabetes are equipped with accurate information on the issue.

• Contact Pharmac on 0800 66 00 50 and ask for Janet who can provide individual assistance if you need help with using the CareSens meter or have concerns about it.

If you have concerns about your meter you can do the following: • Contact your doctor (or diabetes specialist if you see one) to discuss your concerns.

• Test your meter with control solution to see if it is accurate – your local pharmacist will be able to help you here.

• Contact your local Pharmaco representative who will talk with you and test your meter and replace it if needs be.

To contact your local Pharmaco representative ring 0800 458 2673.

It’s important to remember it is possible that two blood glucose meters will give different results, but this doesn't necessarily mean either of the meters is wrong.

The most accurate means of seeking a blood glucose reading is through a medical lab-based glucose analyser.

There is a worldwide standard for handheld blood glucose meters.

They are deemed accurate if their results are within plus or minus 20 per cent of what a lab test would show when taken at the same time as the meter test.

Pharmac requires all meters to be independently tested to show that they meet accuracy requirements before they are subsidised. No meters would be subsidised in New Zealand without this independent testing.

CareSens meters have been independently tested at the Christchurch Diabetes Centre and fall within these parameters.

If you are still concerned, you could register a complaint with Medsafe (the Government agency responsible for ensuring medicines and medical devices in NZ are safe). Medsafe can be contacted on 04 819 6800 (or visit their website www.medsafe.govt.nz).

Medsafe had received 53 complaints by mid August about the CareSens meters. A review of these has so far not identified a problem with the meters however Medsafe is continuing to monitor the situation and has requested information from the supplier about the performance of the meters to assist in the ongoing investigation.

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DIABETES | Spring 2013

CA RES ENS VS PERFO RM A

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RE SEARCH

CareSens meter study A recent study comparing the blood glucose readings of the new CareSens meter with another popular model found the new meters are reading slightly higher but the difference was too small to significantly impact on clinical outcome or management.

The following article explains the results of the study, which was carried out in the ‘ideal’ environment of a diabetes clinic.

Researchers compared the blood glucose readings of the new CareSens N POP meter with another popular model, the Accu-chek Performa.

The tests were carried out at Christchurch Diabetes Centre with 104 volunteers giving a paired finger stick sample. This allowed the study team to compare the CareSens meter result with the Performa meter result.

in readings on its own should not result in the major self-management errors that people feared, say the researchers. However it might occasionally cause people to make a treatment decision that was slightly different to their previous decision.

Dr Helen Lunt, who supervised the research, said: “The Christchurch researchers thought it was important to let the diabetes community know about these study findings, as it might help them with their dayto-day self management decisions during meter changeover.”

“Once you become a regular user of any brand of meter and you get used to how it reads in similar day-today situations, you can then make appropriate decisions about your own management.

Preliminary results show the new meters are reading slightly higher but the difference was too small to significantly impact on clinical outcome or management (see the graph below).

In the study, the volunteers gave the research team two samples. The paired results are shown on a graph called a Consensus Error grid (see below). Results from the two meters look quite similar, with only one result of the 104 falling outside the green zone (clinically safe) into the blue zone.

The difference in the blood glucose readings from the two meters averaged 0.6mmol/L. This difference

Being in the blue zone suggests the discrepancy between this one pair of results might have changed clinical

management slightly. This overall finding is considered to represent acceptable meter performance by clinicians.

The results were similar to a comparison of two paired Accu-chek Performa results (if someone did two consecutive tests with the Performa meter, researchers would expect a similar amount of ‘scatter’ between the two results) or even two paired CareSens results.

The results show the CareSens meter is reading a little higher overall than the Accu-chek Performa meter when tested in the ideal environment of the diabetes clinic. When the researchers calculated the exact value using a statistical method called Bland Altman comparison, the CareSens glucose read higher than the Accuchek Performa glucose by 0.6mmol/L glucose.

A fifth year medical student undertook this project as part of their University of Otago Christchurch summer studentship project, in conjunction with Christchurch Diabetes Centre researchers. *A version of this article was first run in View Point, Christchurch Diabetes Society’s local newsletter.

Zone A: No effect on clinical action CareSens (mmol/L)

Zone B: Altered clinical action, but little or no effect on clinical outcome Zone C: Altered action, likely to affect the outcome Zone D: Significant medical risk Zone E: Could have dangerous consequences Performa (mmol/L)

Results of the comparison between CareSens and Performa meters show 99 per cent of the readings fall in Zone A and one per cent in Zone B. Spring 2013 | DIABETES

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CO M M U N IT Y

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A HISTORY OF D IABETES

Diabetes in antiquity Diabetes has been around since ancient times but it would be three millennia before insulin was invented and a lifesaving treatment was found. Caroline Wood looks at the first recorded description of diabetes in the history books.

The ancient Egyptians were the first to describe clinical features of diabetes mellitus 3,000 years ago, saying the condition was marked by ‘too great emptying of the urine’ and advocating the use of wheat grains, fruit and sweet beer as a remedy.

The first mention of what is thought to be patients with type 1 diabetes is contained in the Ebers Papyrus (see panel right), written by Egyptian physicans in 1500 BC. The 110-page scroll describes 700 remedies and magical formulas and is one of the oldest and most important medical writings in the world.

Physicians in India around the same time observed that urine from people with diabetes attracted ants and flies and named the condition ‘madhumeha’ or honey urine. They noted that patients experienced extreme thirst and foul breath.

The term diabetes was first coined around 230 BC by an Egyptian physician, who used the Greek words dia meaning ‘to go’ and betes ‘through’, in reference to the large volumes of urine generated by patients. Apollonius of Memphis considered diabetes a disease of the kidneys and recommended bloodletting and dehydration as remedies.

Roman Aulus Cornelius Celsus is thought to be the first person to give a complete clinical description of diabetes in his eight-volume

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DIABETES | Spring 2013

Roman Aulus Cornelius Celsus is thought to be the first person to give a complete clinical description of diabetes.

medical encyclopedia De medicina, in around 30-50 BC. The first person to distinguish between what we now call diabetes mellitus (mellitus means ‘honey sweet’ in Latin) and diabetes insipidus was the Greek physician Aretaeus of Cappadocia, who practised in Rome and Alexandria in the second century AD. He gave a detailed account of diabetes mellitus and made the observation that its onset commonly followed acute illness, injury, or emotional stress.

However at that time diabetes was still a rare disease.

In his work On the Causes and Indications of Acute and Chronic Diseases, he wrote: “Diabetes is a dreadful affliction, not very frequent among men, being a melting down

of the flesh and limbs into urine.

The patients never stop making water and the flow is incessant, like the opening of the aqueducts. Life is short, unpleasant and painful, thirst unquenchable, drinking excessive…”

Two Indian physicians, Sushruta and Charaka, were the first to observe the differences between what later became known as type 1 and type 2 diabetes mellitus in the fifth century AD. They noted that thin people with diabetes had developed it at a younger age, compared with heavier individuals who had a later onset and lived longer after diagnosis.

References: Principles of Diabetes Mellitus, L Poretsky (ed), Part 1: The Main Events in the History of Diabetes Mellitus, (J Zajac et al) 2010; History of diabetes mellitus, AM Ahmed, 2002; History of diabetes, Wikipedia, 2013.

Diabetes timelines First written reference to diabetes

Ancient Egypt, circa 1500 BC, written in the Ebers Papyrus

The name diabetes given to the disease from the Greek words meaning ‘to pass through’

Ancient Egypt, 230 BC, by the physician Apollonius of Memphis

First clinical description of diabetes

Rome, First Century AD, Aulus Cornelius Celsus in his eight volume encyclopedia of medicine De medicina

First to distinguish between what we now know as diabetes mellitus and diabetes insipidus

Europe, Second Century AD, Aretaeus of Cappadocia, a Greek physician who practised in Rome and Alexandria

First distinction between type 1 and type 2 diabetes mellitus

India, Fifth Century AD, observed by Indian physicians Sushruta and Charaka

A H I STO RY O F DI A BETES

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COM MUNITY

The Ebers Papyrus

The Ebers Papyrus is one of the oldest and most important medical documents in the world.

The 110-page scroll (about 20 metres long) was written in about 1500 BC but is believed to have been copied from earlier texts from as far back as 3400 BC. It is named after Georg Ebers, who excavated the papyrus from an ancient grave in Thebes in about 1862, publishing it in 1874. It is currently housed at the University of Leipzig, in Germany.

The Ebers Papyrus is written in hieratic Egyptian writing (not hieroglyphs) and contains the most extensive record of ancient Egyptian medicine known. The scroll contains about 700 magical formulas and remedies. It includes the first written reference to diabetes, even though it was a rare condition 3,000 years ago.

As well as writing about diabetes, Egyptian physicians wrote a treatise on the heart noting it was the centre of the blood supply, with vessels attached for every member of the body. The papyrus also contains descriptions of mental disorders, such as depression and disorder, in the chapter called the Book of Hearts. It also includes descriptions covering the diagnosis of pregnancy, gynaecological matters, contraception, intestinal disease, parasites, eye and skin problems, dentistry, tumours, bone setting and burns.

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The trip of a lifetime James McKenzie was one of 15 children chosen to take part in the annual Ticket of Hope weekend in Queenstown organised by the charity Cure Kids. Mum Tania McKenzie tells their story.

I took James to the doctor last May as he didn't seem to have any energy, was losing weight and was generally not quite right. The GP did a precautionary urine test and the sugar strip came up black, so he said he would have to give James a finger prick. The level came back as ‘high’.

The doctor told us that it appeared James had diabetes and we had to get to Dunedin Hospital right away.

We went straight down and they found James had a blood reading of 28 and a ketone level of 4.4. He was admitted for a week to the paediatric ward, where we learned he had type 1 diabetes. We had to learn to finger prick before every meal, to count carbs and give insulin accordingly.

Learning that this was for life has been an incredible shock to us all.

In April Jenny rang and said she had been asked to select a child with type 1 diabetes for the weekend of a lifetime. She said Cure Kids organise a weekend every June, where they take 15 children with life-threatening illness on a trip to Queenstown.

James and I were very excited in the weeks leading up to the weekend.

We flew to Queenstown and headed straight to the Skyline and went luging. James loved this so much.

We stayed at the beautiful Mercure Resort and on the first night they put on a welcoming party. The rest of the weekend flew by: bungy jumping and flying foxes, jetboating, hydro-sliding. The kids got to go up Coronet Peak in snow groomers and then had a huge snowball fight. We

even had a helicopter ride to the Hill Top golf course. The next morning we went to Arrowtown, where James had his one and only low of the weekend (I was surprised to have only had one).

We had the most amazing time with the Cure Kids team, they really know how to make you feel special. It is warming to know there are organisations trying to find a cure for us. It didn't mean a break from diabetes – we can never get away from that. We still had to test every couple of hours and give insulin after everything he ate. But it was great to be able to have some real fun and show James that he can still do all this stuff even though he has diabetes.

“It didn't mean a break from diabetes… but it was great to be able to have some real fun and show James that he can still do all this stuff even though he has diabetes.”

James is eight and the eldest of three children (soon to be four), Aayden is 5 and Sarah is 3. James and Aayden go to Balaclava School in Dunedin.

Sarah has hip dysplasia and earlier this year underwent another operation on her hip/leg, her fifth time to theatre for this (hopefully her last) operation.

James visits the diabetes clinic every couple of months to see his doctor, educator and a dietitian. He has been making steady progress with his overall levels coming down nicely.

We quite often pop in and see Jenny, our diabetes educator, when we feel things aren’t going so well and she helps us to sort things quickly.

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James McKenzie enjoys the snow in Queenstown.

*The Ticket to Hope weekend takes place once a year in the Alpine wonderland of Queenstown. Cure Kids invites 15 children with lifethreatening illnesses from all over New Zealand to take part in the trip of a lifetime. For details visit www.curekids.org.nz.

NATI O NA L WA LK

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Major profile-raising initiative launched – the Diabetes Youth National Walk I am delighted to announce Diabetes Youth New Zealand’s first ever National Walk. People and families all over the country will participate in a national walk on Sunday 9 March 2014 to help raise awareness about diabetes and youth, as well as fundraise to support their local and national organisations.

Why a walk? Two main reasons – visibility and fundraising.

Sometimes one of the biggest areas of difficulty for us as an organisation is raising our profile and understanding when it comes to young people with diabetes. There will be national and local media campaigns focused on discussing youth with diabetes as well as promoting the walk.

We feel the walk will offer the opportunity for us as a community to get out and spread the word in a grassroots-style fashion. We want people to learn about the two

different types of diabetes and also how valuable our local organisations are in supporting our families. And what better way to make a statement than by having thousands of people participating all over the country?

We hope you and your family will participate in the Diabetes Youth National Walk on 9 March 2014.

Put the date on your calendars and contact your local organisation to see how you can get involved.

The walk will also be our signature fundraising event. You may be aware that it's becoming more and more difficult for charities like ours to gain funds to keep up all of our activities.

Most of the funds raised through the walk will be retained locally to support local families. These funds will allow our local organisations to add to existing educational events and camps, or start up new programmes we wouldn't be able to do otherwise. A small portion of the funds will go back to Diabetes Youth NZ. These funds will be used to help support our efforts in advocacy, as well as helping us to complete some important initiatives of our own.

You can visit our website or Facebook page to find out more information about the National Walk, how you can participate and get the latest details on what each area is doing locally on the day.

Renata Porter

President Diabetes Youth NZ Please share your feedback, suggestions or questions with Diabetes Youth NZ. Email contact@diabetesyouth.org.nz.

To find out how to get involved in New Zealand’s first national walk for diabetes youth visit: Website: www.diabetesyouth.org.nz/walk Facebook: www.facebook.com/WalkDiabetesYouthNZ or email walk@diabetesyouth.org.nz

Diabetes Youth New Zealand

JOIN YOUR LOCAL SUPPORT GROUP BY VISITING

General enquiries: contact@diabetesyouth.org.nz Phone: (09) 623 2508 Do you have a story idea? Contact editor@diabetes.org.nz

FIND US ON FACEBOOK AND TWITTER

www.diabetesyouth.org.nz Spring 2013 | DIABETES

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CO M M U N IT Y

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Four pillars of our diabetes family It is with deep sadness that we advise you of the passing of the following people who all made a significant and invaluable contribution to the Diabetes NZ family. They will all be very much missed, writes Lisa Woods, Communications Manager Diabetes NZ. Diabetes NZ Gisborne Branch sadly advise of the passing of Elaine Muir, who was for many years President of the Society. Elaine was reputed to have been one of the longest surviving type 1 diabetes sufferers, having been diagnosed with the condition when she was four years

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old and subjected to the treatments of that time. Elaine and others formed the Gisborne Society over 20 years ago providing a focal point for people with diabetes to gather and learn more about their condition and its treatments.

Diabetes Waimate Society sadly advise of the passing of Mrs Kathleen Ruddle after a long illness.

Kathleen has been the backbone of the society for many years having served on the executive committee for all of the 15 years she was involved with the society. Kathleen was instrumental in the Waimate support group becoming a fullyfledged incorporated society and was granted life membership three years ago for her services to the society.

She resigned from all positions in June 2011 due to continuing ill health.

Diabetes NZ Southland Branch sadly advises of the passing of Henry (Ossie) Osborne and Nola Mills.

Ossie made a huge contribution to Southland, and was a foundation member of the society. He was President of the society for a number of years and a life member. Latterly he was Patron of the society. Ossie also received a Diabetes NZ award. Nola Mills was a recent President of the society and a committee member for a number of years. Nola’s contribution to the society was immeasurable.

She ensured the society was involved with promoting diabetes awareness at every opportunity.

Join Diabetes New Zealand today!

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DIABETES | Spring 2013

DI A BETES NZ CO NFERENCE 2 013

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All together now More than 200 delegates are expected to attend this year’s Diabetes NZ conference and AGM. There’s an action-packed schedule with something for everyone. Caroline Wood offers a sneak preview of some of the highlights of conference 2013.

The theme is ‘All of us together’ and that means everyone affected by diabetes, whether type 1 or type 2, child or parent, Māori, Pasifika or Pākehā. And this year’s conference has something for everyone whether they are young, old, newly diagnosed or have had diabetes for many years.

There is still time to register for the Diabetes NZ conference and 51st AGM, which takes place from Friday 20 September to Sunday 22 September, 2013.

One of the highlights will be Buck Shelford, former All Black Captain and front man for the heart and diabetes check programme, who will be the guest speaker at the gala dinner on Friday.

Conference’s keynote speakers will be talking about cutting edge research seeking a diabetes ‘cure’ or technologies to reverse the condition. Dr Andrea Grant from Living Cell Technologies will talk about the xeno transplantation – the transplant of cells from pigs to produce insulin in people with diabetes. And Dr Paul Turner, of the Spinal Cord Society of New Zealand, will present the latest results from his work looking at whether stem cells can restore insulin function.

Dr Helen Lunt, from the University of Otago, Christchurch, will talk

about emerging technologies in the management of diabetes and Dr Kirsten Coppell will give some tips on the little things people can do to make a difference to their diabetes care.

The varied workshop programme includes sessions on travelling with diabetes, healthy food, healthy feet and physical activity from a Māori perspective. Young people will be well represented with Diabetes Youth President Renata Porter talking about the inaugural Diabetes Youth National Walk. There is also a workshop session on the importance of diabetes camps for children and young people.

Organiser Russ Finnerty said: “There is a large training and educational component in our workshop programme. The whole business of diabetes is good management and there is a lot in this programme around education and providing practical advice to people of all ages, regardless of whether they have type 1 or type 2 diabetes.”

Other speakers include Lindsay McTavish, Clinical Nurse Specialist and Team Leader at Capital and Coast District Health Board, who will present his research on the efficiency of common treatments for hypoglycaemia, which produced some surprising results. Another interesting speaker will be Terry Ehau, who will tell delegates his personal story Mate huka, my story and his part in the successful Ngati and Healthy programme.

The programme was set up by Ngati Porou Hauora and the Edgar National Centre for Diabetes Research in a bid to tackle the problem of type 2 diabetes on the East Cape.

What you need to know Diabetes New Zealand Annual Conference and 51st Annual General Meeting Date: Fri 20 – Sun 22 September 2013 Venue: James Cook Hotel Grand Chancellor, 147 The Terrace, Wellington Cost: Variable depending on the number of days/events you choose to attend. From $30 for Friday afternoon only to $450 for the full conference programme including gala dinner.

It is still possible to register up until the day, see www.diabetes.org.nz for details.

The Diabetes NZ AGM takes place on the Friday. On the Sunday there are sessions tailored for branch development with regional hub workshops, presentations on how to get the most out of Diabetes Awareness Week and the latest on the development of national standards of diabetes care and the e-learning platform.

The keynote speaker on the Sunday is Sophie Devine, Diabetes Youth NZ’s new ambassador. *Programme change: Due to circumstances beyond Diabetes NZ's control, conference will no longer visit Wellington's Pipitea Marae.

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POSTER CAMPAIG N

Local initiative highlights diabetes message Earlier this year hospital nurses, a local gym and a bus company joined together to take a hard-hitting message to the streets linking sugary drinks, childhood obesity and type 2 diabetes. Caroline Wood reports.

Did you know it could take someone two to three hours of walking to burn off the amount of energy contained in a can of sugary drink?

This is the message contained in a bus poster campaign launched in Wellington earlier this year. The campaign combined the efforts of different groups in the community that share a common concern about childhood obesity and the link to type 2 diabetes in later life.

The campaign was a joint initiative between diabetes nurses from Capital and Coast DHB and a local gym. Wellington City Council offered to display the posters free on the buses for a month.

The idea arose from a workshop that was run at a national Diabetes Nurse Specialist Symposium last year. Wellington Hospital diabetes nurse Tess Clarke explains: “One of the issues we identified was the high consumption of sugary drinks that we observed in our patients, their families and in the communities where we lived in general.

“This was particularly relevant as around that time a study published in the New England Journal of Medicine (NEJM) provided strong evidence that if you are genetically predisposed to put on weight, this effect will be more pronounced if you regularly consume sugarsweetened beverages. In other

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words drinking sugary drinks like fizzy drink, fruit juice, energy drinks and sports drinks is especially harmful to people with genes that predispose them to put on weight.”

of the posters, and these were run for free by Wellington City Council on the buses during March 2013.

“We want to raise awareness about the link between consumption of sugary drinks and Type 2 diabetes.

If you regularly drink sugary drinks you are more likely to put on weight and if you put on weight, you will be more at risk of developing type 2 diabetes.”

Dan McNaughton, co-owner of the Results Room gym said: “We’ve chosen to focus our fundraising efforts on type 2 diabetes prevention in youth. This issue is something we believe in and we thought it was a good opportunity to get the word out to the wider public.”

Another study also published in the NEJM in October last year focused on children between the ages of four and 12 years. This study found that replacing sugar-containing drinks with sugar-free alternatives significantly reduced weight and body fat gain in healthy children.

“We've had a really good response to this message at the health promotion events we've run as most parents find this message quite shocking,” added Tess.

“Together these studies suggest that sugary drinks cause us to put on excessive amounts of weight, independent of other factors such as over eating or getting too little exercise,” adds Tess.

The Capital and Coast DHB communications team designed the poster, working with Wellington hospital diabetes nurses.

The Results Room gym, in Featherston Street, paid for the printing

The same public health message is contained in flyers the nurses use at their health promotion events.

Type 2 Diabetes:

Don’t buy it It takes

2

½ hours

To walk off a can of sofT Drink.

Type 2 Diabetes - It’s Your Choice

Helping to Manage Your Diabetes Care

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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