Diabetes Wellness Autumn 2019

wellness

AUTUMN 2019

DIABETES

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

STIGMA SURVEY • CAN YOU REVERSE T2 DIABETES? • THE WALKING SAMOANS • THE FAST 800 MARATHON MAN • QUIZ TIME • HERE TO HELP • MANA TŪ • MY DIABETES LIFE • HUNDY & FIDDY

DIABETES & WORK Know your rights

FREE TO BE A KID WITHOUT LANCETS*

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Ask your healthcare professional how a FreeStyle glucose meter may assist you. Always read the label and use only as directed. *Scanning the sensor does not require lancets. ‡A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or if hypoglycaemia or impending hypoglycaemia is reported by the System or when symptoms do not match the System readings. ††For a complete glycemic picture, scan once every 8 hours. The FreeStyle Libre software, designed to be used in conjunction with FreeStyle Libre reader and sensor, provides a snapshot of glucose patterns and variability; for more information, see the Software page. §The reader can capture data from the sensor when it is within 1 cm to 4 cm of the sensor. †The indication for children (age 4 - 17) is limited to those who are supervised by a caregiver who is at least 18 years of age. The caregiver is responsible for managing or assisting the child to manage the FreeStyle Libre Flash Glucose Monitoring System and also for interpreting or assisting the child to interpret FreeStyle Libre readings.

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Contents AUTUMN 2019 VOLUME 31 | NO 1

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4 EDITORIAL

23 CARE: Healthy feet

5 UPFRONT: Fitbit MoveMeant Challenge

24 YOUR DIABETES NZ: Five new faces

6 UPFRONT: Lifting the lid on diabetes stigma

25 QUIZ: Test your diabetes knowledge

8 COVER: Diabetes and your rights in the workplace

26 RECIPES: Michael Mosley’s new book The Fast 800

10 OPINION: Chris Baty on your healthcare rights

30 YOUR DIABETES NZ: Common diabetes Q&As

12 COMMUNITY: Walking Samoans trek

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32 TECHNOLOGY: New Pharmac pumps compared

14 CARE: Can Type 2 diabetes be reversed?

16 CARE: “I changed my life” Ngawai Hamblin’s T2D story 18 DIABETES ACTION MONTH: 2018 DAM a runaway success 21 COMMUNITY: What not to say to someone with diabetes 22 LIFE WITH T1: Teen Samantha Williams on her T1 journey

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33 READER RECIPE: Sugar-free carrot muffins 34 MOVE: Ben Trollip on how to train for a marathon 36 HEALTHIER LIVES: Mana Tū supporting Māori with diabetes 37 DIABETES YOUTH: John McLaren Award winners 38 LAST WORD: Speedway brothers “Hundy & Fiddy”

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DIABETES WELLNESS | Autumn 2019

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Editorial

Welcome to 2019. I’m the new President of Diabetes NZ and I’m looking forward to rolling up my sleeves to work for everyone living with diabetes across Aotearoa New Zealand. My interest in diabetes started six years ago when I was diagnosed with T2D. I signed up for membership with Diabetes NZ so I could access its website and support services. At the same time, I also joined my local Diabetes Otago branch and became a committee member. This led to my election to Diabetes NZ’s Advisory Council and then to the Board. In all of these roles, I have been fortunate enough to meet many people who also have diabetes and we have been able to discuss and plan how we can work together to help others live well with all kinds of diabetes.

I was encouraged by the number of members who attended Diabetes NZ’s AGM and conference last November. The passion and dedication shown by our volunteers and staff are two of the reasons our organisation is so strong. We need to build on this and grow our capability and capacity to ensure we can continue to provide services, information, and support to all of our communities across New Zealand. Like many other non-governmental organisations, we face the dual challenges of declining membership and a highly competitive funding environment. We need to develop and implement strategies to better manage both of these issues.

We had a clear mandate at the AGM to move from an incorporated society to a charitable trust that will serve everyone with diabetes, not just the membership. A charitable trust allows more flexibility for governance, giving a stronger focus on all people affected by all kinds of diabetes, and the ability to respond more quickly to making changes for the benefit of the organisation. We are currently looking at the proposed trust deed to ensure it is fit for purpose, so we can move forward to becoming a charitable trust later this year.

I would like to see us reach out to groups in the community that are not currently engaging with our organisation and start conversations about how Diabetes NZ could work with them.

We have seen some great local initiatives across the country, and we also need to share these ideas and successes across the whole organisation.

Finally, I would like to congratulate National Office and the branches for a fantastic Diabetes Action Month. It’s a great example of National Office and branches working together.

I look forward to representing everyone with diabetes over the next three years.

PETER SLEEMAN

National President, Diabetes New Zealand

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DIABETES WELLNESS | Autumn 2019

Diabetes New Zealand is a national charity that provides trusted leadership, information, advocacy and support to people with diabetes, their families, and those at risk.

Our mission is to provide support for all New Zealanders with diabetes, or at high risk of developing type 2 diabetes, to live full and active lives.

We have a network of branches across the country that offer diabetes information and support in their local communities.

Join today at www.diabetes.org.nz

DIABETES NEW ZEALAND Patron Sir Eion Edgar President Peter Sleeman Chief Executive Heather Verry Diabetes New Zealand Inc. National Office Level 7, 15 Murphy Street Thorndon, Wellington 6011 Postal address PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Email admin@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Twitter twitter.com/diabetes_nz

DIABETES WELLNESS MAGAZINE Editor Caroline Wood editor@diabetes.org.nz Publisher Diabetes New Zealand Design Rose Miller, Kraftwork Print Inkwise Magazine delivery address changes Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email admin@diabetes.org.nz Back issues issuu.com/diabetesnewzealand ISSN 2537-7094 (Print) ISSN 2538-0885 (Online)

ADVERTISING & SPONSORSHIP Business Development Coordinator Jo Chapman jo@diabetes.org.nz or +64 21 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion.

Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes Wellness does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

Upfront

MOVE IT LIKE YOU WERE MEANT TO Last year 16 Kiwi celebrities were put through their paces and helped raise $81,000 for Diabetes New Zealand.

This year, it’s YOUR turn to “out-step” them!

W

e are hoping as many New Zealanders as possible will put their best foot forward and join one of our biggest fundraising events of the year – the Fitbit MoveMeant Challenge.

Participants will be encouraged to strap on a Fitbit and start walking at least 30 minutes every day during the month of May. They will pit themselves against each other and be challenged to find ever more creative ways to fit more movement

into their day – the race is on to make every step count.

Studies continue to establish the substantial benefits of regular exercise and physical activity in the prevention and management of diabetes. In fact, we know that a person’s risk of progressing from prediabetes to type 2 diabetes can be halved if they do more exercise, change their diet and lose weight.

Founded in 2015 as a fun way to highlight the importance of physical activity in people with diabetes, the Fitbit MoveMeant Challenge’s message is simple: “We are all meant to move!” With this in mind, and building on the success of the past four challenges, we are expanding this year’s event to include all Kiwis.

The last Fitbit MoveMeant Challenge, which took place in February 2018, was a huge success.

Sixteen well-known Kiwis took up the challenge and collectively they managed to clock up more than 2.7 million steps, covering approximately the same distance as walking from Auckland to Sydney.

Diabetes NZ’s patron Sir Eion Edgar tapped many a shoulder and encouraged his contacts to support his exercise efforts via his online fundraising page set up especially for this event. Sir Eion managed to raise a whopping $74,000 through his commitment to the challenge.

This, plus the sponsorship raised by other challenge participants, led to an incredible $81,000 for Diabetes NZ’s vital work.

LAST YEAR’S CHAMPION: The winner of the 2018 Fitbit MoveMeant Challenge was Hamish Walker, MP for Clutha-Southland, who racked up an impressive 294,124 steps in three weeks – proving that having type 1 diabetes doesn’t stop him from achieving his fitness goals.

HOW CAN YOU GET INVOLVED? The Fitbit MoveMeant Challenge will run throughout May and will include some famous faces competing for the title of “supreme stepper”. This year we are encouraging as many members of the public to join the challenge and have a go at stacking up as many steps as possible in a month. You could ask people to sponsor you or simply use it as an opportunity to become more active.

To sign up, register your interest at fundraising@ diabetes.org.nz before 1 May and we will send you a full Fitbit MoveMeant Challenge participants’ pack via email.

If you don’t want to take part but would like to make a donation, details will be posted on Diabetes NZ’s Facebook and Instagram pages. We will also include updates and some great prize draws, so don’t forget to like our Facebook page: facebook.com/diabetesnz/

DIABETES WELLNESS | Autumn 2019

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Upfront

SURVEY LIFTS LID ON DIABETES STIGMA Diabetes NZ’s ground-breaking survey reveals that diabetes prejudice is a significant problem in New Zealand.

“Y

ou shouldn’t be eating that” and “You brought it on yourself” are just two of the comments reported by respondents. “I don’t tell people I have diabetes,” another said.

The diabetes stigma survey, the first of its kind in New Zealand, was carried out by Diabetes New Zealand last year. The results show that most people with diabetes encounter negative attitudes and prejudice that add to the stress of living with their condition.

More than 250,000 New Zealanders have diagnosed diabetes – that’s one in 19 adult Kiwis.

“A shocking number of respondents reported that they

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DIABETES WELLNESS | Autumn 2019

have been blamed, judged or treated differently because they have type 1 or type 2 diabetes,” says Diabetes NZ’s Chief Executive Heather Verry.

The findings of the Diabetes NZ Stigma Survey of 824 members reveal a remarkable similarity with Australian findings published previously by The Australian Centre for Behavioural Research in Diabetes.

“Dealing with ignorance and prejudice places a further burden on people who already face the difficult challenge of managing the physical aspects of their condition every day as well as its emotional burden,” says Heather.

“What people experienced most

was blame and judgement from others. This is an area where we can all help by being more aware of the realities of living with diabetes, and also being more respectful in what we say to and about people with diabetes.

It is clear from the research there is a massive negative stigma around the most common form of diabetes, type 2.

“Given this stigma exists, it’s no wonder many people with diabetes don’t tell others they have the condition,” added Heather. “But this can lead to isolation, loneliness, and people potentially not getting the help they need in a medical emergency.”

KEY FINDINGS FOOD 68% of people with type 1 diabetes and 40% of those with type 2 reported being judged for their food choices. Some have been left out of social events involving food or drink that other people think they shouldn’t have.

Diabetes NZ says: Managing diabetes is not about avoiding certain foods. The decision of what to eat always lies with the individual, and it’s the job of those around them to provide support, without making decisions for them.

SELF-BLAME Respondents younger than 65 with type 2 diabetes are more likely to experience negative attitudes.

Half of them blamed themselves for having the condition and nearly as many said they feel guilty or embarrassed because of their diabetes. One in three said having diabetes makes them feel “ashamed” or “a failure”.

Professor Jane Speight, Director of the ACBRD, whose Australian research inspired the Diabetes NZ Stigma Survey, says that self-blame is rarely constructive.

“While we know a lot about the risk factors for type 2 diabetes, no-one knows exactly what has caused a particular individual to develop the condition. People need to focus on what they can do now to live well with this challenging condition, not beat themselves up over what they may or may not have done in the past,” she said.

TYPE 1 DIABETES People with T1D encounter negative responses when they inject in public. Nearly half said they were embarrassed by (48%) or selfconscious (45%) of needing to manage their diabetes in public.

More than one in three (38%) said they worry that people think they’re taking illicit drugs when they’re injecting insulin. And 60% of people with type 1 diabetes said others blame them and think it is a result of eating too much sugar.

Diabetes NZ says: There is a common myth that sugar intake causes type 1 diabetes, but of course this is simply not the case.

Apart from the emotional stress this causes, it can have very real health impacts if people feel inhibited or discouraged to properly manage their condition in public.

TYPE 2 DIABETES One in two respondents with type 2 diabetes said that people assumed they are overweight or must have been so in the past.

Diabetes NZ says: While weight is one of the risk factors for type 2 diabetes, it is not the only risk factor. Not everyone who is overweight develops diabetes and not everyone with the condition is overweight.

PUBLIC REACTION 39% of people surveyed said they avoided telling people they have diabetes, to avoid negative reactions. Two in three respondents (66%) with type 1 diabetes also said that people make unfair assumptions about what they can or cannot do because of their diabetes.

Diabetes NZ says: There is no reason people with diabetes cannot perform as well as anyone else and achieve their goals in life. The number of sports stars, performers and leading figures in business, politics and other fields who have diabetes bears ample testimony to this.

OVERCOMING STIGMA Find your support. Talk to your whānau and friends about diabetes and join the conversation on Diabetes NZ’s Facebook page.

Ask people who make hurtful comments to take some time to learn about the condition and show some empathy instead of judging or blaming people with diabetes.

DIABETES WELLNESS | Autumn 2019

7

Cover

Workplace discrimination is a big issue if you have diabetes.

Caroline Wood looks at employees’ rights and responsibilities in New Zealand.

KNOW YOUR (EMPLOYMENT) RIGHTS

M

ore than one in ten Kiwis living with diabetes say they have been discriminated against at work because of their condition, especially those who are insulin dependent.

Diabetes NZ, which commissioned a diabetes stigma survey last year, said people with type 1 diabetes were the most affected with 18% of respondents saying they had been discriminated against in the workplace.

A further 8% of working age adults with type 2 diabetes also reported discrimination by their employer because of their condition.

“Discrimination is an extreme form of stigma. With so many people affected, this is an alarming statistic when, barring a medical crisis, there is nothing about diabetes that affects a person’s ability to work,” says Heather Verry, Chief Executive of Diabetes NZ. “Given that there are so many Kiwis with the condition, it stands to reason that many thousands of them make positive contributions in the workforce every day. This is more likely if others support them with understanding and empathy.”

Diabetes NZ supports members with advice on their workplace rights and also helps employers who want practical guidance on how to support employees with diabetes.

“We encourage employers to find out as much as they can about diabetes and what it is like to live with a lifelong condition,” adds Heather.

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DIABETES WELLNESS | Autumn 2019

People with both type 1 and type 2 diabetes are protected under the Human Rights Act 1993, which says it’s illegal to discriminate against anyone with any form of disability subject to certain exceptions.

Having diabetes is considered a disability under the Act. Below we summarise the protections, rights and responsibilities of employees and employers in relation to diabetes in the workplace in New Zealand.

You should be able to work with diabetes In most cases employers cannot discriminate against you because you have diabetes – they can’t refuse to hire or promote you, and they can’t fire you because you develop it.

Under the Act, “discriminated against” means a person’s employment cannot be terminated and they cannot be disadvantaged or subjected to detriment in their employment by reason of their disability.

However, there are some exceptions to that. The first of those is where the person cannot do the job safely because of their disability.

For example, if you regularly have uncontrolled hypos (low blood sugar) while operating heavy machinery.

If, because of the work environment, or the nature of the duties, there is a risk to the individual or to others, then an employer may be able to discriminate on the basis of the disability, including terminating employment.

First, however, the employer must consider whether there are reasonable measures that it can take to reduce the risk to a normal level (and if there are, to take those).

Another exception is where the employee can only perform the duties with the aid of special services or facilities, and it is not reasonable to expect the employer to provide those.

This will depend on the particular facts of your situation. The size and resources of the organisation, the nature of the disability, and what is required in the job, are all relevant.

Each case is different. Diabetes NZ recommends that people seek legal and medical advice specific to their individual circumstances.

Your employer must take reasonable steps to help you work Under New Zealand law, employers are expected to make “reasonable accommodations” in the workplace for people with disabilities, including diabetes. If they don’t, you may be able to make a complaint to the Human Rights Commission alleging discrimination.

Diabetes Manawatu, Unions Manawatu, and Palmerston North City Council have put together a useful pamphlet for people with diabetes called Diabetes – What are your Rights and Responsibilities at Work?

It says people with diabetes are entitled to:

I feel I am being discriminated against beca use of my diabete s, what should I do?

They say I am a safety risk due to my diabetes.

Will I lose my job if my diabetes causes me to have too much time off work?

I’m facing harassment because of my diabetes

Some of the work-related questions and comments Diabetes NZ has received from its members.

• A safe diet.

• Regularly scheduled break times.

• Rest periods to avoid workplace accidents if you are feeling dizzy or have other symptoms of low or high blood glucose.

Depending on the type of work you do, you may also be entitled to: • Access to a clean area for blood glucose testing or insulin injection.

• Specially tailored work boots to offset neuropathy.

• Specially tailored gloves for the same reason.

• Subsidised regular eye examinations to avoid the risk of retinopathy.

However, different employers may offer different entitlements depending on their interpretation of “reasonable accommodations”.

What is reasonable requires an assessment of what is practical and proportionate in the circumstances, balancing the interests and needs of both employee and employer. For example, Diabetes NZ would expect employers to be understanding of employees needing to take a brief break to have a snack or finding a private space to inject themselves with insulin in the workplace.

However, if employees cannot do the job safely, or take an excessive or unreasonable amount of time off work, then an employer is allowed to address that. Employers must consult with employees before making a decision that may affect

their employment – and give them time to seek legal advice and to respond to proposed outcomes, before decisions are reached.

You may need to disclose the fact you have diabetes to an employer If a person has a hidden disability that will not prevent the job applicant from carrying out the work satisfactorily or safely, they don’t need to tell their prospective employer, according to the Human Rights Commission in its Getting a Job guide.

If you are diagnosed with diabetes while working for your current employer you may have to tell them you have diabetes. It depends on your personal circumstances – whether your condition impacts, or potentially impacts, on your work, including the safety of others. For some employees and some types of employment, you will have to tell your employer, for example longdistance lorry drivers. It’s a complex area of employment law and if unsure, Diabetes NZ recommends seeking legal advice for your particular circumstances.

But remember you can only receive protection under antidiscrimination laws if your employer knows about your condition.

And if you’d like workplace accommodations, you will need to disclose your diabetes.

Taking responsibility It’s important to properly manage your diabetes in the workplace. If things aren’t going so well, ask your diabetes team for advice on whether you need to change your diet, exercise, or medication at work. This may be especially important if you work shifts or long hours, or operate machinery.

Be conscientious and timely in taking your diabetes medication.

It will keep you healthy and also prevent accidents in the workplace.

Tell your employer about any medication you take and the possible side effects if you are unable to take it at the proper time.

If you are feeling unwell and are operating machinery, you may need to stop what you are doing and rest.

Explain to your supervisor why this is happening.

For more information about your rights at work: • Diabetes NZ on 0800 342 238 or go to www.diabetes.org.nz.

• The Health & Disability Commissioner www.hdc.org.nz • The Human Rights Commission www.hrc.co.nz • Community Law NZ http://communitylaw.org.nz/ free-legal-help/ • Your union if you have one, or ask your CAB to recommend a local specialist employment lawyer.

With thanks to McBride Davenport James for their assistance with this article.

DIABETES WELLNESS | Autumn 2019

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Opinion

Patient advocate Chris Baty says it’s important to know your healthcare rights when it comes to having a long-term condition like diabetes.

TAKE CONTROL I

n October 2015 I was proud to co-launch, amid much fanfare, a new strategy for diabetes with the then Minister of Health.

The launch of Living Well with Diabetes: A plan for people at high risk of living with diabetes 20152020 took place at Middlemore hospital, in South Auckland, arguably the diabetes heartland of New Zealand.

As President of Diabetes NZ, I was a member of the National Diabetes Services Improvement Group. This committed, energetic and expert group, which was convened by the Ministry of Health and chaired by Dr Paul Drury, developed a world-class plan to help people with diabetes to live well, keep well and stay well.

It was underpinned by key documents like Quality Standards of Diabetes Care and the Australasian standards of care for children and adolescents (see www.health.govt.nz/diabetes).

Fast forward to 2019 and twothirds of the way through the

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DIABETES WELLNESS | Autumn 2019

strategy’s five-year timeframe, I’m frustrated that little has changed in terms of meaningful diabetes care and outcomes.

While I know that change takes time in a complex system like health, the fact remains that despite all the hoo-ha back in October 2015, it was all mouth and no money. No extra funding has been provided for implementation of the strategy.

It has become apparent that any changes in care, including prevention, must come from existing budgets.

It is fair to acknowledge the few district health boards (DHBs) that are developing some exciting, person-centred diabetes initiatives, and I congratulate them. But should issues like access to quality care be determined by the priority, or otherwise, the local DHB gives to diabetes?

While we should never back away from collectively reminding health officials of the priority and importance of good diabetes care

– especially in the face of growing demand – good care is about keeping well. Not one of us wants any of the too-much-talked-about diabetes complications!

What can we do? We each have the right to the cornerstone of good diabetes wellness care which is a diabetes annual review (previously known as Get Checked), and in my opinion we must assert that right by asking – demanding if necessary – for one at least annually. Don’t wait to be offered it. Let’s take control of our own good health by reminding ourselves it is very possible to live well over a long time with diabetes (see p19).

Simple tests exist to detect early damage to our feet, eyes, kidneys, nerves and heart. These tests are easy to carry out anywhere – marae, churches, as well as in doctors’ rooms. And if any changes are detected, treatment can be started straight away.

Everyone with diabetes has a right to receive retinal screening, careful foot checks, heart and

“The reality is if we don’t ask we never get!”

Medical IDs that are fun, fashionable & stylish My Identity are excited to team up with Diabetes NZ to create custom pieces of medical ID jewellery.

We have invited Ruby McGill – Director of Youth Diabetes NZ – to help with the first design for 2019, and we are delighted to be introducing The Ruby.

kidney checks in a timely way so we can keep as well as possible and remain functioning members of our whānau and communities.

Sadly, not all general practices will offer these reviews to you free of charge although I would argue they should. Do ask what the situation is in your practice though. It is a fact that those of us enrolled with a GP and coded with a long-term condition – which diabetes surely is – do receive extra funding in recognition of this.

If the diabetes annual review is not directly funded via your DHB’s Diabetes Programme,

it may be possible for other funding sources to cover the cost of it. Ask your GP about Care Plus funding. General practices generally want to support those wanting to help themselves and self-care for their diabetes in the best way they know.

The reality is that if we don’t ask, we never get! And if lots of us ask we may just be surprised by what we do eventually get.

None of us can help getting diabetes, but once we have it there is stuff we can do to help ourselves, including expecting the “system” to work with us to stay well.

All the profits from the sale of The Ruby go to supporting Diabetes NZ’s work.

RUBY Bracelet only $25 RUBY TUESDAY Pendant and bracelet $49

Available in a limited number.

During her tenure as President of Diabetes NZ, Chris Baty was a strong advocate at national level for all people affected by diabetes. She still works as a health consumer advocate at a regional level in her home city of Auckland. She has lived with diabetes for most of her life.

Shop now for a beautiful piece of jewellery and support our community www.myidentity.co.nz

Community

THE WALKING SAMOANS Martin Mariota, Siaosi Anamani and Hoani Fuimaono explain why they trekked 120km to raise awareness about diabetes.

“I

t all starts with a first step” is the motto of the Walking Samoans Porirua group. Their members go out walking together every Saturday morning, whatever the weather.

Last November, three of the group, Siaosi Anamani, Hoani Fuimaono and Martin Mariota, spent three days walking an epic 120km from Palmerston North to Porirua to raise awareness of diabetes in the community.

The aim was to engage with Pacific and Māori communities along the way, especially focusing on men’s health, and share their personal wellbeing journeys.

Siaosi Anamani expressed his gratitude to all who were involved and supported this journey, especially for their prayers.

“It is not about the actual walk, but the message behind it,” he says.

“We began training and preparations last July for the November walk. We had to prepare ourselves spiritually as well as physically and mentally for this journey.”

Diabetes, high blood pressure and obesity disproportionately affect Pacific and Māori families in New Zealand. Walking Samoan groups around the country are determined to change these poor health statistics and start the ripple effect of positive change for their members, families, communities and future.

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DIABETES WELLNESS | Autumn 2019

Hoani (fourth from left), Siaosi (third from right), and Martin (standing, second from right) making new friends at Hanana Te Kohanga Reo in Shannon.

One of the trio’s “walking champions” is Hoani Fuimaono, 53, who has type 1 diabetes. Five weeks before the walk Hoani was admitted into the intensive care unit at Wellington hospital but this did not stop him from taking part in November’s gruelling trek.

“I don’t let my condition define me or limit what I can achieve,” says Hoani.

The third member of the group, Rev Martin Mariota, was previously prediabetic and weighed 167kgs.

He has lost an impressive 40kg and no longer has prediabetes.

He achieved this by changing his diet, drinking more water and walking. He believes Pacific communities need to be better informed to ensure they are able to invest in their health and wellbeing before it is too late.

Siaosi, Hoani and Martin were warmly welcomed along the way.

At their first stop, in Shannon, the locals made a sign for them to carry and they got to meet the kids, teachers and whānau at the local kohanga reo.

Other communities were equally supportive. Levin Aquatic Centre gave the group free access into their pools so they could use the spa pool to soothe their aching legs. And further along the road, the community at Kāpiti’s Ekklesia Church offered the trio dinner and they were able to speak to some of the church members about their journey.

The Walking Samoans would like to thank their support team Christopher Te’o, Terri Hughes and Epi Anamani for ensuring they were safe along the road. They also paid tribute to their families, friends, and the Walking Samoans Palmerston North group for sharing the journey with them, and for their continued love, support and prayers.

The Walking Samoans Porirua group meets Saturday mornings at 8am.

All welcome to join to walk in a fun and supportive environment. For more information see www.facebook. com/WalkingSamoans. There are 20 groups across the country.

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The t:slim X2 Insulin Pump can be used solely for continuous insulin delivery and/or as part of the t:slim X2 System to receive and display continuous glucose measurements from the Dexcom G5 Mobile Sensor and Transmitter. The t:slim X2 System also includes continuous glucose monitoring (CGM) indicated for the management of diabetes. The Dexcom G5 Mobile CGM is designed to replace fingerprick blood glucose testing for diabetes treatment decisions. The t:slim X2 System combined with the Dexcom G5 Mobile CGM aids in the detection of episodes of hyperglycaemia and hypoglycaemia, facilitating both acute and long-term therapy adjustments, which may minimise these excursions.

Interpretation of the t:slim X2 System results should be based on the trends and patterns seen with several sequential readings over time. The device is indicated for use with NovoRapid or Humalog U-100 insulin. For detailed indications for use and safety information, contact NZMS Diabetes on 0800 500 226. © 2017 Tandem Diabetes Care, Inc. All rights reserved. Tandem Diabetes Care is a registered trademark and t:slim X2 is a trademark of Tandem Diabetes Care, Inc. Dexcom is a registered trademark of Dexcom, Inc. All other trademarks are the property of their respective owners. Distributed in New Zealand by New Zealand Medical & Scientific Ltd, 2a Fisher Crescent, Mt Wellington, Auckland.

Care

CAN TYPE 2 DIABETES BE REVERSED? Here at Diabetes NZ we get a lot of questions about whether T2D is reversible. Dietitian Helen Gibbs looks at the latest evidence.

TYPE 2 DIABETES REVERSAL IS POSSIBLE: Research has found that losing 15kg of weight through lifestyle changes can result in HBA1c dropping to under 40 (within normal range).

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DIABETES WELLNESS | Autumn 2019

W

hen Prof Roy Taylor’s team at Newcastle University published its groundbreaking low-calorie diet study in 2011 and said it could reverse type 2 diabetes in some people, most experienced dietitian practitioners like myself pretty much said “Yep, tell us something we don’t know.”

Across years of practice, I have had a few patients who make a commitment to major lifestyle change immediately after or within a few years of their being diagnosed with type 2 diabetes.

They lost weight, their blood glucose values came down and they could stop their medication.

The Newcastle University study, which put participants on an extreme low-calorie diet, was carried out in its Magnetic Resonance Imaging (MRI) Centre.

Researchers wanted to see what happened to overweight people’s bodies when they lost weight. In particular they wanted to measure changes to the liver and pancreas.

The test subjects went on a meal replacement programme and shed

weight. As well as being able to see fat loss on the MRI, it was also evident that diabetes was reversed in some patients – their HBA1c was less than 40 mmol/mol without taking any medications.

Like all good clinicians, the Newcastle researchers were careful about how they presented the results. But the study’s findings went viral and hundreds of people with diabetes contacted them to ask how they could follow the diet themselves. There is excellent information available about the diet and study for PWD on the Newcastle University website http://bit.ly/2SIdl0b.

Subsequent research across the world has confirmed the Newcastle study’s findings. So should clinicians, friends and family be encouraging people who are newly diagnosed with type 2 diabetes to try and make lifestyle changes that will result in weight loss of approximately 15kg?

This kind of weight loss will not cure everyone with type 2 diabetes and it is very important that people who have an unusual presentation

of their diabetes discuss it with their GP or specialist before trying any kind of low-calorie diet, as weight loss will not reverse diabetes for lateonset type 1 diabetes, post-surgical or trauma diabetes or monogenic diabetes.

But for some people it does work, people’s blood sugar levels return to normal levels and they can come off their diabetes medication. Experts are split over whether their diabetes is “reversed”, in “remission” or “cured”. Time and more research will answer this question.

Since the Newcastle University study was published, many lowcalorie diet plans, books, blogs and diet programs have sprung up. One of the best known is Dr Michael Mosley’s 5:2 diet, which recommends intermittent fasting to lose weight.

This diet reversed the UK doctor’s own type 2 diabetes (for information about his new book, see p26).

All low-calorie diet plans have one thing in common. The programmes aim for a weight loss of around 15kg.

Good programmes then work with individuals on maintaining a better lifestyle to either continue with further weight loss or to maintain the new lower weight.

The data collected from the public after the initial Newcastle study showed something very important.

It didn’t matter how you lost the weight, what mattered was that you did it. And those who could sustain the diet and exercise changes within their lifestyle kept the weight off and their T2D at bay.

The research also shows that the sooner you lose weight after your diagnosis the more likely you are to succeed. However even people making lifestyle changes 10-15 years post-diagnosis may get a reversal if the beta cells in their pancreas are still producing enough insulin.

Is it worth trying it? I believe so and offer this as one of my services in my private practice. However, I also advise people who eat for emotional reasons that they need to

address that first before the weight loss, to avoid setting themselves up to fail on yet another programme.

Binge eating and emotional eating can be made worse by the restrictions placed on someone trying to attempt a diabetes reversal, so unpicking that problem first will help you manage your diabetes in the longer term.

Already slim people may not need to lose 15kg of weight – in some cases this would make them unhealthily underweight. However some adults with near normal body weight have significant amounts of fat in and around their liver and pancreas (apple-

shaped body types). They may see an improvement in their blood glucose levels if they lose some weight. If you are in this category and want to try losing weight, ask your GP or diabetes nurse to set you an individual goal so your BMI doesn’t go below 21.

Anyone wanting to try diabetes reversal should consult with their diabetes team before starting. Not everyone will be successful but even if you don’t put your diabetes in remission, eating more healthily and being more active will improve your wellbeing, so making changes will have benefits for everyone who tries it.

WANT TO GIVE IT A GO? See p17 for Helen’s tips >>

I DID IT! Fraser, 46, a freelance digital animator from Foxton Beach, north of Wellington, was diagnosed with type 2 diabetes a year ago and immediately jumped into a self-managed health improvement programme using diet and exercise (under his GP’s supervision). Fraser, who works from home, has lost an amazing 40kg over the past year.

At diagnosis Fraser was taking the diabetes medication metformin twice daily (his HbA1c was 61 mmol/mol), then as he lost weight, his GP reduced his medication to once a day. At 12 months Fraser’s HbA1c was 38 mmol/ mol, which is in the normal range for blood sugar, and his doctor took him off metformin altogether.

“I wanted to share my story to show it’s possible to ‘beat’ diabetes. I’ve come to see getting diabetes as the most positive thing to ever happen to me and those around me.

“People ask if I still have diabetes. My take on it is that I am diabetic and always will be. I just get to manage my diabetes via diet and exercise. If I started eating and living like I used to, I would definitely get sick again.”

DIABETES WELLNESS | Autumn 2019

15

Care

A HEALTHIER ME I thought being diagnosed with type 2 diabetes was the end of my life but I’ve found it’s actually the beginning of a better me.

By Ngawai Hamblin.

“I

turned 30 last year and two months before that, in June 2018, I was diagnosed with type 2 diabetes. Three other whānau members have T2D, one of them hasn’t looked after himself well and his kidneys have failed, so diabetes is huge in my family.

I had the warning signs, including gestational diabetes with my second child, but I didn’t change my lifestyle until it was too late. But I did take action from the day I was diagnosed.

Now I go to the gym three times a week and swim once a week. I can run three-minutes non-stop, that’s a huge achievement for me.

My diet has completely changed for the better and I’m 2kg away from my initial 10kg weight loss goal. My blood sugar level dropped from 15 to 6-8mmol\L. I have a long way to go but I’m making a difference for myself and my family. I’m really proud of what I’ve achieved and I don’t say that about myself enough.

I live in Cambridge with my husband and our two girls, now aged four and two.

When Ella was a few months old, I was still feeling tired during the day, I couldn’t sleep and I put on so many kilos that I was back at my pregnancy weight. My energy was gone – I had none, and the nature of my job and my kids put a lot of pressure on me. I realised I couldn’t fit my clothes well and my house was getting messier, I was too tired to look after it.

I kept blaming it on my iron being low, I have thalassemia minor, but at the back of my mind I knew it was diabetes. I didn’t want to have diabetes so I put off getting tested.

Then last June I had major pain in my side and went to the doctor. I felt horrible, with fatigue and migraines, and I was always hungry or thirsty. I asked for a diabetes test too. Later that day he asked me to come back as soon as

16

DIABETES WELLNESS | Autumn 2019

Ngawai with her children Alanna and Ella.

possible and the truth came out. I already knew though. I felt like a failure to myself and that my life was heading the same way as my grandad and uncle.

Two things helped. A friend on Facebook had been going through the same as I was and she posted publicly about her diabetes journey. Then there was my own determination. No more excuses – I was soon to be 30 and it was time to make things right.

I told my boss and one friend, who were both very supportive. A few days later my doctor contacted me and organised a meeting with a nurse as support. The appointment was amazing. She sat down and explained about good foods and put them in categories, which to this day I’m so thankful for because it’s made my meal planning and diet so much easier.

After many attempts going cold turkey and failing after one day, I decided to try making small changes. I cut down sugar in week one, the next I cut down my bread to two slices, then in week three I cut other carbs. I found changing gradually was a lot easier to stick to.

I trained my mind in small steps and I think this has been the reason why I’ve kept going.

After a few weeks I went from 1015 blood sugar levels to 5-8. I was feeling good. I was eating a boiled egg on toast, Weetbix, or a healthy smoothie for breakfast. I had fruit and Greek yogurt for morning tea rather than white bread (I really like bread). I eat low-carb lunches and dinners and allow myself a treat now and then.

Exercise was another issue. I didn’t know what to do or when

to do it. Then we had our annual staff days at work, where you could choose healthy activities to try. I chose tai chi and a gym circuit. I enjoyed the tai chi and loved the circuit. Three days later I signed up at a local gym along with a friend. We go Monday, Friday and Sunday and we do running, biking, strength and circuit training. I swim once a week.

I still have days where I fall back into old habits and have extra bread or a small treat, but instead of one leap backwards it’s one step back and three steps forward. I now get lots of compliments about how I look. I still have a way to go before I can say I’ve reversed my diabetes, but I’m thankful my diagnosis kickstarted my determination to get back to better health and a new me.

GIVING IT A GO

”

By Helen Gibbs, Diabetes NZ’s dietitian If you want to try to reverse your diabetes, make a plan first and talk to the doctor who manages your diabetes so you can safely stop or adjust any medications you are taking as you shed the kilos.

To lose weight you need to eat less energy (calories or kilojules).

There are many ways to do this and it’s important to find a diet that suits you – see p12 of the Spring issue “Which diet for you” for my analysis of different diets and their benefits/drawbacks for people with diabetes.

I usually prescribe around 1500kcal (5000kJ) for women and 1800kcal (7500kJ) for men but bigger adults may need more. If you are following a weight loss plan, the most important thing to consider is whether you can stick with it in your lifestyle. Although

the health benefits of different diet compositions are still hotly debated, if it is difficult to stick to it, you won’t achieve your goal.

As well as diet changes, all diabetes-related weight loss studies encourage a minimum of 150 minutes of moderate intensity physical activity spread across the week. A recent New Zealand trial showed the benefits of 10 minutes of physical activity after breakfast, lunch and dinner and I have seen some excellent results in people who are trying to reduce their blood glucose levels doing this.

If you are taking type 2 diabetes medications you may need to adjust these as you diet and lose weight.

For help talk to your diabetes nurse or GP. This two-page summary for GPs written by the University of Newcastle is particularly useful

if your doctor is unfamiliar with diabetes reversal diets: http://bit. ly/2RBTbHJ If you are taking insulin or sulphonylurea medications (glipizide, gliclizide), seek advice on how to reduce these medications before you start. It’s important to monitor your blood glucose four times a day if you are taking insulin or a sulphonylurea. If you are going low, then you need to ring your doctor to discuss reducing your dosage even further. They may also want to check your liver function if you have a history of fatty liver disease. If you have gout, it is important that your uric acid levels are under control before trying to shed the kilos. Blood pressure medications will also need to be reduced as you lose weight – talk to your GP. DIABETES WELLNESS | Autumn 2019

17

Diabetes Action Month

Act Now to Live Well Here is our round up of the highlights from Diabetes Action Month 2018.

D Heather Verry with Jesse Mulligan at Radio New Zealand studio.

Diabetes NZ staff Jenni Anderson, Liz Dutton, Nicky Steel and Ruby McGill head to the Beehive for the Parliamentary launch of Eat Well Live Well at Parliament (see overleaf).

Branch events helped raise awareness in communities across New Zealand.

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DIABETES WELLNESS | Autumn 2019

iabetes Action Month 2018 was a runaway success reaching thousands of New Zealanders across the country through a host of local and national events and activities plus great exposure on television, radio, print and social media.

The month-long theme was Act Now To Live Well with the aim of encouraging Kiwi families to take action to help themselves or their friends and whānau live better with type 1 or type 2 diabetes and/or reduce the risk of developing type 2 diabetes.

Diabetes NZ also wanted to highlight the growing issue of diabetes stigma – negative attitudes towards people with diabetes – and encourage people to become better educated about the condition.

Chief executive Heather Verry kicked off proceedings with a number of high profile interviews. She was interviewed on TVNZ Breakfast, with the discussion focusing on discrimination against people with diabetes. Heather also appeared on Newstalk ZB Breakfast with Mike Hosking, Radio New Zealand’s Afternoon with Jesse Mulligan, as well as RadioLive’s The Long Lunch.

In all the interviews Heather pushed home the important message that people with any kind of diabetes need support, not blame, shame or judgement.

Events organised by various Diabetes NZ branches also helped raise the profile of Diabetes Action Month. Regional highlights included the Taranaki Youth Branch relay around Mt Taranaki with Diabetes ambassador Brett Renall and his wife Angel. The Wairarapa branch held a very successful cooking workshop with celebrity chef Jax Hamilton, and Auckland branch hosted a wonderful whānau day at Manukau Square.

TELLING OUR STORIES

A

major focus throughout the month was telling the stories of New Zealanders living with diabetes. Four videos featuring Kiwis talking about how diabetes impacts on their lives and the stigma they sometimes feel reached more than 300,000 people through social media.

The Rock DJ Lee Weir featured in one of the videos, and also shared his story with thousands of New Zealanders on TV3’s The Café and on The Rock radio station. Lee spoke about his experience being diagnosed with type 2 diabetes, the stigma associated with it, and how he’s taken action to live well.

If you haven’t seen the videos yet, check them out on Diabetes NZ’s Facebook page.

Director of Youth for Diabetes NZ, Ruby McGill, was interviewed on RadioLive’s Weekend Life show about her personal experience of diabetes discrimination, and the impact it has on young people with type 1 diabetes.

Heather Verry said it was wonderful to see so many people from around the country supporting Diabetes Action Month 2018 in so many different ways.

“It was an extremely busy and successful month-long campaign.

Above: Lee Weir being interviewed

by Mel Homer on The Café.

Left: Lee Weir with daughter Lucy Weir filming their video story.

It shows the strong diabetes community we have here in New Zealand and how we can use our combined voice to demand a better deal for people living with the condition.

“We succeeded in raising awareness in all corners of New Zealand and we are pleased our message about diabetes stigma

being a significant issue is being taken seriously.

“We will continue to campaign for more understanding about what it’s like to live day-to-day with a serious condition like diabetes and how people need support and encouragement, not negativity and prejudice, to live well.”

RECORD-BREAKING WIN Diabetes NZ member, the record-breaking Winsome Johnston, was interviewed on primetime television on 30 November, ending Diabetes Action Month on a high.

Diagnosed at the age of six Winsome, who has just turned 90, holds the record for being on insulin for the longest number of years in New Zealand and possibly the world.

A heart-warming interview with Winsome, her family, and Rab Burton, her diabetes nurse of 15 years, aired on Seven Sharp.

Diabetes NZ has written to Guinness World Records to submit Winsome as a world record breaker – the current record for the longest diabetes survival is held by Australian Hazel Davies, who had diabetes for 81 years and died in 2002.

DIABETES WELLNESS | Autumn 2019

19

Diabetes Action Month

Eat Well Live Well book launch The launch of Diabetes NZ’s popular Eat Well, Live Well recipe book was held at Simon Gault’s restaurant Giraffe in Auckland. It was well attended by food writers and prominent media personalities.

Special guest Dame Valerie Adams, who contributed the foreword for the book, was the star of the show along with her beautiful 1

daughter Kimoana.

Simon also talked about his experience with type 2 diabetes, stigma, and what he has done to help himself and inspire others to live well. His passion for good food that suits a healthy lifestyle shone through in the fabulous dishes he served on the day.

3

Recipe book contributors Claire Turnbull, Jax Hamilton and Kit Perera were at hand to answer questions about their contribution to the book and show their support for Diabetes NZ, too.

So far more than 3,000 copies of the book have been sold and it is selling out fast!

4

2

At the Auckland launch of Eat Well Live Well at Simon Gault’s restaurant Giraffe.

1. Heather Verry, Mike Puru and Melissa Davies. 2. Kit Perera, Marsha Mackie, Jax Hamilton. 3. Simon Gault preparing lunch.

4. Claire Turnbull, Valerie Adams with Kimoana. Photos by Hayley Roberts.

Eat Well Live Well (RRP $34.95) is chock-full of recipes from well-known Kiwi chefs. Each dish is family-friendly, quick to prepare, and is suitable for people with all kinds of diabetes. Grab a copy quick before they sell out at www.diabetes.org.nz or check it out at your local Whitcoulls, The Warehouse or PaperPlus. All profits go towards supporting Diabetes NZ’s work.

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DIABETES WELLNESS | Autumn 2019

WHAT NOT TO SAY...

TO SOMEONE WITH DIABETES

“Did you get diabetes because of your weight?”

A: Not all overweight people get diabetes.

Longer answer: Although people who are overweight tend to have a higher risk of developing type 2 diabetes, it’s not the only risk factor. And weight doesn’t play a part in type 1 diabetes at all.

“Do you have diabetes because you (or your mother) ate too much sugar?”

A: No (and how many times have we heard this one?).

Longer answer: A large proportion of young people with diabetes have type 1, which is an autoimmune condition. No one knows what causes it, however we do know (and please repeat after us), eating sugar does not directly cause diabetes.

“Should you be eating that?”

A: Yes but thanks for your concern.

Longer answer: People with diabetes think about food, counting carbs, and keeping an eye on our nutrition at every meal. So if I decide to enjoy a piece of birthday cake, then it’s OK.

“Isn’t diabetes a fat, lazy person’s disease?”

A: No, just no!

Longer answer: People with diabetes comesin all shapes and sizes and weightshaming those with type 2 diabetes stigmatises people with all kinds of diabetes.

Being overweight and inactive may increase the risk of developing type 2 diabetes, but there are other risk factors too. Slim active people get diabetes too, and there is a strong genetic link. Type 1 diabetes has nothing to do with weight or activity levels.

“Why are you testing yourself all the time? You need to chill out more.”

A: To keep myself alive.

Longer answer: Regular blood testing is an important part of diabetes self-management and discouraging someone from testing can be dangerous. People don’t choose to have diabetes and if we didn’t have to test our blood sugars so often, trust me, we wouldn’t!

Diabetes NZ is highlighting how people living with diabetes often feel stigmatised due to a lack of understanding about the condition.

Join the kōrero online at www.facebook.com/diabetesnz/

DIABETES WELLNESS | Autumn 2019

21

Life with T1

LIVING WITH AN INVISIBLE CONDITION Teenager Samantha Williams, from Auckland, reflects on her T1D journey and talks about some of the prejudices she has experienced.

“H

ere I am, still staring at my blank piece of paper wondering what to write, struggling to come up with the words I need to say. Usually I can’t stop typing, but for some reason the words just aren’t coming today but as I’ve learned in 12 years of having diabetes, you’ve just gotta keep trying until you get it so here it goes.

Most people don’t fully understand the challenges of living with a lifelong disease that most of the time is invisible to everyone around you. It’s like a part of you that is hidden or misunderstood all of the time. I think it’s hard not to feel alone and isolated when it’s not something that is necessarily visible to the people around you.

Sometimes that’s a positive as it can be challenging living with diabetes and it’s often easier to hide the pain and pretend everything’s okay because in the end that’s less complicated than explaining to someone what’s really wrong. But other times you just wish that people understood why you’re in a bad mood, or why you’re absolutely exhausted and it’s only 12pm.

22

DIABETES WELLNESS | Autumn 2019

Sam Williams says she’s had 30,681 insulin injections and 25,568 finger pricks in the 12 years she has been living with type 1 diabetes.

Type 1 diabetes comes with challenges and complications that most people wouldn’t expect or even think of to be honest.

It has the capability to severely affect the lives of individuals, as well as the ones closest to them, and change the way they go about their day-to-day business.

It’s a disease that although common, is still misunderstood by so many. And many of its victims are subject to harsh judgements and comments because of its similarities in name to type 2 diabetes.

Every day I realise how much I don’t know about this disease, how every day I seem to stumble upon a new surprise.

Even after 12 years I still can’t get it right because it’s constantly changing.

I was diagnosed on 27 October 2006 at the age of five and I didn’t understand the implications of having type 1 diabetes. I was a kid who wanted to play with her friends at school and run

around like any child does but instead I was in Starship Hospital wondering why I was being pricked and poked with needles and being woken up at 3am in the morning being told I had to eat right then. Even though it’s been 12 years I still remember that day, it’s one I don’t think I will ever forget. I was terrified and had no idea what was actually going on, other than that I was really sick.

Little did I know that there were more challenges to be faced in the coming months and then years.

But somehow, I got through it.

With the help of an incredibly supportive family who endured many battles with me in those early years (I did not adjust to injections very easily and put my family through hell), we carried on and eventually came through.

Now I’m 17 years old, I’ve finished high school and am getting ready to start at Massey University in February. Type 1 diabetes has never stopped me from doing anything that I have wanted to, at times I’ve had to do them differently to some people but I’ve always been able to do them and that’s something that I’m so thankful for.

”

Care

STEPS TO HEALTHY FEET Angela Bayley, a diabetes specialist podiatrist, explains the importance of regular foot checks.

D

iabetes increases your chance of developing ongoing foot problems. Not everyone with the condition is at risk, but the chances of foot complications may increase the longer you have diabetes.

Managing your diabetes is the best method of taking care of your feet and will help avoid complications.

HOW OFTEN SHOULD I GET MY FEET CHECKED?

If you have type 2 diabetes you need to have an annual foot check, usually performed by your doctor. If there are any problems, you will be referred to a primary care podiatrist. Referrals can be made by general practitioners, practice nurses, diabetes nurse NZ_Diabetes Wellness.pdf

1

31/5/18

educators and other health professionals. A person identified as having high-risk feet is referred to hospital care.

The New Zealand Management of Diabetes Guidelines recommend that people with type 1 diabetes have their feet checked at least once a year, starting five years from diagnosis. However, contact your health professional straight away if you any detect any problems when checking your feet.

HOW WILL A PODIATRIST HELP ME?

Podiatry is a branch of medicine that is part of the multi-disciplinary team needed to treat diabetes.

A good podiatrist will: • Take your full medical history.

• Make sure he or she is aware of your medication.

• Spend the first part of every consultation assessing the pulses in your feet, your circulation and any nerve damage.

• Check there are no areas of undue pressure to the soles of your feet or trauma from ill-fitting footwear.

• Advise you on the care of your skin and nails.

• Provide you with prevention strategies to avoid harming your feet.

HOW OFTEN DO I NEED TO VISIT A PODIATRIST?

This is usually a joint decision between you and your podiatrist, diabetes nurse educator and doctor, and depends on the level of risk. You should always be kept informed of all results of the assessment and have a good understanding as to why you do or don’t need to return.

If you have nerve damage or heart, kidney or eye problems, or have had a stroke, then you need to be seen much more frequently than someone who has no complications. Those with renal failure or at risk of renal failure need to have their feet checked every three months. People with existing circulatory problems or nerve damage also need regular foot inspections.

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DIABETES WELLNESS | Autumn 2019

23

Your Diabetes NZ

NEW FACES

Welcome to Diabetes NZ’s five new Board and Advisory Council members. They have a big year ahead as the organisation moves towards a new charitable trust model following a unanimous vote at last November’s AGM.

PETE SLEEMAN – PRESIDENT

LYNDAL LUDLOW – VICE PRESIDENT

Pete Sleeman was diagnosed with type 2 diabetes six years ago and served on his local Otago branch committee before joining Diabetes NZ’s Advisory Council and Board. Pete, who was elected President last November, works for Downer NZ in Dunedin, where he is responsible for business planning, training and staff development.

Lyndal worked in the education sector for many years before taking on event management and communications roles.

She is a Southland regional councillor and arts sector advocate. Lyndal became involved with Diabetes Youth NZ eight years ago when her oldest son, aged 8, and husband were both diagnosed with type 1.

MAURICE TRAPP – INDEPENDENT BOARD MEMBER

Maurice has been involved in the financial services industry since 1980, launching the Maurice Trapp Group in 2006. Maurice is also President of New Zealand Rugby, a director of the New Zealand Rugby Foundation, and has had long association with the New Zealand Spinal Trust.

MELANIE HARRINGTON – ADVISORY COUNCIL (INDEPENDENT)

With 20 years in the public sector, Melanie brings a plethora of skills, senior management, governance experience and ideas to the Board. Melanie, who has a close family member with type 1 diabetes, wants to help positively influence the lives of those with diabetes through advocacy and support in communities.

SIANNE OLPHERT – ADVISORY COUNCIL (INDEPENDENT)

Sianne is a chartered accountant from Auckland, who is currently raising her two children. She has lived with type 1 diabetes for more than 20 years, is involved with the diabetes online community and enjoys helping others.

Sianne is focused on improving access for all New Zealanders to outstanding diabetes support, education and technology.

INVEST IN YOUR HEALTH Subscribe for just $24 a year* Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

* Four issues delivered to your door – $6 per issue, including P&P. To subscribe visit www.diabetes.org.nz, click on ‘Join now’ and select ‘Magazine only’.

24

DIABETES WELLNESS | Autumn 2019

Quiz

Test your knowledge How much do you know about diabetes? Take our quick quiz to find out!

1.

Who was the Canadian orthopaedic surgeon that discovered insulin in 1921?

2. Can type 2 diabetes become type 1?

3.

Name the cells in the pancreas that manufacture insulin?

4. What period of blood glucose does an HbA1c result reflect?

5. How much of your food plate should be coloured vegetables?

6. Name a hormone other than insulin

AVOID A LOW OR TREAT ONE?

ADVANCED DIABETES TECHNOLOGY

Introducing the Power of Prediction by Medtronic. A world-first technology in insulin pumps and continuous glucose monitoring, that predicts your lows with enough time to prevent a hypo.

Experience the power to plan less and do more every day.

manufactured by the pancreas.

7.

Is LDL cholesterol good or bad?

8. What is the normal range of blood glucose?

9. Can family history be a risk factor of type 2 diabetes?

10. What do the liver and muscles store?

11. How much of your food plate should be protein ie meat, fish, egg?

12. What does the word hypoglycaemia

Please review the product’s technical manual prior to use for detailed instructions and disclosure. Always seek advice from your medical practitioner to determine your suitability for insulin pump therapy and CGM. Use as directed.

‘Prediction’ refers to the data retrieval, processing and computing capabilities found in the MiniMed®640G insulin pump system (inc. Pump & CGM continuous glucose monitoring system) and Guardian Connect System. These systems and their computing capabilities are part of, but not replacement for, your daily diabetes management.

1) Frederick Banting. 2) No. 3) Beta cells. 4) 2–3 months. 5) 1/2 of the plate. 6) Glucagon. 7) Bad. 8) 4–8 mmol/L. 9) Yes. 10) Glucose.

11) 1/4 of the plate. 12) Low blood glucose.

12.

InterMed Medical Limited Free Phone: 0800 333 444 www.intermed.co.nz 71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740 The MiniMed 640G Insulin Pump is fully funded in NZ for eligible patients by Special Authority.

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January 2019

mean?

Recipes

Fasting for life

You can still eat delicious healthy meals while following a lowcalorie diet, according to Dr Michael Mosley’s new book The Fast 800.

S

ix years ago, Dr Michael Mosley created a health revolution with The 5.2 Fast Diet, telling the world how he reversed his type 2 diabetes after intermittent fasting. Based on the latest ground-breaking science, Mosley’s new book The Fast 800 is an evolution of the 5:2 diet with people allowed to eat 800 kcal (rather than 500 kcal) on their “fasting” days making the diet plan more flexible and easier to follow.

Recent studies – including the results of Professor Roy Taylor’s pioneering DiRECT study (http:// bit.ly/2FntiF8) – have shown that 800 kcal is the magic number when it comes to successful

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DIABETES WELLNESS | Autumn 2019

dieting; it’s an amount high enough to be manageable but low enough to provide rapid weight loss and trigger a range of desirable metabolic changes, including preventing and reversing type 2 diabetes.

Mosley says The Fast 800 will help people lose weight, improve mood and reduce blood pressure, inflammation and blood sugars.

“For years we’ve been told the best way to lose weight and keep it off is to take things very slowly — eating a little less and moving a little more with the aim of dropping 1-2lb a week”, Mosley said in his Daily Mail column in January.

“But the science of weight loss is progressing and now there’s good, strong research to suggest that eating just 800 kcal a day could be not only the most rapid, but also the most effective, way to diet — with the added bonus that it appears to be extremely good for many aspects of your mental and physical health.”

The Fast 800 is designed to be flexible. You can follow the original 5:2 schedule, with two “fasting” days of 800 kcal a day each week.

On the remaining five days you eat a healthy Mediterranean-inspired diet, keeping carbohydrates low and portions small — but there is no calorie counting. Alternatively Mosley recommends eating 800 kcal a day every day for 6–12 weeks to bring about rapid weight loss.

Based on latest research, Mosley also introduces the concept of “Time Restricted Eating” which basically means eating dinner earlier in the evening and breakfast later in the morning.

Ideally this extends the night fasting period to 16 hours and

speeds up weight loss, according to Mosley.

Working on his personal rationale that he always tries the things he recommends, Mosley put on 10% of his body weight – about 8kg – for the book. In his own ‘Supersize Me’ experiment, he documented what the extra weight did to his blood pressure, cholesterol, blood sugar levels, hunger hormones and gut bacteria, and then saw how quickly he could shed it on the Fast 800 plan.

The book contains many delicious and easy-to-prepare recipes and healthy 800-calorie “fasting” daily menu plans developed by Mosley’s wife Dr Clare Bailey (see p28).

Diabetes NZ recommends checking with the doctor who looks after your diabetes before embarking on any low-calorie diet plan, including The Fast 800. You may also wish to discuss your plans with a dietitian so you can receive individualised advice for your health and circumstances.

To find a dietitian locally https://dietitians.org.nz/ find-a-dietitian/.

WHAT DOES AN 800-CALORIE DAY LOOK LIKE?

Turn the page for recipes

• Speedy eggs and avocado • Miso eggplant ‘steaks’ with roasted carrots and cashews • Lemon and thyme chicken kebabs

DIABETES WELLNESS | Autumn 2019

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Recipes SPEEDY EGGS AND AVOCADO 290 KCAL (1200KJ) | SERVES 1

This is one for people who say they don’t have time to cook eggs for breakfast – prepare them the day before, then assemble the dish in the morning.

2 eggs ½ medium sized avocado squeeze of lemon 1. Cook the eggs for 6–7 minutes in a pan of boiling water, then place them under cold running water. Peel them and put them in the fridge (if you’re preparing them in advance).

2. In the morning, peel, stone and slice the avocado. Place it on a plate and squeeze the lemon juice over it.

3. Cut the eggs into quarters. Mix them with the avocado slices and some seasoning.

MORE SUBSTANTIAL: serve the mixture on a slice of rye bread (add 55 kcal or 230kJ) or wholemeal sourdough toast (add 72 kcal or300kJ).

AVERAGE NUTRITIONAL VALUE PER SERVE: PROTEIN 15.3g | FAT TOTAL 25.5g (SAT FAT 6.5g) | CARBS 1.4g (SUGARS 0.9g) | SODIUM 145mg

LEMON AND THYME CHICKEN KEBABS 220 KCAL (920KJ) | SERVES 2

Not only do chicken thighs contain more nutrients than breast meat, they are also more succulent and flavourful. Kebabs are well designed for eating on the hoof – take them to work in a lunchbox with a generous salad and a dressing in a small jar.

4 small, boneless, skinless chicken thighs, diced (about 250g) juice and zest of ½ lemon ½ tsp dried thyme 1 garlic clove, crushed 1 tbsp olive oil 1 medium onion, cut into 8 pieces

MISO EGGPLANT ‘STEAKS’ WITH ROASTED CARROTS AND CASHEWS 315 KCAL (1320KJ) | SERVES 2

Please don’t be tempted to reduce the amount of olive oil in this recipe – this wonderful healthy fat gives this dish its rich taste and texture and will help keep you satiated for longer.

200g yellow and orange carrots, cut into batons 3 tbsp olive oil 30g cashews 1 eggplant, trimmed and sliced into ‘steaks’, 1cm thick 2 tsp miso paste juice of ½ lime or lemon 100g baby spinach 1. Preheat the oven to 200°C/180°C fan/gas mark 6. Place the carrots in a baking tray and drizzle 1 tbsp of the olive oil over them. Roast them for 15–20 minutes or until they start to turn golden brown. Add the cashews for the last 5 minutes.

2. Meanwhile, spread both sides of the eggplant steaks with miso paste. Place the remaining olive oil in a large non-stick frying pan over 1. Mix the diced chicken in a bowl with the lemon, thyme, garlic and oil and season well with salt and freshly ground black pepper. Leave it to marinate for 2 hours, if time permits.

2. Heat the grill to maximum. Divide the chicken and onion pieces between 4 skewers.

3. Place the skewers on a grill pan under the grill for about 15 minutes, turning them frequently, until the chicken is cooked through and golden brown.

TIP: if using wooden skewers remember to soak them in water for

a medium heat and gently fry the steaks on both sides until they are lightly browned.

3. In the last few minutes of cooking, drizzle the lime or lemon juice over the eggplant. Then stir in the spinach, allowing it 1–2 minutes to wilt in the pan.

4. Finally add the roasted carrots and some salt and black pepper.

TIP: these eggplant ‘steaks’, with their fabulous ‘umami’ flavour can be eaten with salads or any combination of cooked veg (32 kcal (135kJ) on their own).

MORE SUBSTANTIAL: add a green or coloured leaf side salad (insignificant kcal unless you add a dressing).

NON-FAST DAYS: add an extra eggplant ‘steak’. Serve with boiled peas and a dollop of butter or a drizzle of olive oil. You might add 3 heaped tablespoons (approx. 100g) cooked wholegrains such as brown rice (111kcal/ 465kJ), or a similar amount of pulses, such as Puy or French lentils (116kcal/470kJ).

AVERAGE NUTRITIONAL VALUE (SERVES 2): PROTEIN 7.6g | FAT TOTAL 29.5g (SAT FAT 4.7g) | CARBS 14.5g (SUGARS 12.1g) | SODIUM 259mg

10 minutes before grilling so they don’t burn.

MORE SUBSTANTIAL: serve the kebabs with a handful of green and coloured leafy salad (no calorie counting required). Add a dressing such as the olive oil and cider vinegar on p244 (add 100 kcal (420kJ)).

NON-FAST DAYS: double the portion and add 2–3 tablespooons cooked brown rice.

AVERAGE NUTRITIONAL VALUE (SERVES 2): PROTEIN 26.7g | FAT TOTAL 16.1g (SAT FAT 16.1g) | CARBS 3.6g (SUGARS 3.2g) | SODIUM 87mg

Extracted from The Fast 800 by Dr Michael Mosley, published by Simon & Schuster Australia, RRP NZ$35.

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DIABETES WELLNESS | Autumn 2019

measures spoon-for-spoon like sugar Carrot Cake with Cream Cheese Frosting Preparation 20 mins | Cooking 1 hr | Serves 16 Ingredients

Instructions

Cooking oil spray, to grease 3 cups coarsely grated carrot, firmly packed (4 large peeled carrots) 2 cups EQUAL Spoonful ¾ cup extra virgin olive oil 3 eggs, separated ¾ cup milk 1 Tbsp golden syrup 2 cups plain flour 1½ tsp baking powder 1 tsp bicarbonate of soda 1 tsp ground cinnamon 1 tsp ground nutmeg 1 tsp mixed spice ½ cup walnuts, finely chopped ½ cup sultanas, roughly chopped Extra 1¼ cups finely chopped walnuts, to decorate

1. Preheat oven to 160°C. Grease a 20cm round cake tin with cooking oil spray and line base and sides with baking paper.

Cream Cheese Frosting 1 Tbsp milk ¼ cup EQUAL Spoonful 250g block cream cheese, chopped 1 tsp vanilla extract

2. Put carrot, EQUAL Spoonful, oil, egg yolks, milk and golden syrup in a large bowl. Mix with a spatula until combined.

3. In a separate large bowl, sift flour, baking powder, bicarbonate of soda and spices.

Make a well in the centre and pour in carrot mixture. Gently stir until well combined, then stir in walnuts and sultanas. Put egg whites in a large bowl and beat until stiff peaks form, then fold into batter in 2 batches.

4. Spoon batter into prepared tin. Bake for 1 hour 5 minutes or until cooked when tested with a skewer. Cool in tin for 5 minutes, then turn out onto a wire rack to cool completely.

5. Meanwhile, to make icing, put milk and EQUAL Spoonful in a small bowl and mix until well combined. Put cream cheese in the bowl of an electric mixer and beat on high, using paddle attachment, until light and fluffy. Add Equal mixture and vanilla and beat on low until combined, then increase speed to high and beat until fluffy.

6. Spoon icing on cake and spread to coat top. Decorate with extra walnuts. Serve.

Nutritional Information Average Quantity Per Serve: • Energy 1571 kJ (376 Cal) • Protein 7.2g • Fat Total 26.9g • Fat- Saturated 6.1g • Carbohydrates Total 25.9g • Sugars 9.3g • Sodium 376.3mg

The Essential Ingredient Equal Spoonful has almost no calories and measures spoon-for-spoon like sugar. Perfect for your recipes cereals and drinks.

Find more delicious recipes at club

.co.nz

Your Diabetes NZ

Diabetes NZ operates a helpline (0800 DIABETES or 0800 342 238) weekdays from 9am to 3pm providing free diabetes support and advice to New Zealanders around the country. After hours, you can leave a message on the answerphone. In a diabetes emergency call 111.

HERE TO HELP Diabetes selfmanagement, healthy eating, and new products are just a few of the things people want to know about when they call the Diabetes NZ telephone helpline.

M

ore than 200 people a month call Diabetes NZ’s telephone helpline to ask for support and advice about their diabetes. Our friendly membership support coordinator Nicky Steel is ready to help members of the public with all manner of questions from “Where can I get diabetes socks?” to “Do you have any healthy eating information in Punjabi?”

Here’s a selection of recent topics people have called about*: Caller 1: Pam from Tauranga rings asking what foods people with diabetes should eat. She lives with her adult son Gary, who has just been diagnosed with diabetes and has anxiety issues. Pam prepares all his meals and is keen to provide the right foods. Pam is a regular caller over the next two weeks with specific queries about whether certain foods are okay to eat and if so, how much can her son have.

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DIABETES WELLNESS | Autumn 2019

Nicky discusses the importance of healthy eating for people with all kinds of diabetes and sends Pam a copy of Diabetes and Healthy Food Choices, which is published

by Diabetes NZ. It’s an excellent resource for people with all kinds of diabetes, see http://bit.ly/ Diabetesandhealthyfoodchoices.

Health professionals can bulk order this pamphlet for their diabetes patients, as well as other patients who have weight management issues. See www. diabetes.org.nz/pamphletordering/.

Caller 2: Tom, the general manager of a transport company, calls. One of his truck drivers has type 1 diabetes and cab camera footage shows that he has been driving erratically. Tom is concerned his employee is not managing his diabetes and asks how the company can support him.

Nicky advises Tom to go to Diabetes NZ’s website to learn about type 1 diabetes and its dayto-day management www.diabetes. org.nz/type-1-diabetes-day-today-management/. Employees and employers have certain rights and responsibilities at work, see p8 for more details. The NZ Transport Agency has some useful information about driving with diabetes on its website, including a guide about how to assess the fitness to drive of any individual, see https://nzta.govt.nz.

Caller 3: Bill, a retired sheep farmer from Southland, phones.

He has been told by his GP that he has prediabetes and needs to make some changes to reduce his blood glucose levels. Bill is in his mid-60s and is less physically active than when he was working the farm. He wants to know what steps he needs to take to avoid developing diabetes.

For many people, a diagnosis of prediabetes is a wake-up call that they need to make some lifestyle changes to avoid developing diabetes. These include eating a healthier diet and taking measures to be more physically active every day. Nicky emails Bill a copy of Diabetes NZ’s popular prediabetes leaflet http://bit.ly/ DNZprediabetespamphlet.

Caller 4: Judy from Palmerston North rings and asks to talk to someone confidentially about a sensitive issue. Her husband has type 2 diabetes and requires medication. Since he has been taking it, his libido has dramatically declined. Judy is concerned about the impact on their sex life.

This can be a very difficult subject for men in particular to discuss. The first step in dealing with impotence is talking about

it with your partner and a health professional. It is a condition that is usually treatable. Nicky advises checking with the couple’s GP to see what treatment might be suitable. She also gives Judy a link to more information at https://www.diabetes.org.nz/ complication-mens-health.

Caller 5: Marama, who has type 2 diabetes, calls from Northland.

She is eating lots of fruit – at least seven large bananas per day. She says she is doing this to “help control her diabetes” but is concerned that this is not making any difference to her high blood sugar levels.

While fruit is an important part of a healthy diet, many people don’t realise that eating lots of it will raise blood sugar levels.

Bananas, especially over-ripe ones, are high in sugar. Dietitians advise people with diabetes to eat three to four servings of fruit every day. It’s preferable to eat these throughout the day rather than in one sitting.

One small banana (or half a large one) = one serving of fruit. For more information, see http://bit.ly/ Diabetesandhealthyfoodchoices.

Caller 6: Ruth, who has type 1 diabetes, rings from Auckland saying she finds it painful to check her blood sugars using the traditional strip-and-meter method and her fingers are calloused. She asks if there are any other options.

Nicky explains that new technologies are available, for example the Freestyle Libre is a flash glucose monitor that uses a sensor and scanner to read blood sugar levels. Other devices, including the Dexcom or Medtronic Continuous Glucose Monitors, can also reduce the number of finger prick tests needed per day.

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes.

A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on.

No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 257,000 New Zealanders with diabetes to live full and active lives.

For a confidential discussion, please contact Jenni Anderson jenni@diabetes.org.nz or 04 499 7150

*All names and locations have been changed.

DIABETES WELLNESS | Autumn 2019

31

Technology

Pharmac has announced it will fund two new insulin pumps.

Ruby McGill looks at the features offered by both.

NEW PHARMAC PUMPS

L

ast November Pharmac announced its two funded insulin pumps, the Animas Vibe and the Paradigm 522/722, were being replaced with newer, more advanced, insulin pump technology.

Kiwis can now access exciting new features that have been available in other countries but not in New Zealand, although users will need to self-fund a new continuous glucose

monitor to access the advanced hypo protection on both models.

The MiniMed 640G replaces the Paradigm 522 and 722 pumps, while the Tandem t:slim X2™ replaces the Animas Vibe pump.

As older insulin pumps reach the end of their warranties or when their consumables are no longer funded, they’ll be replaced by one of the new brands.

Animas Vibe pump users can access consumables until 30 September 2019. After this, there will no longer be Animas consumables or support available because of the global discontinuation of the brand.

The following table sums up the key differences between the two new pumps.

MiniMed 640G

Tandem t:slim X2™

NZ supplier

InterMed

NZMS (New Zealand Medical & Scientific Ltd)

Replaces

Paradigm 722 and 522 insulin pumps *Existing Paradigm consumables are compatible with the new pump.

Animas Vibe insulin pump and consumables *Existing Animas consumables are not compatible with the new Tandem pump.

Advanced protection against hypos. This new feature hasn’t been available in New Zealand until now. The pump can predict hypoglycaemic events and suspend basal rates until blood glucose levels rise.

SmartGuard feature available when paired with an Enlite Continuous Glucose Monitor. You will need to self-fund the CGM to access the advanced hypo protection feature on the pump.

The t:slim X2™ insulin pump will support a software upgrade to allow the Basal-IQ™ feature when paired with a Dexcom G6 continuous glucose monitor (neither is currently available in New Zealand). The Basal-IQ™ software update will be provided free of charge to NZ customers. Charges may apply for subsequent updates.

Remote software updates. Another first for New Zealand. These software updates allow users to access new features without having to buy a new pump.

NO

YES.

Screen

Large colour screen which automatically adjusts to the surrounding light

Large colour touch screen

Waterproof rating

Waterproof IPX8 rating (3.6m for 24 hours)

Water resistant IPX7 rating (1m for 30min)

Battery

1 x AA (alkaline, lithium or rechargeable)

Rechargeable battery. (Another new feature for New Zealand users).

Reservoir size

180 units or 300 units

Up to 300 units

Compatible web-based data management system

Carelink

Glooko+diasend

Questions about transitioning to a replacement pump and consumables

Contact sales@intermed.co.nz or phone InterMed Medical on 0800 333 444.

Contact NZMS Diabetes on 0800 500 226 during office hours or email switch2tandem@nzms.co.nz

There are no changes to the eligibility criteria for a Pharmac-funded insulin pump. For more information, contact Pharmac on 0800 66 00 50 or email enquiry@pharmac.govt.nz.

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DIABETES WELLNESS | Autumn 2019

Sandy Garman

READER RECIPE CARROT MUFFINS MAKES 12 MUFFINS, EACH WEIGHING 70g.

These sugar-free carrot muffins are lovely and moist and satisfy a sweet tooth. The recipe is based on one supplied

by Sandy Garman, from Warkworth, who has type 1 diabetes and prefers not to eat any added sugar in her diet. Sandy has been experimenting with healthy snacks that are sweetened with fruit rather than sugar or maple syrup and wanted to share the results of her labours.

These muffins have been made with monounsaturated oil (rather than butter or coconut oil) which reduces the amount of saturated fat per muffin. They can also be made gluten-free by substituting almonds for flour (see ingredients). The gluten-free version is higher in fat and lower in carbohydrate, so please check the nutrition panel when calculating your carbohydrates.

All the sweetness comes from fruit sugars, there are no free sugars. Find out more about free sugars here: www.who.int/bulletin/volumes/92/11/14-031114.pdf DRY INGREDIENTS 1 cup plain flour OR 1 cup ground almonds (for gluten-free version) 2 tbsp coconut flour 1 tsp cinnamon ½ tsp nutmeg 1 tsp baking soda ½ cup walnuts chopped finely WET INGREDIENTS ½ cup chopped dates or mixture of dates/apricots 3 eggs 1 banana 2 tsp cider vinegar 2tbl canola or olive oil 1 cup grated carrot 1 cup grated apple 1 tsp vanilla essence

METHOD Mix all dry ingredients in a bowl. Mix all wet ingredients together. Fold dry into wet, don’t overmix.

Bake at 180°C for 20–25 minutes in oiled muffin tins.

NUTRITIONAL VALUE PER SERVE: STANDARD VERSION (MADE WITH PLAIN FLOUR): 694kJ (166kcal) | PROTEIN 4.5g, FAT 8.2g (SAT FAT 1.1g) | CARBS 16.4g (SUGARS 7.9g) | SODIUM 128mg GLUTEN-FREE VERSION (MADE WITH ALMONDS): 845kJ (202kcal) | PROTEIN: 5.8g | FAT 14.8g (SAT FAT 1.6g) | CARBS 9.2g (SUGARS 8.4g) | SODIUM 126mg

We need your help to help them A diabetes diagnosis can be scary, overwhelming and confusing. It’s a steep learning curve whatever kind of diabetes you have.

We want Kiwis to know they are not alone, we are here to help them live well with diabetes and support their journey every step of the way.

Your generous gift will improve the day-to-day lives of people living with diabetes and help us to spread the prevention message far and wide.

As a charity, every dollar we raise is crucial – please support our work today:

H

Give securely at www.diabetes.org.nz or call 0800 342 238.

w

Donate via Westpac 03 0584 0197985 09

m

Send a cheque to Freepost Diabetes NZ,

– use your full name as reference.

PO Box 12441, Wellington 6144.

Move

GOING THE DISTANCE

W

hile I’ve always run to keep fit, I had only completed one halfmarathon before I was diagnosed with type 1 diabetes shortly before my 29th birthday. As many of you can probably relate, I spent the first few months wrapped in cotton wool; scared to do anything that might upset the delicate balance between insulin and blood glucose. However, I can still remember the feeling of elation when I was given the all clear to have my first light jog. Since then, running has become a meaningful part of my lifestyle.

Running marathons is a personal challenge I would never have thought I could achieve when I was first diagnosed six years ago. But last October I ran the Auckland marathon to raise money for Diabetes NZ and this year I’m doing the Hawke’s Bay Marathon, in May, and the

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DIABETES WELLNESS | Autumn 2019

Last year Ben Trollip set himself the challenge of completing a marathon to raise funds for Diabetes NZ. Here he shares his story and some practical tips on how to train for a marathon.

Chicago Marathon in October.

So how do you go about training for a long-distance run? Aside from the typical things that everyone should do (stretch, wear good shoes, develop a training programme, maintain a healthy diet, hydrate), there are several things that a T1D needs to think about. I’ve tried to cover the main things I’ve learned below but everyone is different. If I could give one overriding piece of advice, it would be to learn what works for you. Read from varied sources, speak to other people with diabetes, listen to your body and learn from your experiences in training.

One great resource is Runsweet (www.runsweet. com), which is a fantastic website for people with diabetes covering all kinds of sport. It is well worth checking out.

DIABETES GEAR

I am on an insulin pump (Medtronic MiniMed) and a continuous glucose monitoring system (Freestyle Libre). Both are not required to run long distance but I find them hugely helpful.

A pump system means that you’re only on short-acting insulin (dispensed regularly by the pump) rather than a longacting basal shot once every 12 or 24 hours. Doing the latter requires you to plan ahead and adjust your dosage lower when you have a big run coming up.

With the pump, you can simply turn the basal rate off and pretty quickly the short-acting insulin works its way out of your system and your blood glucose level (BGL) will begin to rise. I find this very convenient because extended cardio activity makes my BGL plummet and so getting rid of background insulin from

my system as soon as possible is a good idea. Before a big run, I will turn off my pump 15-30 minutes before the start. If doing a shorter run (and my BGL is relatively high) I might only turn the pump down to 30-60% of my usual basal rate.

The benefits of a continuous glucose monitoring (CGM) system are obvious. It’s much easier to monitor how your BGL is tracking without having to stop and prick your finger. If you’re not on a CGM, I’d suggest checking your BGL 60, 30 and 15 minutes out from the start to make sure it’s tracking well. I’m now confident in running a half-marathon length without checking my BGL (unless I’m feeling off) but when starting out you may want to plan to check around the one hour mark.

NUTRITION

For a long run, I like having as close to zero “on-board” insulin as possible. This is because I find that my BGL will fall quickly after more than 30-60 minutes of constant activity, even if it is only moderate.

Because I find a meal bolus can still be having an effect on my BGL three to five hours after the meal, I tend to run in the mornings before breakfast. This means my last meal will have been at least some eight hours earlier. If you prefer afternoon running, I’d recommend not going within four to five hours of your last meal (although, again, see what works best for you).

I don’t eat anything out of the ordinary the night before a race: I just aim for a well-balanced meal. Typically, it might be 40-60g of carbs. Personally, I’ve found that eating something that’s too carb-heavy or fatty can weigh on my performance the next day. I’ll sometimes set an alarm for around midnight to briefly wake up and do any corrections so that my BGL is perfect in the morning. (I don’t want to have to bolus close to the race, as explained above.)

Ideally, at the start of the race my BGL is 10-15mmol/L and gently rising. I’ll have a muesli bar (15-20g carbs) as close to the start of the race as I can manage. This serves me well for half-marathons (1:30 to 1:45 hours). However, I do check my BGL if I’m feeling unusually sluggish, and it’s not uncommon for me to take 15g of fast-acting sugar somewhere around the 15km-20km mark. I run with glucose tablets or gels which are easy to consume without stopping.

When training for a full marathon, I found that 15g of carbs (glucose tablets or gels) at around the 20-25km mark and thereafter every 5km worked well for me.

OTHER TIPS

Hypos (low blood sugar levels) are a significant concern. Running with friends or, even better, other T1Ds, is a good way to build confidence. Have a look for a local diabetes running group.

Wear some form of ID that shows that you’re T1D. For races, make sure the organisers know you have diabetes. There’s usually a spot on the registration form to disclose any medical conditions and I also write it on my bib. Make sure you’ve given accurate emergency contact details.

After a race, keep an eye on your BGL because it’s not unusual to be more susceptible to hypos for the next day or so.

Long-distance running is a surprisingly mental sport.

Achieving a good result relies on maintaining discipline and sticking to your plan. My advice would be to accept that sometimes things go awry when you have diabetes.

Try to learn from the experience but don’t let it demotivate you.

Sometimes perfect planning and management don’t result in a great run for some unknown factor beyond your control. Don’t dwell on it, and look forward to improving at the next opportunity.

BECOME A CHARITY HERO Supporters like Ben Trollip raised an incredible $25,000 for Diabetes NZ by taking part in the Auckland Marathon last year.

Please consider joining “Team Diabetes” in 2019 and take part in either the Rotorua marathon, in May, or the Auckland marathon, in October.

Your fundraising efforts will help provide much-needed support for our communitybased child and adult diabetes programmes.

To find out more, and receive a special marathon Diabetes NZ fund-raising pack, email fundraising@diabetes.org.nz

DIABETES WELLNESS | Autumn 2019

35

Healthier lives

A new study aims to help Māori living with poorly controlled diabetes improve their health.

MANA TŪ P eople with poorly controlled diabetes have a significant impact on the hospital system, often presenting with complications. A staggering 80% of them are Māori or Pacific Islanders, according to health researcher Dr Matire Harwood.

Dr Harwood is leading the Mana Tū study that uses kaimanaakiwhānau (community champions) to help people with diabetes achieve better control.

The project came about, explains Dr Harwood, because it was clear from previous studies that things like poverty, housing, and a lack of engagement with the health system were affecting people’s ability to take charge and live a fulfilling life with type 2 diabetes.

Evidence from work done overseas with indigenous communities shows that case managers working within primary care practices could have a positive impact on these patients.

A 12-month trial is currently operating in five GP practices – four in Auckland and one in Northland. The case managers, who are called kaimanaakiwhānau, work as clinical ‘champions’ in each practice to identify people with poorlycontrolled type 2 diabetes. They recruit them to the study and work with them and their whānau for 12 months to help them take control of their diabetes.

Currently, patients with poorly

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DIABETES WELLNESS | Autumn 2019

controlled diabetes are often left to their own devices, getting no more support than threemonthly GP visits. Doctors often struggle to get patients engaged, or to even attend appointments.

People with an HbA1c greater than 65 are the ones who are going to end up on dialysis, blind or with amputations, says Dr Harwood.

So what do the kaimanaaki do once people are on board with the programme?

There will usually be group education to start, says Dr Harwood. Then, they’ll discuss each person’s needs.

“We’ll ask what are the things that are going to help you take control of your diabetes?”

The answers vary from person to person. Dr Harwood shares some examples: “Someone would say it’s all good telling me to cook healthy kai, but my kitchen is rubbish, I don’t have a functioning oven.

So the group went to the person’s house on a weekend and cleaned up the kitchen. Then they worked with the local supermarket to get it stocked with spices to cook healthy food.”

For others, exercise was a challenge, but not in ways we might expect.

One woman said: ‘I’m too ashamed to go out and exercise because everyone makes fun of me being so fat’. So the group organised for a donated bike to be set up on a rotator system in her

Members of the Mana Tū kaimanaaki team from left clockwise: Taria Tane (network manager), Janine Thomas (health psychologist), Kimiora Hawkins (kaimanaaki at Whangaroa Health), Ngaraiti Rice (kaimanaaki at Otahuhu Health Centre), De Ann Nicholls (kaimanaaki at Papakura Marae), Richard Cooper (kaimanaaki at Papakura Marae) and Laura Broome (research manager).

house, like an exercycle. She lost 50 kilos and is now happy to get outside and go for a walk.

It’s this kind of empowering approach that can have lasting impact, believes Dr Harwood.

She hopes the project will provide proof that this type of programme works, and that in the future it will be funded through primary care.

The Mana Tū project is jointly funded by the Healthier Lives National Science Challenge, the Ministry of Health, and the Health Research Council of New Zealand (HRC) as part of the Long Term Conditions Partnership.

See www.healthierlives.co.nz.

Diabetes youth

Achieving their goals The John McLaren Youth Awards recognise the pursuit of excellence across cultural, academic and sporting fields by young people with diabetes.

The 2018 winners will each receive $1,500.

AMIYA FOTU, 14, FROM AUCKLAND

Amiya, who was diagnosed with type 1 diabetes at four, loves playing sports, including netball, tag football, touch, tennis, volleyball, basketball and rugby. One of her goals is to represent New Zealand at the highest level in basketball. Last year Amiya, a year 10 student at Westlake Girls High School, was asked by North Harbour Basketball Association to attend a basketball tournament in Melbourne but couldn’t go because of the $2,500 cost. This year she will be able to represent North Harbour internationally, thanks to her McLaren award.

LANCE RUEHORN, 18, FROM OAMARU

Lance has been passionate about tourism and hospitality for two years. He says he has worked hard to control his diabetes by knowing his limits, talking about how things are going, and making sure he doesn’t fall into bad habits. This year he will be travelling away from home to study hospitality and plans to use the McLaren award to finish his diploma and work in an industry he is passionate about. Lance believes people with diabetes can do anything they want and he hopes to inspire others to try new things and follow their dreams.

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Recipe from

2017 MAGAZINE MEDIA AWARDS

DECEMBER 2017

easy als 20+me

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THAI LAMB SALAD SERVES 2 • COST PER SERVE $9.80 • TIME TO MAKE 20 MINUTES • DIABETES FRIENDLY • NO DAIRY • LOW FODMAP Ingredients

Method

spray oil 300g lamb leg steaks 1 red capsicum, thinly sliced 1 cup halved cherry tomatoes 1 Lebanese cucumber, thinly sliced 2 cups mesclun or other salad leaves juice and zest of 1 lime 1 teaspoon fish sauce ½ teaspoon sugar ½ teaspoon chilli flakes ½ cup fresh coriander 2 tablespoons roughly chopped roasted peanuts 1 cup cooked brown or black rice

1 Spray a barbecue grill or heavybased pan with oil and heat to high.

2 Cook lamb steaks for 2-3 minutes each side, until done to your liking.

Set aside to rest.

TIPS

Make it gluten free Check fish sauce is gluten free.

Make it vegan Substitute diced tempeh for lamb and seaweed flakes for fish sauce.

3 In a bowl, combine capsicum, tomatoes, cucumber and salad leaves. In a cup, combine lime zest and juice, fish sauce, sugar and chilli flakes.

4 Add half of the dressing to the salad and toss well. Divide between 2 plates. Slice lamb into 1cm slices and add to salad.

Drizzle with remaining dressing and garnish with coriander and peanuts. Serve with rice on the side.

DIABETES WELLNESS | Autumn 2019

37

Last word

PHOTO: BM PHOTOGRAPHY

“O A NEED FOR SPEED Speedway racing brothers Kieran and Kyle Davies, from Nelson, are on a mission to prove that you don’t need to live life in the slow lane while living with type 1 diabetes.

ur story began when we were young. A family friend first introduced us to speedway. The trip over from Takaka had us squealing in our seats. From the first meeting, we were hooked. A Holden car loving family, it’s only natural that we love racing.

In 2017, Kyle Davies (aka Hundy) was offered the chance to get into a Streetstock and well, the rest is history. Having watched his big bro race for one season and learn more about cars and the dynamics of the pits, in 2018, it was time for Kieran Davies (aka Fiddy) to join Hundy on the track and the Hundy & Fiddy Racing Team was born.

With the help of Mum, Dad, other family and friends, the boys stepped onto the track with a mighty big bang.

Fiddy has had type 1 diabetes since he was 17 months old and

when he joined the team, it was decided it was time to give back.

Zoe Goodwin, our team manager, reached out to Nelson Diabetes Youth and a strong partnership was formed.

The main objective is to raise money and awareness. So many people confuse type 1 diabetes with type 2. So many kids with type 1 don’t believe that they can still get as much out of life as those that don’t have it and with Fiddy on the scene, that was all about to change.

From sausage sizzles to selling cookies, and with the support of Nelson Speedway and some amazing people, we have raised more than $2,000 for Nelson Diabetes Youth and their annual family camp. It’s been a humbling experience but it’s not over yet. In fact, this is only the beginning of the Hundy & Fiddy/diabetes story and we plan to raise more money this year.

”

You can follow Hundy and Fiddy at www.facebook.com/HFRacing23N26N/

38

DIABETES WELLNESS | Autumn 2019

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