Diabetes Spring 2014

Diabetes Spring 2014

Living well with diabetes

Adorable Ada New Zealand’s first diabetes response dog

GO BLUE

FOR WORLD DIABETES DAY Doctors reveal challenge of early diabetes conversations

Understanding HbA1c STROKE RISK

9 tips that could save your life

healthy breakfasts + interval training + spring peas

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Diabetes: the national magazine of Diabetes New Zealand | Vol 26 no 3 Spring 2014

INSIDE spring 2014 4 5

From the Chief Executive From the President

Upfront

6

News, views and research

Focus

10 Doctor-patient early

conversations survey

Living with diabetes

12 Living life with no regrets

31

Community

14 Diabetes Awareness Week latest

23 Go blue for World Diabetes Day

31 Diabetes tour:

Machu Picchu

Treatment

16 Understanding HbA1c Families and children

18 Diabetes response dogs Care and prevention

20 Reduce your stroke risk

28 Parties pitch for the diabetes vote

Gardening

24

General election 2014

22 Peas please

Research

Food

32 Global type 2 prevention trial

24 Healthy breakfast ideas

Diabetes Youth

Let's get active

33 Teen camps set to launch

26 High intensity interval

The last word

training

34 NZ’s diabetes plan 2014/15

COVER PHOTO: VICKI PARRY AND DIABETES RESPONSE DOG, ADA. See page 18. PHOTO Š JONO GRIBBLE

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 342 238 Email: admin@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 342 238 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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Joining forces with Lions Clubs New Zealand Regular readers of this column will know we have been working hard to build relationships with groups and organisations that have an interest in helping people with diabetes. Lions Clubs New Zealand is one of these organisations. Its brand is well recognised and respected nationally and internationally with almost 270 clubs across New Zealand and more than 10,000 active members.

For many years Lions Clubs NZ has raised awareness about diabetes with support from our diabetes branches.

The Lions Clubs’ mission statement on diabetes is ‘to conduct and support local and large-scale effort leading to the control and treatment of diabetes and its complications through education, prevention and research’.

Over the past 18 months I have been working with the Lions Clubs

National Council and their diabetes coordinator Mandy Hebben to develop a stronger relationship between our two organisations. Last year Lions Clubs helped distribute information during our Diabetes Awareness Week and we have been working together to see how we can get our information booklets and magazine out through the clubs.

We also recently signed a Memorandum of Understanding with Lions Clubs NZ – a meaningful milestone because it gives us a solid foundation and framework for joint activities at a community level. We hope this will see partnerships being developed between Lions Clubs and our branches and volunteers that will raise awareness about diabetes.

Another aim is to raise funds locally to help support individuals and families affected by diabetes.

Initially we will work with Lions Clubs NZ to alert the public to type 2 diabetes, its impact and the dangers associated with obesity and lack of physical activity. We hope this work will help slow the increase

of type 2 diabetes in the community.

We will also work together to increase public awareness about the complications associated with all types of diabetes.

Working together will help get our messages more widely into the community and raise the profile of Diabetes NZ and Lions Clubs NZ while encouraging the next generation to become involved in community action. We are also talking about how we can add collective value during Diabetes Awareness Week in November – please see our website www. diabetes.org.nz for updates.

Partnerships bring strength. So if you have an idea, suggestion or want to get involved, speak to your local branch of Diabetes NZ or Lions Clubs NZ – they will be in a town near you.

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). Membership includes subscription to the magazine.

Email: admin@diabetes.org.nz or call 0800 342 238 to find out more.

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DIABETES | Spring 2014

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FROM TH E PRESIDE NT

Heart and diabetes checks save lives There would be few among us who would disagree that having diabetes ‘is the pits’ at times. In darker times it can be tough identifying any redeeming feature of living a life with this disease. Sometimes the struggle just seems too overwhelming.

We do however enjoy one benefit – which is the opportunity (amply provided) to be regularly checked for development of any of the known complications of diabetes. While it is tempting to not want to find out about any possible bad stuff, it is much worse to not become aware until it is too late! Eye laser treatment would have to be better than blindness for instance.

Every one of us should prevail upon our health care providers to ensure we have regular HbA1c tests, our kidneys, feet and heart health checked (all easy tests) and of course, our eye screening undertaken. It is not just up to our

doctor to organise this, but also up to us to ensure it happens.

Last year you will recall Diabetes New Zealand, in association with the Health Promotion Agency and National Heart Foundation, launched a national media campaign encouraging people to get their heart and diabetes checks done.

It was a very successful campaign, helped no doubt by Buck Shelford’s involvement.

We were really surprised at Diabetes NZ that there should be some complaints about the campaign from within our own community.

These largely emanated from young people/children with diabetes, or their family members. They felt the campaign was of no relevance to the young with type 1. But heart and diabetes checks should have resonance among everyone in our community. There is no discrimination between types of diabetes when it comes to the insidious complications of the disease. And there is a very strong incidence of cardiovascular disease in those with diabetes.

Certainly most people get type 1 when they are younger and today with modern insulins, greater

understanding of the disease and increased use of technology in its management, people can reasonably expect to live close to a normal life span. This does not mean that problems cannot still occur though.

Regular checks maximise the chances of them being satisfactorily managed or their impact minimised.

Everyone will eventually get to the age when they should have heart and diabetes checks. The age this happens depends on a person’s ethnicity, age and gender. If you have diabetes – including type 1 – you will be at that age a full decade before you otherwise would if you didn’t have diabetes. And you will be (or should be) very grateful for the fact that you are entitled to such early and thorough health monitoring.

After all, the goal to live a normal life span is one worth having I reckon.

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 NATIONAL COMMUNICATIONS MANAGER: Nicky Steel 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 Freephone 0800 342 238 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 a donation 0800 DIABETES (0800 342 238)

Spring 2014 | DIABETES

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UP FRO NT

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NEWS, VIEWS AND RESEARCH

Artificial pancreas success

Diabetes atlas published

Adults with type 1 diabetes have used an artificial pancreas in their own homes for an extended period for the first time. The study, funded by Diabetes UK and carried out by researchers in Cambridge, London and Sheffield, involved 24 adults with type 1 diabetes using the artificial pancreas system overnight for four weeks in their homes. It is the first time anywhere in the world that adults have used an artificial pancreas for more than a couple of days without medical supervision.

New Zealand’s first Atlas of Healthcare Variation for diabetes, which shows how health care for people with diabetes is delivered by different district health boards, is now available online. Dr Paul Drury, Medical Director of the New Zealand Society for the Study of Diabetes, said he was pleased to see that overall there was not a lot of variation between district health boards in most aspects of diabetes care.

Participants used the device overnight only. Every 12 minutes during the night, the software would draw on real-time feedback from the sensor to adjust the amount of insulin administered by the pump. The findings, announced in June at the American Diabetes Association’s 74th Scientific Sessions and published in The Lancet Diabetes & Endocrinology journal, showed people using the system spent 13.5 per cent more time with their glucose levels in the ideal range, compared to people using the current gold-standard insulin therapy.

See www.thelancet.com for the full study results.

“However, the continuing increase in the number of people diagnosed with diabetes is concerning – 243,000 people in 2013, up some nine percent from 226,000 in 2012 – and suggests DHBs need to be proactive in detecting and managing this condition well in the community.”

Call for healthier diets A New Zealand expert panel of 50 independent public health experts has recommended 34 actions, including seven immediate priorities, to improve Kiwi diets and reduce future health care costs.

These include targets for reducing childhood obesity and a tax on sugar-sweetened drinks.

For details see Benchmarking Food Environments on www.fmhs.auckland.ac.nz.

Restricting carbs recommended A multinational team of researchers has put forward a comprehensive case for recommending dietary carbohydrate restriction as the default intervention in managing type 1 and type 2 diabetes. The review, published online by the journal Nutrition, presents 12 points to support the use of a low carbohydrate diet. In people with type 2 diabetes, the review recommends a low carbohydrate diet as the first intervention. In type 1 diabetes, a low carb diet is advised as the default diet in addition to taking insulin. See the full study at: www.nutritionjrnl.com/ article/S0899-9007(14)00332-3/abstract.

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DIABETES | Spring 2014

Diabetes centre celebrates 10th anniversary The Edgar Diabetes and Obesity Research (EDOR) centre in Dunedin is celebrating its 10th anniversary this year. The centre, based at the University of Otago, is at the forefront of diabetes and obesity-related research in New Zealand. It was established in 2003 following a generous donation made by the Edgar family. Sir Eion Edgar, who is a Diabetes New Zealand patron, is chairperson of EDOR’s advisory committee. Formerly known as the Edgar National Centre for Diabetes and Obesity Research, EDOR has launched a new website showcasing its work – see www.otago.ac.nz/diabetes.

US diabetes figures The prevalence of type 1 diabetes increased 21 per cent in children up to 19 years of age from 2001 to 2009. The prevalence of type 2 diabetes among children aged 10-19 rose by 30 percent during the same period. The figures come from the Search for Diabetes in Youth study, for details see www.searchfordiabetes.org.

Heart failure study Auckland University medical researchers have been awarded nearly $160,000 to study heart failure in people with diabetes. People with type 1 and type 2 diabetes have a 2.5-fold increased risk of heart failure and the study aims to understand why and to develop new treatment options. The research is being funded by the Auckland Medical Research Foundation.

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UP FRO NT

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NEWS, VIEWS AND RESEARCH

Diabetes NZ conference & AGM – a day of inspiration Plans are in place for the Diabetes New Zealand conference and AGM, which will be held at Wellington Airport Conference Centre on 8 November.

Registration is free for members of Diabetes NZ and the day has been organised to make it as easy as possible for people to attend from around the country. Organisers are hoping as many members as possible will attend. “It is your day, your conference, your AGM and a good opportunity to have your say,” says Russ Finnerty.

The day will run from 9am to 4.40pm. This will allow most people to fly in and out on the one day. With refreshments and lunch provided, there will be no need to leave the conference centre in the main terminal of the airport.

The programme will open at 9.30am with a welcome from the President followed by a presentation from Sam Kemp-Milham, of the Ministry of Health, on the ministry’s current plans for diabetes care improvements.

The Annual General Meeting will be held at 11am, followed by lunch. The afternoon programme will include a talk by Tony Hall, a Horowhenua member, whose life passion is racing speed boats, and a presentation from Dr Poornima Nair on her research on the impact of web portals for the primary care of people with diabetes. The topic chosen by the closing speaker (TBC at time of writing) is intended to leave participants challenged and inspired.

As space is limited please register as soon as possible by downloading the registration form from the Diabetes NZ website (www.diabetes.org.nz). You can also ask for a hard copy from National Office (call 0800 DIABETES) or by calling your local branch.

Self-compassion study People with diabetes are being offered the chance to take part in ground-breaking research into the mental and physical health benefits of mindfulness and self-compassion practice.

Evidence from more than 200 scientific studies over the past 10 years suggests learning to be kinder to oneself in the face of negative events improves mood, motivation, and key signs of good health. Now these benefits are being tested in people with diabetes in a study led by Auckland health psychologist and doctoral researcher Anna Friis.

“Living with diabetes can be tough at times, with patients living with this condition more than twice as likely as the general population to experience low mood and depression, often further complicating the original diagnosis,” she says.

“There is now a compelling body of evidence to suggest that self-kindness might be an antidote to some of the distress experienced by diabetes patients, and that this might help protect against some of the downstream problems associated with low mood.”

The randomised controlled trial involves people with type 1 or type 2 diabetes being assigned to one of two groups, both of which involve selfcompassion training at no cost. The study is being run under the auspices of the University of Auckland and the Waitemata District Health Board. The New Zealand Society for the Study of Diabetes and the New Zealand Diabetes Foundation are helping to fund the study. *For further information see: www.facebook.com/ mindfulselfcompassion. If you are interested in taking part contact Anna on 0274 999 696 or email annamfriis@gmail.com.

Welcome Nicky Steel Diabetes New Zealand is delighted to welcome Nicky Steel as our new National Communications Manager. Nicky comes to us with experience in senior communications roles for organisations such as Supporting Families in Mental Illness NZ and Grow Wellington. Nicky joined us in June and is based in our national office in Wellington. You can contact Nicky on (04) 4997143 or email nicky@diabetes.org.nz

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DIABETES | Spring 2014

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FO CU S

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GLO BAL D IABETES SURVEY

Survey highlights importance of ‘early conversations’ IntroDia

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Shaping dialogue in early type 2 diabetes

First results are in from the world’s largest ever type 2 T2D) diabetes survey to focus on y overwhelming ‘early conversations’ between doctor and patient at the time of diagnosis and onset of medication. The global survey involved nearly 17,000 respondents in 20 countries.

Caroline Wood reports.

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Joan, 70 from Blenheim, has just been diagnosed with type 2 diabetes.

She is feeling anxious and is worried about what it means for her future health. She has lots of questions for her doctor and wants to know why she has got diabetes when she has always looked after herself. In Wellington at the same time John, 46, has received news he didn’t want to hear. He has type 2 diabetes but he is in denial about his condition, he feels fine so why should he modify his diet or do more exercise as his doctor is discussing with him? Meanwhile in Hamilton Carla, 57, is accepting about her diabetes. Her father had diabetes too and she is OK with her diagnosis. She wants to work out a plan with her GP because she knows it is important to prevent serious health complications.

The three scenarios described are common but very different emotional reactions to a diabetes diagnosis. In each case the patient’s GP will need to respond appropriately and ‘say the right thing’. Research suggests the way a patient responds at diagnosis, and at onset of diabetes medication, will define how successfully they accept and manage their diabetes in the future.

The global IntroDia survey is being carried out in more than 20 different countries and will include contributions from 6,750 doctors and 10,000 people with type 2 diabetes (see panel). The aim is to explore how patients and physicians perceive early type 2 diabetes conversations and how this could be related to patient wellbeing.

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of T2D has been shown to:

Early conversations Type 2 Diabetes (T2D) Improve in self-care

Reduce complications can be challenging and emotionally overwhelming

date investigating ns in T2D

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10 OUTCOME

DIABETES | Spring 2014

To develop tools to

Type 2 Diabetes

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G LO BA L DI A BETES S URVEY

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FOCUS

Global IntroDia survey focuses on patient wellbeing What is it?

IntroDia™ is the largest global type 2 diabetes survey ever conducted to focus on early conversations – providing key insights on how physicians and patients interact at the time of diagnosis and when additional oral medication is required to control blood glucose levels. It has been developed in partnership with the International Diabetes Federation (IDF).

Why is it happening?

IntroDia will explore how physicians and patients perceive early type 2 diabetes conversations and how this influences patient wellbeing and other self-reported outcomes. The aim is to develop better tools for doctors so they can help patients with the long-term management of type 2 diabetes.

How is it being carried out?

The survey is being conducted via online questionnaires and face to face interviews – gathering data from approximately 17,000 respondents. It is being carried out in more than 20 countries including the UK, France, Germany, Argentina, the USA, Australia, Indonesia, India, Russia, Canada, Israel and Saudi Arabia. An international advisory board of diabetes experts is overseeing the study. *For more information, see www.introdia.com

The IntroDia survey will try to answer the following questions: • What are the best ways to support early type 2 diabetes conversations between patients and physicians?

• What do patients recall being told during the conversations in which they were diagnosed with type 2 diabetes, or when additional medication is required?

• What is the experience for physicians in these early conversations? What challenges do they face?

• What solutions will support even better conversations and outcomes?

The first results from the IntroDia survey were presented at the American Diabetes Association’s 74th Scientific Sessions in June.

Many physicians reported a variety of challenges during the diagnosis conversations. These included patients not keeping up with the required changes, patients returning to old habits, and doctors not having enough time to carry out

these important conversations with patients. Most physicians (92 percent) also indicated they would like tools to help people with type 2 diabetes sustain behaviour changes.

New Zealand is not part of the global survey but the insights gained should inform best practice here, as it will around the world.

Wellington GP Dr Danuta Young, who works at Muritai Health Centre, welcomed the IntroDia survey saying she would like more tools to help patients, particularly regarding lifestyle advice for those with prediabetes or early type 2 diabetes.

“It’s certainly hard to broach the subject with some patients.

Sometimes they are very shocked and haven’t yet identified with the fact that they may develop diabetes.

We often need to send a letter asking people to come in and discuss their results. Some people are there the next day and others take up to a year to come in.

“It’s sometimes hard to motivate people to put lifestyle changes into

practice. I find people tend to do this in pulses after major life events, for example they keep it going for 6-12 months and then relapse.

It’s important for us to keep on prompting and encouraging people to have annual reviews.”

“We also need to discuss the natural history of diabetes and explain how it’s not a failure on their part if they require an increasing amount of intervention to help avoid complications.”

Dr Young said a new system was being introduced that would prompt doctors to make sure they gave diet and exercise advice to patients, including those with diabetes. However it was often hard to do this properly in a standard 15-minute consultation, especially if the patient had other health related issues.

The next part of the IntroDia study will be to gather insights from people with type 2 diabetes about their experiences of early patientdoctor conversations.

Spring 2014 | DIABETES

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LIV ING W ITH D I A B E TE S

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VINEYARD OWNER DAVI D BRYCE

Living life with no regrets David Bryce says he felt bullet proof when he was first diagnosed with diabetes 30 years ago. He didn’t let diabetes get in the way of taking risks and building successful businesses. But years of not properly controlling his diabetes led to a number of health challenges, including stroke and kidney failure. Caroline Wood reports.

Go getter: David Bryce with the Stroke Foundation’s Judith Hyslop in front of the steam train he bought a month after having a massive stroke.

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DIABETES | Spring 2014

From establishing a vineyard from scratch to buying a vintage steam train just a month after having a massive stroke, company director David Bryce has never been one to rest on his laurels. The 55-yearold from Renwick hasn’t stopped taking risks and setting himself goals despite having ongoing diabetesrelated health complications, which mean he is now waiting for a kidney transplant.

David was diagnosed with diabetes in his mid-20s and admits his doctors were never happy with his ‘numbers’ – he didn’t do enough to control his diabetes, preferring to get on with the business of living life to the full and not letting his diabetes put him off his goals.

He said: “I was young and I felt bullet proof. I never let diabetes stand in my way, I was off doing things, like setting up a vineyard and farming. I could have wrapped myself in cotton wool but I chose to continue my life as normal and I guess it had to catch up with me one day or another.

“The doctors were never happy with me, my numbers were always outside the box. I did manage my diet well, I have always looked after myself well in that way.

“I was put onto Lantus® (insulin glargine) after the stroke and that has made a big difference to my blood sugars. My advice is to get on top of it [diabetes] and get control as soon as you can. But at the same time continue with living your life.”

VINEYARD OWNER DAVI D BRYCE

In March 2011 David suffered a huge stroke, which meant he couldn’t swallow, eat, talk or walk. After becoming frustrated with the lack of support from his local health services, he turned to the Stroke Foundation for help with his rehabilitation and he began to get better.

No stranger to adversity, David had had a terrible farm vehicle accident in 1990. Although he was resuscitated he temporarily lost the use of his left arm. This was David’s first experience of rehabilitation involving a daily training regime to regain the use of his arm. He drew on this experience to recover from his stroke.

“Life doesn’t go on forever and you need to get the balance between achieving what you want to achieve without detriment to your health.”

“I got some squeezy balls, dumbbells and other rehab devices that I knew I needed. I’d been told that rest was important, but so was exercise, so I got some Nordic walking poles to give me some stability and started walking again.”

David continued to set goals. His first was to walk from his home to his farm in Renwick, about eight kilometres away. The first time he tried he had to be taken to hospital after a fall. He tried again about three weeks later and made it.

Within a month of the stroke, David had bought the historic steam train Kingston Flyer on the southern shore of Lake Wakatipu near Queenstown.

“It offered me a great project to get me up and running in terms of rehab”, he insisted.

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LI V I NG WITH DI ABE TES

“I thought to myself: let’s have some fun. Not just me though, I want other people to have fun too.”

And they did. After two years languishing in the railway shed the Kingston Flyer – dating back to the 1890s – was brought back into service with bells shiny and whistles blowing. The first 2011/12 season was hugely successful, the locals from Southland and Otago getting in behind their beloved train. David Bryce’s dream had come true.

He made sure he thanked the Stroke Foundation, raising $5,500 (a percentage of a whole weekend’s ticket sales) as a donation.

David had overcome a devastating stroke but then his kidneys started to fail and he is now on dialysis and waiting for a kidney transplant. Another diabetes-related blow came 12 months ago when he started having trouble reading his mobile phone. David was diagnosed with diabetic macular oedema, a complication of retinopathy and the most common cause of vision loss in people with diabetes.

Last year David reluctantly made the decision to put the Kingston Flyer business up for sale so he could focus on his health.

After 30 years of diabetes, does he have any advice for people just diagnosed?

“Diabetes can strike at any age and there are consequences, you can get other health issues as a result of diabetes so be aware of these. I have certainly encountered a few of them and they have their consequences,” he says.

“Life doesn’t go on forever and you need to get the balance right between achieving what you want to achieve without detriment to your health.”

His advice is to never give up and his achievements to date are certainly testament to that philosophy. *Part of this article first appeared on www.stroke.org.nz.

See p20 for the Stroke Foundation’s top tips for reducing stroke risks.

GPSI DIABETES

Spring 2014 | DIABETES

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CO M M U N IT Y

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D IABETES AWARENESS WEEK UPDATE

Gearing up for Diabetes Awareness Week Diabetes Awareness Week runs from 11 to 17 November. It’s our community’s opportunity to make some noise about diabetes, remind people that anyone can get it –and that Diabetes New Zealand is here to help. Caroline Wood reports on plans for this year’s event.

Do you have a story about diabetes to share, or do you know anyone who makes a great diabetes ‘ambassador’. Could you organise a fundraising event for diabetes in your community or school? Or volunteer to help your local branch with one of their awareness raising events? These are a few of the ways you can get involved in Diabetes Awareness Week 2014.

Last year during Diabetes Awareness Week events around the country included a zoo visit for children with type 1 diabetes, a family fun day, a school blue jeans mufti day, a fun walk, a high society tea and information stalls, workshops and displays. Plus over 30 workplaces in Auckland took part in a ‘Take the Break’ campaign and held a morning tea for diabetes.

One of the key messages for this year’s campaign is ‘Anyone can get diabetes’ reflecting the fact that diabetes affects all kinds of people from all walks of life – regardless of their age, shape, income or ethnicity. The aim is to help remove the stigma some people feel when talking about their illness and encourage them to seek help to manage their condition.

Another key message is ‘Whoever you are, we can help,’ which is aimed at raising the public’s awareness of Diabetes New

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DIABETES | Spring 2014

Zealand and its network of dedicated volunteers who support people with diabetes in their own community.

Following the success of last year’s Diabetes Awareness Week, there will be a national radio campaign, as well as posters popping up in local libraries, GP surgeries, supermarkets and other places around town. Local media will be invited to feature stories about local people with diabetes and branches will be holding special events and fundraisers.

Diabetes New Zealand’s new National Communications Manager Nicky Steel says: “It’s a great opportunity to give a heads up that anyone can get diabetes and the number of people living with the condition is growing every day. There are nearly a quarter of a million Kiwis with diabetes – and every day 50 more people are being diagnosed.

“We want everyone to know that Diabetes New Zealand is the go-to place for information about diabetes, whether you have type 1, or type 2, or gestational diabetes.

Come to us for information, support and access to your nearest branch.

“Diabetes Awareness Week is also an important week for our branches to do lots of fundraising and awareness raising activities.

IF YOU HAVE

DIABETES WE CAN HELP. You don’t need to go it alone. Diabetes New Zealand is here to help.

Call 0800 DIABETES or go to diabetes.org.nz to find a helpful branch near you.

We want as many people as possible to get involved. If you don’t want to do your own activity there are lots of other things happening around the country that you can help with.”

Nicky would love to hear from anyone who wants to organise a fundraising event or who wants to be put in touch with their local branch. You can contact her on 0800 DIABETES (0800 342 238) or nicky@diabetes.org.nz *Information and updates about Diabetes Awareness Week 2014 will be posted to Diabetes New Zealand’s website www.diabetes.org.nz or you can contact your local branch.

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HBA1C GUID E

Understanding HbA1c and why it matters Research shows the higher a person’s HbA1c, the greater the risk of developing diabetes-related complications. But many people are confused about their blood tests and what they mean. Inspired by a reader’s question (see below) Diabetes Nurse Specialist Gavin Hendry explains all you need to know about HbA1c.

Perhaps you can identify with George when he goes for a routine visit to his doctor. At some point in the visit his GP says something like this. “Now George, your aitch bee aye wuncey is high. It’s 76. We really have to get that lower so do the best you can and see if you can get a better result by the next time I see you.”

HbA1c confusion common Are you newly-diagnosed/don’t really understand your blood tests? You are not alone. This article was inspired by a reader’s letter (see below).

Dear Editor, The above edition was excellent and contained much useful information.

However one of the articles talks about HbA1c readings. Could you advise how this reading converts to the readings shown on the blood testing meters?

I find the use of this type of reading very confusing.

From a recent blood test I had, the nurse used this reading and she did not know how to convert this to the normal meter reading. I am a type 1 diabetic.

HbA1c – what is it?

Hb is the abbreviation for haemoglobin, which is the oxygen transporter situated in the red blood cells. Each red blood cell lives for 120 days and the red blood cells are continuously being replaced.

Glucose can get stuck onto the haemoglobin on red blood cells in a process called glycation. The higher the blood glucose levels the more glycation occurs. This is shown in the graphic opposite.

Meanwhile George has switched off and in his mind he thinks “aitch bee aye wuncey? What’s that? So what if it’s high? All my other tests are high too, just another one to add to the list.

How am I supposed to get it lower anyway?”

If we measure the concentration of glycated haemoglobin we can get an overall indication of someone’s level of glucose control. Since none of the red blood cells are older than 120 days it indicates the level of control for the previous three months, although it is most reflective of the most recent month.

If you have diabetes you will have had this blood test done quite regularly. The test is HbA1c.

Other names for the same thing are A1c, glycated haemoglobin, glycosylated haemoglobin, and haemoglobin A1c.

HbA1c is reported in mmol/mol, which is just a measurement of concentration. Up until a year or so ago HbA1c was reported in % and the numbers were on a different scale. It is possible to convert from one scale to the other. If you want to find out what

The test should be done on a regular basis for people with diabetes and is theControl most useful HbA1C as indicator of Glycaemic indicator of diabetes control.

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%

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HbA1C as indicator of glycaemic control mmol/ mol

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5

40

50

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60

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70

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Estimated average blood glucose (mmol/l)

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DIABETES | Spring 2014

80

90

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100

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110

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120

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140

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The graphic shows HbA1c readings in mmol/mol and how they translate to the readings shown on your blood testing meter (estimated average blood glucose mmol/l).

COURTESY OF NZSSD

H BA 1C G UI DE

a value on the new scale means compared to your old scale you can use the converter on the Diabetes New Zealand website, see www. diabetes.org.nz/resources/ hba1c_reporting_changed.

A normal HbA1c is less than 40mm. A higher result than this would indicate an increased risk of developing diabetes. A result above 50 indicates a diagnosis of diabetes especially if symptoms are present.

Once someone has been diagnosed with diabetes we try to keep the HbA1c as low as we can safely achieve. Usually a goal of 53mmol/ mol is ideal. There does not seem to be significant benefit in achieving a lower HbA1c than this. Indeed trying to get it lower than this can increase the risk of hypoglycaemia and related risks as well as cause unwarranted stress and anxiety trying to achieve it.

In many people, especially elderly folk, we need to adjust our goal to allow higher levels which are both achievable and safer for a particular individual. It is important to discuss with your doctor or diabetes nurse specialist what level would be appropriate for you.

Why is it important to keep HbA1c low?

We know from various studies observing thousands of people with diabetes that by improving HbA1c the risks of the long-term complications of diabetes are significantly reduced, especially for retinopathy, nephropathy, and neuropathy (ie eye, kidney and nerve damage). This is one of the reasons your health team are always interested in your HbA1c result.

TREATMENT

What is Hba1c?

HbA1c tests measure the amount of 'glycation' ie glucose stuck to the haemoglobin (Hb) on your red blood cells.

However it is probably best to just become accustomed to the new scale.

What do the HbA1c levels mean?

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Low HbA1c

High HbA1c

Why do I also need to check my blood glucose levels?

Think of HbA1c as an overall indicator of control. It does not tell us what your glucose levels are doing each day or at different times of the day. In order to optimise your diabetes therapy it is usually important to test glucose levels regularly to obtain glucose profiles to help decide on insulin doses or to guide medication changes as needed.

So the health team use both sets of information to formulate suggestions for optimising therapy.

How often should HbA1c be checked?

HbA1c is normally checked by your GP or diabetes clinic every three to six months. It is useful to have a recent result available each time you visit your doctor or diabetes nurse. Usually this will be processed by a laboratory, however sometimes the HbA1c will be obtained with a finger lance sample at the diabetes clinic using a desktop machine.

This result is obtained in about six minutes. A laboratory test is cheaper for the health service but if a result is needed for the consultation it is very convenient to have the result available immediately.

Glucose

The benefits of lowering HbA1c Two large-scale studies – the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT) – demonstrated that improving HbA1c by 11 mmol/mol for people with type 1 or type 2 diabetes cut the risk of microvascular complications (eye, nerve and kidney disease) by 25 per cent.

Gavin Hendry has been a diabetes nurse specialist since 1988. He works at Dunedin Hospital as part of a specialist diabetes team. Gavin believes the better informed someone is about their diabetes/treatment the better they will manage their condition.

He recognises living with diabetes is not easy and we ask a huge amount from people in asking for ‘perfection’.

Gavin has held senior positions on the National Executive Committee of the New Zealand Society for the Study of Diabetes (NZSSD) and the Diabetes Nurse Specialist National Committee.

Spring 2014 | DIABETES

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FAM I LI ES A N D CH I LD RE N

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D IABE TI C RES PO NS E DO GS

A girl’s best friend 18

DIABETES | Spring 2014

© JONO GRIBBLE

Ada is New Zealand’s first fully trained diabetic response dog.

She can ‘sniff out’ when her owner Vicki Parry’s blood sugars go too low, or too high. Caroline Wood reports.

D IABE TI C RES PO NS E DO GS

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ne night earlier this year Vicki Parry was washing dishes at home when her husky Ada came up and bumped her hard on the leg with her nose and held it there. She wouldn’t go away until Vicki dried her hands and went to check her blood sugars, which she found were about to go dangerously low. Meet Ada – New Zealand’s first diabetic response dog.

Ada has a potentially life-saving skill – she can scent when her owner has high or low blood sugars. She has been trained to ‘indicate’ when that happens so Vicki can test and adjust her insulin accordingly.

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checked myself and I was seven and I thought that’s ok. Then 20 minutes later I dropped really quickly.

“I use a pump and after having Ada I have made some changes and I don’t go low nearly as often as I used to. My control is much better, I’m much more stable.

“I am so grateful to Flip, I wouldn’t be here were it not for him and there would be no Ada,” she added.

There are about 120 diabetic response dogs worldwide but Ada is a New Zealand first – and the first husky in the world to be fully trained. Experts don’t know how the Vicki Parry, 30, a communications dogs can smell when blood sugars manager from Auckland, got Ada as are low or high but they think they a puppy because she wanted a pet detect a chemical change in their and fell in love with Ada’s winning personality and husky good looks. She owner’s blood that is secreted took Ada to puppy training classes led through saliva and sweat. by expert Flip Calkoen, of Flip’s Top Ada’s training continues. She Dog, and head trainer for the Kotuku now knows that she is allowed to Foundation. Flip gave a talk about override the ‘rules’ if she finds Vicki his work and Vicki, who has had is unresponsive, for example leaving type 1 diabetes since she was seven her basket even if she has been years old, was inspired to try training told to stay there. She is also being Ada with Flip’s help. Together they taught to get Vicki’s testing gear, or took Ada through the challenging a small juice, and put it in her hand, specialised training programme. not to drop it on the floor.

First Ada had to pass basic obedience Vicki has nothing but praise for the training and medical checks. Then Kotuku Foundation and hopes other she had intensive scent training – people will benefit from a diabetic teaching her to recognise low and response dog. high blood sugars in Vicki and how “I think a lot of people would to indicate – to give a hard shove benefit from having a dog like Ada, on the leg, not to bark or paw. Then particularly families with children. there was the public access training I would recommend it but it’s not to make sure Ada behaved well in an easy undertaking. You suddenly different situations while outside the have an animal 24/7 so people home. She passed with flying colours need to prepare for that. You have and in May became a fully trained to give to the dog or they won’t diabetic response dog. give to you – it has to be a team “She is incredibly accurate. Having relationship. It’s been a complete life her has been a huge benefit, way more change. I love it but it may not be than I was expecting,” says Vicki. for everyone.”

“She responds far more regularly *For more information, or to make a than I was anticipating. She picked up donation, contact Merenia Donne at the that I was going low quite frequently.

Kotuku Foundation: Assistance Animals She also indicates up to 40 minutes Aotearoa. You can email her on before I actually go low. One night I kotuku_foundation_aaa@hotmail.com was doing the dishes. She indicated, I or visit www.kotukufoundation.org.nz.

FAM I LI E S A ND CH ILD REN Response dog study proposed Plans are being drawn up to train more diabetic response dogs and place them in families with vulnerable children as part of a clinically-robust study. The aim, says paediatric endocrinologist Professor Paul Hofman, who would spearhead the research, is to see whether response dogs can consistently detect low or high blood sugars and measure how well they do it.

Prof Hofman, who works at the University of Auckland’s Liggins Institute and Starship Hospital, has known Vicki since she was a child. He has been impressed with Ada and her abilities.

“Vicki and I had a talk about Ada and I thought it was very exciting. Looking at what has been done in other parts of the world, I thought that maybe it would be a non-invasive way of glucose monitoring, I could see it could be of use. It would be an additional safeguard – giving some assurance overnight for parents, for example.

“The idea would be to train three dogs with the Kotuku Foundation and place them with specific families with teenagers. It’s not cheap to train a dog – about $50,000 – but in the scheme of things, you have a dog for seven or eight years, it would be cheaper than the cost of a continuous glucose monitor and testing strips over eight years.”

Prof Hofman is applying for research grants to allow the study to take place.

It would begin next year subject to grant funding being available.

“First, and most importantly, how reliably and consistently can the dogs detect low and high blood sugars? We would measure how well the dog does compared with a continuous glucose monitor,” Prof Hofman added.

Kotuku Foundation founder Merenia Donne is looking forward to being involved in the research study. She also believes response dogs can save money as well as lives.

“People who have type 1 diabetes are going to end up in the hospital system at some time. It’s an average cost of $5,000 per admission. If that can be averted you can save the health system money as well as transforming someone’s life.”

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C ARE A N D PRE VE NTI O N

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PREVENTI NG STRO KES

Simple lifestyle changes reduce stroke risk People with type 1 and type 2 diabetes are more likely to have a stroke than people who don’t have diabetes, which means it’s important to be aware of the risks and symptoms of a stroke.

Julia Rout from the Stroke Foundation explains the best ways to reduce stroke risk.

Strokes happen when not enough blood reaches the brain, causing the brain cells to die. They are usually the result of a combination of factors that have been present or developing for a long period of time. If someone has two or more risk factors, the risk of stroke is dramatically increased. You can greatly reduce your chance of having a stroke by controlling the following risk factors:

stroke than someone the same age who doesn’t smoke and has normal blood pressure.

1. Check your blood pressure

4. Limit alcohol intake

Failure to detect and control high blood pressure is the number one cause of avoidable strokes. A person with high blood pressure is up to seven times more likely to have a stroke than someone with normal or low blood pressure.

High blood pressure puts too much pressure and stress on the walls of blood vessels and increases the risk of both haemorrhages and blood clots.

2. Stop smoking Smoking quadruples stroke risk.

Chemicals and gases in tobacco smoke speed up the process of atherosclerosis (hardening of the arteries) and make blood vessels throughout the body tighten, reducing blood flow. Smoking also makes the blood more likely to clot, especially inside damaged blood vessels. Talk to a GP for advice and support, or call the Smoking Quit Line on 0800 778 778. If you smoke and have high blood pressure you are 18 times more likely to have a

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3. Exercise regularly People who are physically inactive have greater stroke risk than those who keep active. Being physically inactive over a long period is linked to high blood pressure, a leading cause of strokes. Exercise can also help with stress management.

Studies now show that drinking up to two small alcoholic drinks a day can reduce stroke risk – but drinking any more than that increases stroke risk by as much as three times. A drinking binge creates as much as five times greater risk. Regular heavy drinking increases stroke risk because it can raise blood pressure and increase the risk of haemorrhage in the brain.

5. Eat healthily and reduce salt

Keep on top of cholesterol levels by having a blood test and being prepared to change your eating habits. If necessary, a doctor may also prescribe a cholesterol-lowering drug (called lipid-lowering agents), usually a ‘statin’.

7. Find out if you have atrial fibrillation Atrial fibrillation is a type of irregular heartbeat. People with this condition have a five times greater stroke risk because the irregular heartbeat may lead to blood clots forming in the heart. These can then break off and travel though the blood vessels to the brain where they may cut off blood supply, causing a stroke.

If someone suspects they have atrial fibrillation, it is important to see a doctor. The doctor might prescribe tablets to make the blood less sticky and less likely to form clots (warfarin) and to make the heartbeat more regular.

Cutting down on fat and salt should lower your blood pressure and cholesterol levels. Too much fat in a diet can lead to silting of the arteries (atherosclerosis), which can cause strokes. Too much salt can raise blood pressure and this also can cause strokes.

8. Control your weight

6. Lower your cholesterol

People with diabetes are more likely to have a stroke. Controlling blood glucose levels and keeping them within recommended ranges will reduce this risk (see panel opposite). * For more information about strokes see: www.stroke.org.nz

Cholesterol is essential to the body’s cells and normally the body will produce all the cholesterol it requires. Consuming foods high in cholesterol and saturated fats may accelerate atherosclerosis.

Being overweight strains the entire circulatory system and creates higher cholesterol levels, high blood pressure and diabetes – all of which increase stroke risk.

9. Control your blood glucose

PREVENTI NG STRO KES

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CARE AND P RE V ENTION

Warning signs It is important to act fast if you suspect someone has had a stroke. Doctors have many ways to rapidly restore blood flow along blocked arteries. These are most effective when delivered as fast as possible – preferably within three hours from the onset of symptoms.

Remember the handy acronym FAST to check for signs of stroke:

F

A

Face

Arms

Ask the person to smile. Does one side of the face droop?

“If you smoke and have high blood pressure you are 18 times more likely to have a stroke than someone the same age who doesn’t smoke and has normal blood pressure” THE STROKE FOUNDATION

Ask the person to raise both arms. Does one arm drift downward?

S Speech

Ask the person to repeat a simple phrase. Are their words slurred or strange?

T Time

If you observe any of these signs, call 111 immediately.

Diabetes increases stroke risk People with type 1 and type 2 diabetes are more likely to have a stroke than those without either condition. One study published in Diabetes Care in 2007 found type 1 and type 2 diabetes were associated with substantially increased risks of total (and most sub-types of) stroke.

The incidence of total stroke was four-fold higher in women with type 1 diabetes and twice as high in women with type 2 diabetes. More than 115,000 female patients aged 30-55 years were followed over a 25-year period for the study.

A more recent study found people with type 1 diabetes were five times more likely to have a stroke than people who didn’t have the condition. Patients who had a stroke tended to be older and have had diabetes longer, according to the report published in Diabetes Care in October 2013. Having both diabetic nephropathy and retinopathy increased the risk of stroke six-fold. Researchers concluded that an early diagnosis of diabetes complications could lead to a decrease in stroke risk.

Approximately one in eight people with type 2 diabetes will have a stroke, says Professor Merlin Thomas in his book Understanding Type 2 Diabetes. He says the impact of having a stroke is more serious in those with type 2 diabetes because the frequency of irreversible brain damage, recurrent stroke, disability and mortality is higher. Age, high glucose, high blood pressure and high cholesterol levels and the presence of atherosclerosis (in the heart or legs) are major risk factors for having a stroke in a person with type 2 diabetes. Clinical studies show that people with type 2 diabetes can reduce their risk of stroke by over two-thirds if they follow all the guidelines, including improving blood glucose control, he added.

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GARD EN I N G

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SPRING CROP

Peas please Edible gardening expert Rachel Knight explains all you need to know about growing sweet spring peas.

When I was a little girl I wouldn’t eat any vegetables. My Mum insisted I eat a single pea. The next day I had to eat two, the following day three and so on. A few weeks later I was consuming a big spoonful of peas and still making my mum count them all out individually. By that stage I’d grown to like them and I’m glad she persisted in broadening my tastes.

Peas are a cool weather crop so you can often squeeze them into your garden before the tomatoes in spring or after you’ve pulled out your zucchinis in autumn. They need a minimum temperature of just 10°C to germinate reliably and can tolerate a relatively poor soil, preferring a neutral pH. They don’t like the heat, humidity or strong winds.

Starting peas in pots protects them from pests. Mice and slugs are the main culprits. However peas do better if sown directly in the soil and sometimes ‘sulk’ after transplanting from pots. Sowing 20 peas into potting mix in a metre long piece of guttering avoids this, by minimising

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root disturbance. Just dig a trench the same shape and size as the guttering and slide the seedlings into it when they’re about 10cm high. Then it’s time to sow some more seeds to make sure you’ll have a succession of pods ready to eat.

Most kids love to eat peas fresh from the pod and will be a great help picking them – a job that might need doing daily during their peak. You can get purple and golden-podded peas which are definitely easier to spot among the foliage.

Peas need strong support as some varieties grow up to two metres tall and even so-called dwarf ones seem to scramble up to a metre high. They use their tendrils to twine around anything they encounter. I poke prunings from my fruit trees in around young peas to help them get started and keep tender shoots off the ground and away from slugs and snails. Most of us eat plenty of frozen peas and although they’re delicious, fresh ones are even better. If you’re lucky some of them may even make it into your kitchen. In my experience humans have a tendency to be the worst predators of peas in our gardens. I don’t think my Mum would complain. More peas please!

Which green pea for me?

Shelling peas slide out of their pods with your thumb into a bowl with a satisfying rattle. I favour ‘Wando Select’, an English heirloom pea with dark green pods filled with seven or so peas.

Snow peas or ‘mange tout’ are eaten whole when the pods are still flat (before pea seeds start to form).

‘Carouby’ has beautiful purple flowers and pods that become fibrous less quickly than other varieties.

Sugar snap peas with round pods are like a shelling pea but tender enough to eat the fleshy pods with the peas still inside.

Exuberant sweet peas are inedible but I still find space for a few as I love their colour and fragrance.

14 NOVEM BER

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WORLD DI AB E TES DAY

Go blue for breakfast It’s a breakfast club with a difference – organise a healthy breakfast in your community, share the event globally and post your healthy recipes online. It’s all part of a special worldwide campaign to help celebrate World Diabetes Day 2014. Caroline Wood reports.

The International Diabetes Federation is asking people from around the world to organise a healthy breakfast activity in their local community. The aim is to highlight the importance of eating healthy to help prevent type 2 diabetes and avoid the serious complications of the disease. Go blue for breakfast is the theme for this year’s World Diabetes Day on 14 November, which coincides with Diabetes Awareness Week in New Zealand.

You can join the campaign by: • Getting your friends, family, colleagues or members of your organisation together and asking them to join you for a healthy

breakfast to mark World Diabetes Day on 14 November.

• Identifying a public place in your town or city where the breakfast could be held. If possible, choose a well-known location to engage the wider public and attract media interest.

• Ensuring that all participants at the breakfast wear blue, the colour of the blue circle – the global symbol for diabetes awareness. The International Diabetes Federation has a selection of blue-branded materials that you can choose from.

Once your activity is confirmed you can submit it on the IDF’s custom online platform – http://goblueforbreakfast. worlddiabetesday.org – so it can be shared with the global community. All Go Blue for Breakfast events submitted will be displayed on its global map and the number of participants will go towards filling the blue circle in the centre of the platform. Taking part will help the IDF reach the largest total possible in support of the 382 million people with diabetes and the many more at risk.

Submit your healthy breakfast!

The Go Blue for Breakfast online platform will promote the importance of starting the day with a healthy breakfast by showcasing recipes from around the world. If you have a healthy recipe that you would like to share with the global community, you can submit it online by listing the ingredients, measurements and cooking method and providing a picture.

Recipes from Argentina, Mexico, Jamaica and Spain have already been submitted. *Dietitian Ann Gregory has some great tips for healthy breakfasts, see overleaf.

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H E A LTHY BREAKFAST ID EAS

Breakfast the ‘must have’ meal of the day Eating a good breakfast will help with blood glucose control as well as providing a number of other health benefits. Dietitian Ann Gregory gives some tips for eating a healthy breakfast – whether it’s a fast breakfast on the go or a more leisurely weekend affair.

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DIABETES | Spring 2014

We are always told that breakfast is the most important meal of the day, so why is breakfast so important?

Research has shown eating breakfast can help you lose weight, make you more alert and give you more energy.

A recent study from the University of Bath showed that people who eat breakfast used more energy during the morning than those who didn’t have breakfast. It also showed that people who ate breakfast had better blood glucose control late in the day than those who didn’t.

The four breakfast rules Having a healthy but delicious breakfast is easy if you follow the following four ‘rules’:

1

Use low-fat milk and low-fat yoghurt.

2

Choose a breakfast cereal that has 15g or less of sugar per 100g of cereal.

3

Eat wholegrain/multigrain breads.

4

Choose a low-fat spread.

H EA LTHY BREA KFAST I DEAS

Weekday breakfasts – quick and simple It can be tempting in the morning rush to skip breakfast. The ideas below are quick and easy to prepare.

• Breakfast cereals are a great way to start the day. Top with some chopped raw fruit or stewed fruit and low fat milk or yoghurt.

• Try making your own muesli with your personal blend of nuts and seeds added to rolled oats lightly toasted.

Finish off by adding your favourite dried fruit.

• To beat the spring chill start the day with a bowl of porridge. It is easy to make and you can add fruit, nuts and spices to add some zing. If using porridge sachets check the sugar content to make sure it fits with the recommendation above – no more than 15g of sugar per 100g.

• Top toast with marmite, peanut butter or a small amount of low-sugar jam. Or try one or a combination of sliced tomatoes, or cottage cheese, or half an avocado or lean ham. For a special treat try low-fat creamed cheese and smoked salmon.

• A boiled or poached egg with wholegrain toast is quick to prepare and will keep you going until lunchtime.

• Blend up a smoothie using low fat milk, low fat yoghurt and your choice of fruit. Add some fibre by including some rolled oats or ground flaxseed.

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FOOD

Weekend breakfasts – leisurely and relaxed There is more time to prepare and enjoy a healthy leisurely breakfast at the weekend with family or friends. This does not need to be a full fry up. Here are some suggestions to try.

• Scrambled eggs with smoked salmon seasoned with some chopped chives and accompanied by wholegrain toast.

• Try making a healthy version of eggs Benedict – poached eggs on English muffins – and make a sauce using low-fat mayonnaise with mustard and lemon juice.

Add some cooked spinach for eggs Florentine.

• Omelettes are a good choice and can be filled with a wide variety of vegetables in season – for example tomatoes, mushrooms, courgettes. Add a little bit of chopped lean ham and some grated low-fat cheese. Don’t forget some wholemeal bread to provide the carbohydrate.

• Try toasted bagels with low-fat cream cheese and smoked salmon for a taste of New York.

• Fritters made with seasonal vegetables – corn, courgettes, grated carrots and mushrooms served with chutney or salsa – are a delicious start to the day.

Stuck for ideas?

Check out www.breakfast-eaters.org.nz for lots of healthy low-cost breakfast recipes and ideas for the whole family. The Breakfast Eaters campaign is based on evidence that breakfast has a positive effect on academic performance, concentration, general nutrition, and weight. The website is part of an initiative by the Health Promotion Agency to make breakfast the 'must-have' meal of the day and increase the number of kids and wha¯nau eating a good breakfast every day. All the recipes and advice are checked by a nutritional expert and are New Zealand-focused.

™

Spring 2014 | DIABETES

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LE T ’S G E T A CTI VE

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HIGH INTENSIT Y WO RKO UTS

Fast intense workouts Personal trainer Simon Giannotti talks about the benefits of high intensity interval training and gives some examples so you can try it out for yourself.

High intensity interval training (HIIT) is one of the top fitness trends for 2014. HIIT is popular because it gets the heart rate up in less time, is quick and convenient and doesn’t need any equipment. The great thing about HIIT is that there are endless possibilities for things you can do: lots of different kinds of exercise can be turned into high intensity interval training (see the examples below).

20–30 minutes but if you are just starting out maybe try 10-15 minutes.

What is HIIT?

• what exercises are safe for me?

High intensity interval training involves short periods of intense exercise followed by a longer period of light exercise. The aim is to get you to work at near 100 per cent effort for 10-20 seconds and then bring the heart rate back down with 60–90 seconds of light exercise. An ideal session of HIIT is usually between

• are there any activities I should avoid?

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DIABETES | Spring 2014

Preparation Before getting started make an appointment for a medical check with your doctor and let them know you are planning to do high intensity training. Also let them know if you have any joint or muscular pains.

Be sure to ask:

• are there certain times of the day that I should avoid exercising?

• could high intensity exercise affect the medication I take for diabetes or other health conditions?

People with type 1 diabetes and

some people with type 2 diabetes are at risk of hypoglycaemia during or after any type of exercise. A ‘hypo’ occurs when your blood glucose level drops to 4.0mmol/L or below and this requires immediate treatment.

You will be more prone to having low blood glucose levels if you take insulin or some types of oral diabetes medication. Make sure you always have some quick acting and long acting carbohydrate with you.

Frequent testing before, during and after exercise is essential. Be careful exercising when your insulin is having its peak effect. Exercise will make your body cells more sensitive to insulin and this effect can last for up to 24 hours after you exercise.

Make sure you wear supportive shoes and practise good foot care.

H I G H I NTENS ITY WO RKO UTS

Warm up Before getting into the workout you must always warm up. The warm up should replicate the movements you will be performing as well as raise your heart rate.

Warm up example 2 minutes of walking – increasing the pace as you go.

10 squats 5 push-ups Repeat routine twice.

Do the warm up to your ability. For example if you can’t do a full push up, keep your knees on the floor or use a window ledge or bench for support.

Choose your activity One of the benefits of HIIT training is that it can be done by anyone and can be tailored to suit anyone.

Choose an activity that gets your heart going (have a look at the examples below) and do it with as much effort as you can. Follow the short intense ‘snack’ with a longer period of lighter activity.

Example 1 Walking and running Beginner 30 seconds of brisk walking or climbing stairs then 90 seconds of slow walking.

Repeat 5-10 times.

2–3 times a week.

Intermediate 30 seconds of running or sprinting then 60–90 seconds of jog or brisk walking.

Repeat 10-15 times.

3-4 times a week Advanced 1-2 minutes of running or sprinting then 60 seconds jog.

Repeat 10–15 times.

3–5 times a week.

Example 2 Push ups & squats Beginner 30 seconds of push-ups then 90 seconds walk.

Repeat 5-10 times.

2–3 times a week.

Intermediate 30 seconds of push-ups then 60–90 seconds slow squats.

Repeat 10–15 times.

3–4 times a week.

Advanced 1–2 minutes of push-ups then 60 seconds of squats.

Repeat 10-15 times.

3–4 times a week.

Example 3 Cycling Cycle for a minimum of 17 minutes per session. Throw in a handful of 30 second bursts of high intensity cycling. After the bursts, rest or cycle slowly for four minutes.

Research showed that people who followed the above routine were able to metabolise glucose better than before they started doing HIIT.

Other types of exercises you could do • Weights (ask your gym for an HIIT programme).

• Lunges, step ups or tricep dips (substitute for squats or push ups in example 2).

*Thanks to diabetes nurse specialist Tess Clarke for consulting on this article.

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LE T ’ S GE T ACTIVE

Kiwi research shows benefits of HIIT training for blood glucose control Exercise ‘snacking’ – short bouts of high intensity exercise – was found to improve blood glucose in individuals with insulin resistance. Researchers from the University of Otago found that brief, intense interval exercise bouts undertaken immediately before breakfast, lunch and dinner had a greater impact on post-meal and subsequent 24-hour glucose concentrations than did a single bout of moderate, continuous exercise undertaken before dinner.

Lead researcher Monique Francois said: “We found exercise snacking before meals to be a novel and effective approach to improve blood sugar control in individuals with insulin resistance. The practical implications of our findings are that, for individuals who are insulin resistant and who experience marked post-meal increases in blood glucose, both the timing and the intensity of exercise should be considered for optimising glucose control.” The research was presented at the New Zealand Society for the Study of Diabetes’ conference in May.

Simon Giannotti is a personal trainer who works at Results Room Personal Training, in Wellington. He has type 1 diabetes and knows how important exercise is to help keep healthy and positive.

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VOTE DI A BETES

1. What specific policies does your party have to help people living with diabetes?

2. What will your party do to reduce the number of people at risk of developing type 2 diabetes?

Here are the responses from each party's health spokesperson.

Green Party – Kevin Hague Q1: The

Green Party is concerned about health services not being able to meet the needs of people with diabetes now and in the future. We would provide ‘diabetes navigators’ in primary care to work alongside people to manage their diabetes and access the services they need. We would fund primary care services to provide free annual comprehensive checks for people with diabetes and extend Care Plus for more regular doctors’ visits, and Green Prescriptions. We would also properly fund hospitals to keep up with need, rather than having to manage the health cuts delivered by this Government, and we specifically would increase provision for ophthalmology, dialysis, transplantation and bariatric surgery.

C T IO

Q2: The Green Party is extremely

concerned about the rising rates of type 2 diabetes and the current Government’s reduction of diabetes and obesity prevention services.

Calculating and reducing the social and economic cost of diabetes have been a major focus for us this term of parliament. We know that diabetes and prediabetes affect one in four adults, so the projected treatment cost of 1.8 million dollars by 2021 is a likely underestimate.

We have developed a package of 12 specific measures called our ‘Diabetes Action Plan’ to help reduce the future burden of diabetes, mostly through prevention and reduced disease complications.

These measures encompass everything from socio-economic risk reduction, to food education and labelling, change of the food environment, and targeted primary care services. You can read the full plan online here: www.greens.org. nz/factsheets/green-party-diabetesaction-plan

There are nearly 250,000 New Zealanders living with diabetes and an estimated 500,000 people have prediabetes. If the current trend continues, the number of people with diabetes is expected to double over the next 20 years. Strong government leadership is vital to avert this diabetes time bomb.

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AL •

Diabetes asked parliamentary parties about their diabetes policies ahead of the September polls. We asked two simple questions:

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Political parties pitch for your vote

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G E NE RA L E LECTI ON 2014

Labour Party – Annette King

Mana – Annette Sykes

Maori Party – Tariana Turia,

Q1&2: The

Q1: Mana

Q1: Our key

VOTE DI A BETES

impact diabetes is having on our families and on our communities is of enormous concern to Labour.

It is not helped by the fact the National Government dropped diabetes as a health target, buried it as a prevention priority, and slashed funding to many public and preventative health initiatives Labour had introduced to tackle the problem. When we recently asked for the number of patients with diabetes and projected increases in the numbers of people diagnosed with diabetes we were told the Ministry of Health “does not collect projection data, and does not collect information on the actual number of people diagnosed with diabetes”.

This is unacceptable. How can you have a plan to help those with diabetes when it’s not known how many people have diabetes or how many are likely to be diagnosed with it into the future?

Non-communicable diseases, such as diabetes, place significant costs on New Zealand both socially and economically. Labour will make preventing and managing noncommunicable diseases one of our eight core priority areas. We’ll develop, in collaboration with health experts and consumers, detailed public health plans to tackle the major causes of these diseases, and work with them to develop strategies to promote good health and wellbeing.

We recognise the real strain the health sector has been put under in recent budgets. We will ensure the health budget keeps up with rising costs and the growing population, and we will rebalance the health system to better respond to changing patterns of need.

will work to improve the living standards of low-income whānau in terms of housing, income, and employment. Higher standards of living are critical to addressing health issues such as diabetes. A key health focus of Mana is to invest in supporting the health and wellbeing of those living with diabetes by making primary health care visits and prescription charges free and accessible for all and by extending free after-hours medical care to children up to 18 years, those who are still dependents, and for senior citizens. We would also make the public health system more comprehensive by including health services for eyes, ears, and teeth – which is especially important for those with diabetes. Further to this, Mana would introduce plain language information for those living with type 2 diabetes to assist them to successfully manage their condition.

focus is on prevention. We will continue to focus all Māori primary health on wellness programmes and assist whānau to plan and manage these with support. A major focus for us is to return to more natural kai.

We will initiate education in the school curriculum, and post-school training, which supports whānau to provide healthy, nutritious meals.

We will also continue our highly successful support for maara kai.

We recommend Government carries out research on regulating the amount of sugar in beverages or imposing a tax on beverages that contain unhealthy amounts of sugar. We want to promote a campaign against sugar drinks and energy dense foods. We want our whānau to be supported by an equitable, sustainable health system. We want to accelerate clinical and service integration, to achieve equity in access, and to focus on targets that enable public reporting.

Q2: A key aspect of Mana’s health

Q2: Our key focus is on primary

policy is to address those factors that contribute to ill health and make it more likely that people will develop type 2 diabetes, such as diet. Alcohol laws would be tightened to end alcohol advertising and restrict the ability of alcohol companies to sell, promote, and discount alcohol in order to reduce consumption. These laws would also be extended to unhealthy kai, enabling restrictions to be placed on advertising, including that of fast food chains, and to more strongly regulate what goes into processed foods and beverages. Communities would also have the power of veto over whether and where fast food outlets could be established.

health care and prevention. We will also invest further funding into bariatric surgery to address diabetes, obesity and heart disease.

On 20 May I announced, in my capacity as Associate Minister of Health, new funding of $10 million, which has been set aside for at least 480 bariatric surgery operations over four years. Weightrelated illnesses such as diabetes can be improved through bariatric surgery, and I am pleased that through the Māori Party advocacy we now fund this type of surgery.

We will promote a whānaucentred approach where families with a history of diabetes receive screening and on-going check-ups.

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GE N ER A L ELEC TI O N 2 014 National Party – Tony Ryall Q1&2: This

government is serious about tackling diabetes – demonstrated through a range of initiatives that target both the causes and longterm management of the illness.

The earlier diabetes or prediabetes is detected the sooner people can make healthy changes to their lifestyles. This is why we have put a strong focus on prevention. More heart and diabetes checks is one of our six national health targets and is a gateway to better care. When we introduced this target two years ago only 46 per cent of people were getting checked. Latest results show it is now 78 per cent.

We have invested an extra $12 million to expand local diabetes care improvement programmes. This is providing subsidised podiatry services and nurse-led diabetes clinics to help people better manage their health. Diabetes New Zealand is part of the oversight group for this work. The government has made it easier for people with diabetes to get their medication. In 2011 some registered nurses began prescribing medication to diabetes patients: there are now 27 who provide this care.

We know that obesity is a contributing cause of diabetes.

We announced $40 million in this year’s budget for Healthy Families NZ, an initiative that includes community-led local health promotion activity to help families make healthier choices and improve their health. This initiative is based on one of the very few anti-obesity programmes that actually works. It follows from our Budget 2013 commitment to double the number of Green Prescriptions over four years.

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New Zealand First – Barbara Stewart Q1&2: New

Zealand First proposes a largescale national screening programme to identify people with prediabetes. This is urgently required. A preventable health strategy is needed with an investment in health education.

The Government’s shortsighted policies are failing to stem New Zealand’s diabetes epidemic.

Diabetes NZ Supplies Ltd closed its doors because the Government decided its range of test strips, meters, and diabetes information would no longer be Pharmac funded. Removing the extra help provided by DNZS has placed increased pressure on GPs. More than one in four Pacific Islanders, one in five Māori, and just over one in 10 Pākehā aged between 31 and 50 have prediabetes. We have one of the highest rates of diabetes in the world, which has already cost taxpayers more than $1 billion in less than a decade.

Drastic action including widespread education on the impact of fast foods and fizzy drinks is needed to fight the looming diabetes epidemic.

Sugar consumption from fizzy drinks is far too high, particularly for young people. Action needs to be taken now to prevent diabetes rates increasing. It is time to take a hard look at the products of companies who are making large profits at the expense of public health. The cost of establishing coordinated strategies and screening programmes would quickly be recouped through the health savings it would generate.

United Future – Peter Dunne Q1: • Direct

the Ministry of Health to implement a national workforce development strategy to address both current and future long-term workforce shortages, understanding that this may mean drastic changes like a doubling in the number of doctors trained. • Cut tuition fees for those studying medicine, dentistry, pharmacy and nursing. • Broaden community services card coverage to include subsidies for basic dental check-ups and basic procedures. • Continue to reduce waiting lists for elective surgery for those who are likely to wait longer than six months by requiring DHBs to contract out work to Private Hospitals.

• Extend mobile surgical services.

Q2: A key component of our overall

health policy is about prevention.

• Expand the prevention work of the Public Health Office. • Establish a national register for type 1 diabetes.

• Establish a Diabetes Research Fund.

• Increase funding for type 2 diabetes testing. • Expand the development of strategies to reduce noncommunicable diseases. • Support public education campaigns that emphasise the importance of nutrition and exercise and the consequences of poor nutrition such as diabetes, heart disease, stroke, cancer, and premature ageing. • Support the use of Green Prescriptions through the development of safe and convenient venues for physical activity, such as walking paths and bicycle lanes.

• Treat child obesity as a parenting issue and use parent education as the first line of attack to reduce obesity rates. • Support communitybased education campaigns that empower parents and extended families to take responsibility for healthy eating and lifestyles.

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T1D Challenge Machu Picchu An international team of people with type 1 diabetes scaled the heights of legendary Machu Picchu in a physical challenge aimed at delivering a positive message of hope.

Caroline Wood reports.

The 1D Challenge Machu Picchu is the second World Diabetes Tour expedition sponsored by Sanofi, following last year’s successful Kilimanjaro challenge. This year an international team trekked along the famous Salkantay route from the city of Cusco, to reach the ancient Inca settlement Machu Picchu in the Andes mountains.

In doing the challenge, the team members wanted to demonstrate a

positive attitude to type 1 diabetes and show the global type 1 diabetes community that by striving for control of their diabetes, they can dare to dream.

One member Mary Shi, 28, from China, said: “I want to prove that diabetes will never hold us back, we can do whatever we want! I like to explore nature and Machu Picchu is an amazing place for me.”

Representing eight countries across four continents, the 12-strong team (10 of whom have type 1 diabetes) is dedicated to inspiring other people with type 1 diabetes, along with their families and caregivers.

From a variety of different backgrounds, ages and trekking experience, the team members walked for over eight hours a day through the high jungle habitat of

the Andes, travelling more than 70 kilometres to reach their goal.

Managing their diabetes under these circumstances was hard.

They reached altitudes of up to 4,600 metres en route to their destination. They had to deal with altitude sickness while keeping on top of their daily injection schedule to maintain blood glucose control.

By taking part in the July expedition, the team members wanted to show that even when a challenge is difficult, with the right preparation and good knowledge of the body’s dietary and physical needs, it is possible to control type 1 diabetes and open the door to a life full of possibilities.

The World Diabetes Tour Founded in 2008, the World

Diabetes Tour association was created by Christophe Crampé and Delphine Arduini to help people with type 1 diabetes and raise awareness of the condition.

The association unites people with type 1 diabetes from around the world, to learn from each other so they can be stronger. They have ventured on numerous sporting challenges around the globe. During their world tour they have held meetings and conferences in France, India, Thailand, Japan, Polynesia and China. *You can find out more about the World Diabetes Tour association on their website: www.planete-insuline.com

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Participants needed for global prevention trial Volunteers are needed to take part in a study to determine the best lifestyle strategies for preventing type 2 diabetes. Caroline Wood reports.

PREVIEW is an international three-year study that is being undertaken in six European countries, Australia and New Zealand. It aims to determine the best lifestyle strategies for weight loss and prevention of type 2 diabetes in a population of overweight individuals.

The study will compare two nutritional programmes (high or moderate protein/low GI diets) that have been shown to be very effective in weight loss and diabetes prevention, and are comparatively simple to follow.

Participants will also be asked to stick to one of two physical activity plans so the combined effects of diet and exercise can be tracked.

Preview NZ is being led by nutrition expert Professor Sally Poppitt, with general practitioner and obesity researcher Dr AnneThea McGill, nutritionist Dr Marta Silvestre, and exercise specialist Dr Nick Gant, all from the University of Auckland.

Dr Marta Silvestre, who is coordinating the study, answers common questions about how to take part.

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What can I expect if I participate as a volunteer?

Participants can expect to lose a significant amount of their body weight and avoid developing diabetes, as well as learning a new way of eating and exercising to have a better lifestyle.

Am I eligible?

Participants can be male or female, aged 25-70 years, obese or overweight. All participants should be living in the Auckland region, in general good health and should not have diabetes. Applicants will be screened and those with high blood glucose levels (prediabetic) will be eligible.

Meal replacement sachets and dietary and exercise counselling will be provided free of charge.

Participants must be able to travel to the University of Auckland’s Human Nutrition Unit in Mt Eden and TÄ maki campus in Glenn Innes for regular visits with the study team.

What will happen to me during the trial?

I would like to participate. How can I do that?

For the first two months, study participants will follow a low-energy diet using meal replacement sachets, and they are expected to lose at least eight per cent of their body weight.

The ones who successfully lose at least eight per cent of their body weight will be randomly assigned to a nutrition and exercise programme which will provide the basis of their new healthy lifestyle programme over the next three years, to make sure their lost weight is not regained.

Please follow the link below to fill out the online prescreening questionnaire, which will be used to analyse your eligibility: www. surveymonkey.com/s/STQ7MVJ More than 180 participants are already enrolled and the researchers hope to have 315 by February 2015. *For further information, please contact: Marta Silvestre on 09 630 1162 or email nzpreview@gmail.com

Global diabetes epidemic prompts study The PREVIEW study aims to develop international guidelines to prevent type 2 diabetes. Almost 30 percent of New Zealand men and women are classified as obese, which is a major risk factor for diabetes. Type 2 diabetes accounts for about 90 per cent of all cases of diabetes. It affects 347 million people worldwide and is diagnosed in 50 more New Zealanders every day.

Teen camps coming soon We have had a very busy few months at Diabetes Youth New Zealand and it looks like this will continue for the rest of the year!

I am happy to announce our next Diabetes Youth Conference will take place in sunny Nelson from 20-22 March 2015. Following feedback received from the last two conferences, we have decided to move to a break-out or smalllearning session format. We hope to cover a variety of topics for families and people with diabetes from ages 0 to 25 years. The main subject areas will be: support, technology, nutrition, development, schools, sport and psychology. Our aim is to have a variety of speakers so families can learn from one another, so guest speakers will include people with diabetes as well as health professionals. We hope to open registrations before the end of the year, but please mark the date on your calendar now. You can always check our website or Facebook page for updates.

Diabetes Youth New Zealand has been fortunate to be chosen by the Presbyterian Women's Group and the Methodist Women's Group of New Zealand to be the recipient of their national fundraiser for the coming year. We have decided to use this funding to initiate teen camps across the country. Teens have a different set of needs and they absolutely have a different idea on what they find fun and interesting. It is an area in which many local diabetes societies across the country have said they need assistance. We are only in the early stages of what these camps will look like but are excited to have the opportunity to give back to this age group, as well as local societies.

We are happy to announce that we have signed competitive speed cyclist Stephanie McKenzie as our new Ambassador. Steph has just finished competing in the 2014 Commonwealth Games in Glasgow where she had some personal best times. We are very excited to have Steph on board and hope that all aspiring T1 athletes have the opportunity to meet her.

On a not so wonderful note, we have had to cancel the National Diabetes Walk in November. While it's a wonderful idea to raise awareness and funds for local diabetes societies, it was just something a bit too big for local areas at this point in time. We aren't counting it out

for the future, we just have to take a step back and see how we can approach this type of large scale event in a different way.

Lastly, we have many other initiatives taking place. We are a committee of volunteers and could always use help in bringing our initiatives to fruition. It doesn't mean you have to join the committee, it might just mean showing up to help on a day of need or help in putting together Newly Diagnosed Packs for the rest of the country. If you have an interest in assisting us, please let us know. By the same token, if you feel you may have an interest in helping your local society let them know or we will be happy to forward on your contact details. You can reach us at contact@diabetesyouth.org.nz Until next time.

Renata Porter

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

Diabetes Youth New Zealand

JOIN YOUR LOCAL SUPPORT GROUP BY VISITING

General enquiries: contact@diabetesyouth.org.nz Phone: (09) 623 2508

FIND US ON FACEBOOK AND TWITTER

www.diabetesyouth.org.nz

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Charting a course for diabetes A comprehensive plan setting out key priorities for diabetes prevention, diagnosis and management during 2014/15 has been published by the Ministry of Health. Caroline Wood reports.

Health services for people with diabetes in New Zealand will be ‘high quality, patient focused and integrated across the health continuum, from prevention to tertiary care, thereby reducing the diabetes burden and enabling optimum health outcomes’. This is the Ministry of Health’s diabetes vision as set out in its national work programme for 2014/15.

The comprehensive document draws together the work of the Ministry of Health, the National Diabetes Service and Improvement Group, the Health Quality Safety Commission, district health boards and primary health organisations. Together they are tasked with implementing the Government’s priorities for diabetes prevention, diagnosis and treatment.

The Ministry of Health Work Programme for Diabetes 2014/15 sets out five key work programme goals:

1. Prevent: Limit and reduce the risk of developing diabetes.

2. Identify: Reduce the risk of

developing complications for those New Zealanders with diabetes.

3. Manage: Reduce the risk from complications of diabetes where they exist.

4. Enable: Support and develop

systems to provide high quality care for people with diabetes.

5. Monitor: Continually improve

diabetes services to ensure equity of access and quality care.

Under each goal is a set of initiatives and ‘deliverables’ – how success will be measured. Examples of initiatives include: prediabetes pilots, more heart and diabetes checks, developing podiatry and retinal models of care, early identification of complications, quality diabetes care standards, a virtual diabetes register and quarterly reporting by district health boards against their diabetes targets.

Chris Baty, President of Diabetes New Zealand, who also sits on the National Diabetes Service and Improvement Group as a consumer rep, welcomed the work plan. While it nevertheless required more work in the area of prevention, the plan was still the most comprehensive and coordinated she can remember.

“I think it’s important for the diabetes community to know about the diabetes work programme. It shows evidence of a really well coordinated, structured and integrated national system (plan) for diabetes. People can be confident that once they are diagnosed they will be put on good care plans.

“There is such a lot of proactive positive work going on to do with diabetes. It should be of comfort for people in the community to know this. There is a plan from prevention to identification to management.

She particularly welcomed the plan’s emphasis on data collection, evaluation and benchmarking to measure success, and the fact it was being published so the public can see what is in it.

The Ministry of Health’s diabetes team works with the National Diabetes Service Improvement Group, a Ministry-funded group of experts, to develop new diabetes initiatives.

The group is currently looking at: • • • • •

prevention and prediabetes complications of diabetes patients with type 1 diabetes hospital inpatients with diabetes workforce requirements and development • health system performance • self-management.

You can find a link to the Ministry of Health Work Programme for Diabetes 2014/15 on www.nzssd.org.nz.

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DIABETES | Spring 2014

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.

HypoHelp Website & App You and your family & friends can visit www.hypohelp.co.nz 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. 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.

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 (DA):5913RB. McK32787/Diabetes NZ. January 2014.

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