Diabetes Wellness Autumn 2021

wellness DIABETES

AUTUMN 2021 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

MEDICAL ID • LOOK AFTER YOUR KNEES • “EXERCISE SNACKS” • JOURNALIST JODY O’CALLAGHAN • MAKE WATER DELICIOUS • HYPO TREATMENTS & ORAL HEALTH • CUTTING-EDGE TECH • DIABETES QUIZ

DIABETES ACTION MONTH LOVE DON’T JUDGE

OUR YOUTH OUR FUTURE

measures spoon-for- spoon like sugar Ginger Moments Preparation 15 minutes Cooking 15 minutes Serves 32

Ingredients 1 cup plain flour ½ cup self-raising flour 1 cup Equal Spoonful 1 Tbsp ground ginger ½ tsp mixed spice 80g butter, melted 1 Tbsp treacle, warmed 1 egg 1 Tbsp low fat milk 1 Tbsp finely chopped glacé ginger Cream Cheese Filling 125g light cream cheese 2 Tbsp Equal Spoonful 1 tsp ground ginger ¼ tsp grated orange rind ½ tsp vanilla essence

Instructions 1. Preheat oven to 180°C. Line 3 oven trays with baking paper.

2. Put flours, Equal Spoonful and spices into a large bowl and stir until combined. In a second large bowl combine butter, treacle, egg and milk. Add glace ginger then add to dry ingredients and mix until a firm dough forms. Roll teaspoonfuls of mixture into balls and arrange on prepared trays.

Press down gently with a fork.

Bake for 12-15 minutes or until golden brown. Allow to cool on a wire rack.

3. Meanwhile, to make cream cheese filling put all ingredients into a large bowl. Beat with an electric hand beater until smooth.

4. Once biscuits have cooled, sandwich biscuits together with a little filling. Serve.

Nutritional Information Average Quantity Per Serve:  Energy 197.7 kJ  Protein 1.4 g  Fat total 0.9 g  Carbohydrates 8.2 g  Sugars 2.2 g  Sodium 41.1 mg 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

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Contents AUTUMN 2021

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VOLUME 33 | NO 1

4 EDITORIAL 5 UPFRONT: School trips survey and Auckland Round the Bays

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6 UPFRONT: Diabetes Youth camp season

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8 YOUR DIABETES NZ: The Challengers Dinner 10 NOURISH: Quench your thirst with infused waters

COVER: MAI FM MORNING CREW © HAYLEY ROBERTS

14 YOUR DIABETES NZ: Love Don't Judge: Diabetes Action Month 2020

18 MOVE: Looking after your knees 20 COMMUNITY: Tim Haslop – raising funds for Diabetes NZ 23 COMMUNITY: Hayley McDonald celebrates two years of My Identity 26 MOVE: Moving more every day with incidental exercise 28 CARE: The latest research on treating hypos

30 LIFE WITH T1: Journalist Jody O'Callaghan on her life with T1 34 TECH: Digital monitoring for diabetes 35 CARE: Hypos and oral health 36 QUIZ: Test your diabetes knowledge

10 20 Want to receive your own copy of Diabetes Wellness magazine? Subscribe today at www.diabetes.org.nz

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DIABETES WELLNESS | Autumn 2021

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Editorial

K

ia ora koutou! Welcome to a new year, a new season, and new opportunities.

I usually begin a new year with great enthusiasm and with a few goals and ambitions in mind, but I have to admit to taking a more tempered approach for 2021.

I am very mindful of the challenges and opportunities that 2020 brought for so many of us. Covid-19 is changing our world in many ways – and certainly when it comes to health care. For example, it has highlighted the need for accurate and timely information that is easily accessible for those who need it. Diabetes NZ works hard to be a reliable and accurate source of information and advice, and it was encouraging to see how quickly staff were able to keep up with the ever-changing circumstances last year.

But despite how well the entire “team of 5 million” has done and how lucky we have been, for many people, Covid-19 has taken a toll on mental health. In the diabetes community, there has been understandable heightened anxiety.

Our 2020 Diabetes Awareness Month (DAM) theme – love don’t judge – focusing on mental health, was a timely reminder that the diabetes community is no place for judgement. Each of us has our own story, and Diabetes NZ is there to support, encourage, and assist both on a practical level and in the offices of decision-makers.

Now, in 2021, as I look to how the Advisory Council can work to advocate for our diverse diabetes community, I also look to how my own family will be supported as we send our type 1 teenager off to tertiary study away from home. Many families around the country will be in the same situation right now.

Having been under the excellent services of the paediatric team for our entire diabetes lives, we are now discharged from their care and enter the world of adult diabetes services in a new city. Change is exciting and often rewarding, so I look forward to Mr Type 1 gaining even greater independence for his life-long interactions with the health care system.

I will certainly be paying even more attention to how the Advisory Council can keep abreast of this transition for all of our diabetes community.

This issue of Diabetes Wellness contains a round-up of our highly successful DAM campaign on page 14, as well as a report on the Challengers Dinner, a glittering fundraising event featuring many sporting celebrities. There is a focus on youth throughout the issue, along with all our usual healthy living articles, plus a test your diabetes knowledge quiz on page 36.

I wish you all the best for 2021. Let’s look after ourselves and each other.

LYNDAL LUDLOW

Advisory Chair, Diabetes NZ

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DIABETES WELLNESS | Autumn 2021

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 Board Chair Catherine Taylor Chief Executive Heather Verry Diabetes New Zealand National Office Level 10, 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 Johanna Knox 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 Manager 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

TAKE SMALL STEPS – MAKE A BIG DIFFERENCE

School trips and camps: caring for our children As the school year begins, a survey sheds important light on how children with diabetes are cared for during school trips and camps.

D

iabetes NZ collaborated with the New Zealand Clinical Network for Children & Young People with Diabetes to conduct this survey.

Of the respondents, 227 were parents and caregivers of students with diabetes and 267 were school staff. Diabetes clinics were also asked about the School High Health Needs Fund and education sessions.

• Many schools are not aware of education sessions run by diabetes teams.

• Parents are concerned about the level of knowledge that schools have about the complexities of diabetes management.

• Schools want more information and support for excursions, particularly overnight camps.

SUMMARY OF FINDINGS

• That management plans and a checklist for school excursions be developed.

• That a national education package for managing diabetes at school, particularly for excursions and camps, be developed.

• That the Clinical Network for Children & Young People with Diabetes engages with the Ministry of Education about the School High Health Needs Fund.

These recommendations are being actioned.

• Parents, caregivers, and schools engage positively with Diabetes Action and Management Plans (developed by the National Clinical Diabetes Network).

• It’s generally recognised that home/school partnership is essential, which these plans help facilitate.

• Concern exists that these plans don’t address trips and camps to ensure children with diabetes are not missing out.

• There is confusion about the High Health Needs Fund and how to support children to manage their diabetes without this support.

On 28 February, Team Diabetes Auckland will hit the streets for New Zealand’s biggest fun run, the Ports of Auckland Round the Bays.

They’ll raise money for Diabetes Auckland and help to change lives.

Want to join the team?

There’s still time to sign up. You can also make a big difference simply by donating any amount, large or small.

To run or to make a donation, go to: https:// rtb21.grassrootz.com/ diabetes-new-zealand

RECOMMENDATIONS

For more information on the survey, see: www.diabetes.org.nz/news-andupdate/schools-survey-results-2020

DIABETES WELLNESS | Autumn 2021

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Upfront

Summer fun December signals the start of Diabetes Youth camp season, which continues throughout January and February. Here are snaps from around Aotearoa of young people who live with diabetes coming together to learn, challenge themselves, support each other, celebrate, and make the most of the great outdoors we’re so lucky to have access to.

AUCKLAND

Auckland teens made up for their Covid-cancelled April camp with a day of activities in December.

Diabetes Youth Auckland held their 2021 Live Brave camp at YMCA Shakespear Lodge. From 11 to 14 January, 40 kids, nine to 12 years old, sailed, kayaked, climbed, mountain boarded, learned bush cooking, and dressed up for a gameshow night.

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DIABETES WELLNESS | Autumn 2021

NELSON

Diabetes NZ Nelson Youth can’t wait for their Family Camp on 26 February. Meanwhile, they’ve been enjoying day trips.

On 16 January, they went paddle-boarding on the Maitai river.

OTAGO

On 12 January, 23 kids from all around the Otago region gathered at Berwick Lodge for four days of rifle shooting, abseiling, kayaking, night bush walks, confidence courses, and more. Otago photos by Brendan Ward.

Find out more about diabetes youth camps at the Diabetes NZ website: www.diabetes.org.nz/camps-2021

Invest in your health Subscribe for just $28 a year* Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand * Four issues delivered to your door – $7 per issue, including P&P. RRP is $32.00 To subscribe for this special price, visit www.diabetes.org.nz and click on “Magazine Subscription”.

DIABETES WELLNESS | Autumn 2021

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Your Diabetes NZ

THE CHALLENGERS DINNER A NIGHT TO REMEMBER With a star-studded lineup of speakers, a delicious menu, and an exciting fundraising auction, everyone knew the Diabetes Challengers Dinner would be the perfect end to Diabetes Awareness month.

However, it surpassed all expectations when it raised close to $500,000 for people living with diabetes.

fascinating panel discussion.

Also in attendance were sporting celebrities Dan Carter, Dame Valerie Adams, Rob Waddell, Lisa Carrington, and Eliza McCartney – to name a few. Kerre McIvor was our energetic and inspiring MC. However, everyone agreed that the star of the night was 10-year-old Eden Iona, who spoke about her journey with type 1 diabetes. There were certainly some tears shed as she described her diagnosis at age 8 and how it had turned her and her family’s life upside down forever.

When she finished, she received a standing ovation.

eld in Auckland’s Shed 10 on Wednesday 2 December, the Barfoot & Thompson and Diabetes NZ Auckland Branch Gala Fundraising Dinner was billed as a sparkling black-tie affair. The 750 tickets sold out well before the night, and no wonder.

Special guests included the three skippers from the 2020 America's Cup – Sir Ben Ainslie, Dean Barker, and Jimmy Spithill. Well known yachting broadcaster Martin Tasker interviewed them, making for a

The stand-out live auction items had to be the chase boats. We thought we had three to auction: Luna Rosa Parda Pirelli, Ineso Team UK, and NYYC American Magic.

These set the bidding alight.

There were a few laughs as well, especially when Jimmy Spithill got a dig in at Dean Barker and Sir Ben Ainslie, suggesting you'd be in for hotdogs and warm beer on their chase boats, rather than the exquisite fine dining of the Italian team.

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DIABETES WELLNESS | Autumn 2021

BIDDING FOR TREASURES

During the bidding, we were unexpectedly donated a fourth chase boat – for Emirates Team New Zealand. By now, the room was electric. This became the item with the highest bidding – raising $35,000.

Diabetes NZ CEO Heather Verry says, “We received some incredibly generous donations for our live auction, which will go towards supporting kids and adults living with diabetes and digital programmes to prevent the onset of diabetes.”

Those digital programmes will include new interactive learning and online programmes suited to different cultures and languages.

The new digital tools will reach thousands more and change the lives of those living with diabetes, as well as those at risk.

Thanks to our wonderful sponsors for the night Platinum: Barfoot & Thompson Gold: AIA Insurance, ASB, Forsyth Barr, and Giltrap Group Silver: Westpac, Forsyth Barr, Golf Warehouse, and Lindsay Foundation

A star is born: Eden Iona For 10-year-old Eden Iona, the star speaker at the Challengers Dinner, the night was full of highlights: “It was exciting meeting the celebrities like Daniel Carter, Sophie Pascoe and Rob Waddell – he's so tall!” However, what she enjoyed most was “being able to spread awareness about type 1 diabetes and raising money for Diabetes New Zealand.”

Looking back at what she thinks made the biggest impact on the audience, “I spoke about how getting diagnosed wasn't my fault and how there's no cure … but more importantly about how it doesn't stop me from doing what I love, like sport, even with all my finger pricks and insulin injections.”

Eden has always enjoyed public speaking and found it exciting, but, when it comes to talking about diabetes, she says, “I didn't realise sharing my story was helpful until after I spoke at a diabetes fundraiser lunch in 2019.

“My parents shared it on their social media, and family and friends were fascinated about my story. They never realised how serious type 1 diabetes is and how it affects so many children. So that was really important to me – that more people know.”

Eden is inspired to do more speaking if she gets the chance.

“I think about other kids like me who are struggling with their diabetes like I did in the beginning, and hopefully me talking about it lets them know that they’re not alone and we are all awesome.”

Meanwhile, she has plenty of other interests. At school, she loves to “read and write adventurous narratives”. Outside of school, she enjoys “hanging out with family, swimming, going on road trips, and playing sport”. She’s represented her school in swimming, netball, rugby, cross-country, and waka ama. “Waka ama is so fun. I love being part of a team and being out on the water and keeping fit.”

two I’ve had type 1 diabetes for ulous fab my l stil years now, and I’m self.

I have my good days and bad e each days, but have learnt to tak ember day as it comes. I have to rem my that I’m so much more than … s low highs and my pared My routine is different com be to e hav I to others my age, and you do t Bu a lot more organised … men? know what, ladies and gentle .

Type 1 diabetes can’t stop me and Diabetes is always with me e hav I t tha ing always someth t to be aware of. But it doesn’ e type hav y control what I do. I ma es bet 1 diabetes, but type 1 dia doesn’t have me. ner

– Eden Iona, Challengers Din speech, 2020

DIABETES WELLNESS | Autumn 2021

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Nourish

Quench your thirst with infused waters As the warm sunny days of late summer and early autumn stretch before us, stay hydrated with delicious, ice-cold waters flavoured with fruits, herbs, and spices.

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DIABETES WELLNESS | Autumn 2021

W

e all know the benefits of drinking plenty of water. A clear mind, improved digestion, and weight loss are just a few of them. But sometimes plain water can feel just a little boring. For those times, why not turn to infused waters? They’re refreshing, they contain next to no calories, and it’s fun to experiment with the endless flavour possibilities.

YOUR WORLD OF INGREDIENTS

For infused waters, use fresh fruit rather than tinned, as tinned fruit generally has added sugar.

In addition, the New Zealand Dental Association (NZDA) recommends that you avoid adding too much very acidic fruit to your infused water. Water has a neutral pH, and ideally our mouths are close to neutral most of the time as well. While too much sugar is a major factor in tooth decay, acidic foods and drinks can also damage tooth enamel, encouraging decay.

Almost all fruit is on the acidic side and will lower the pH of your water at least slightly. Don’t worry too much about a little bit of acidity, but you don’t want to be washing your mouth in a very acidic mix constantly, so bear in mind the acidity of the fruits you use. Here’s what you need to know.

Citrus fruits

Citrus fruits add sparkle to any drink. Lemon is the classic fruit to add to chilled water, but, along with lime, it’s particularly acidic, so use it sparingly in infused waters – if at all. Orange and kumquat are better choices.

They tend to be the least acidic citrus fruit, and, in fact, are similar to berries in terms of pH. Berries

Berries are middle of the range as far as acidity goes. You can use fresh or frozen berries of any kind for infused waters, bearing in mind that frozen berries break up more and go mushier. (If you want to eat the fruit floating in the drinks, choose fresh!)

Apples, pears, pineapple, and stone fruit

Like berries, these are all of middling acidity. Of course, the exact acidity also varies depending on factors such as the variety of fruit and how old it is. (General rule: unripe fruit is more acidic and older fruit is sweeter.) These fruits are readily available and often cheap, so what’s not to love? In particular, apples that are a little old and have lost their crunch can be put to delicious use in infused waters.

Banana

This might seem like a counterintuitive ingredient: bananas are not exactly juicy! However they impart a surprisingly delicious flavour to water and are less acidic than most fruits.

Basic infused water recipe This recipe makes two litres – that’s the average amount of water an adult is recommended to drink in a day, so you could make this early in the morning, or the night before, then use it to keep you going throughout the day. Alternatively, it’s the perfect size to go with a household meal.

What’s more, if you’re hosting a social event, there are bound to be guests who are trying to cut down on sugar or carbs and will appreciate the extra option of infused water.

About 2 cups washed fruit, chopped or sliced 2 litres cold tap water A few sprigs of herbs (optional) A small handful of whole spice (optional) Put all your fruits, herbs, or spices in a jug, pitcher, or glass bottle.

Pour the cold water over the top.

Place in the fridge to chill and infuse for anything from half an hour to 8 hours. Give it a stir or two during that time.

The longer you leave the water, the more highly flavoured it will become. Serve when ready. Leave the fruit in: children especially will love to eat it as well as drink the water. Add ice cubes for extra chill if you’d like to.

TIPS

If you’re going to be making the water well in advance of drinking it, take the flavouring ingredients out after eight to 10 hours. You can then store the water, covered, in your fridge for two to three days. Add fruit slices or herbs as a garnish just before serving.

If you find yourself with fruit left over after the water is drunk, why not freeze and save for smoothies?

DIABETES WELLNESS | Autumn 2021

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Mango, papaya, and figs

These are all great choices for flavour and acidity levels – with papaya and figs particularly low in acid.

Some starter combinations

Infuse your water with a single ingredient or get creative. The sky’s the limit when it comes to combos of fruits, herbs, and spices, but here are a few ideas to get you started.

Melons

Watermelon and, especially, rock melon and honeydew melon are only very slightly acidic. They impart wonderful subtle flavours and make excellent choices for infused waters!

Watermelon + mint Pineapple + cinnamon

Cucumber and beetroot

Who says use only fruit? Thinly sliced cucumber is another infusedwater staple. Beetroot isn’t quite so traditional but adds delicate flavour and stunning colour. Both are relatively low in acid.

Lots of strawberry + a few slices of lemon

Herbs and spices

A scattering of herbs or whole spices can make an infused water even more delicious. Herbs to try include mint (a classic!), lemon verbena, lavender, a few rose geranium leaves, fennel, coriander, or dill.

Possible spices include cinnamon sticks, sliced fresh ginger, and whole star anise.

USING CARBONATED WATER

Carbonated water contains carbonic acid, so it will always make a more acidic infusion than still water.

But if you love sparkling water and nothing else excites your tastebuds, then by all means use it. Short infusions will be best, before the water loses its fizz!

Cucumber + dill, fennel, or star anise

Blueberry + orange

Pineapple + mango + banana Rock melon or honeydew melon + ginger

Pear + rose geranium or lemon verbena

USING HERBAL TEAS

Apple + pear + cinnamon + lemon

Another way to create delicious flavour is by infusing herbal teabags in your chilled water instead of fresh produce. Peruse the supermarket shelves and see what appeals – but do check the labels. Some herbal teas, especially fruity ones, have added sugar. You’ll want to avoid this.

As with the fresh fruit infused water, simply place the teabags in your vessel, pour in cold water, and chill, stirring very occasionally. Remove after one to eight hours.

You want to use one to two teabags per litre of water. (Any more than that and you’re making strong iced tea, rather than infused water.)

Why not experiment with fresh produce and herbal teas combined?

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DIABETES WELLNESS | Autumn 2021

Take a chilled bottle of infused water with you when you’re out and about.

You might want to experiment with flavours till you find an infused water recipe you love, or maybe the enjoyment for you is in trying out all the different possibilities. Do what makes you happiest.

Even if you replace just one sugary drink with an infused water now and then, you’re doing your health a favour. The more the better of course, but know that, every time you choose water over a sugary drink, it does make a difference.

Set yourself individual goals that work for you, and enjoy!

STICKING WITH THE GOOD STUFF

Every time you reach for an icy glass of water – inluding infused water – you’re doing something kind for yourself.

The research has been in for a while: New Zealanders consume more sugar per capita than any other country in the OECD, and sugary drinks (soft drinks, energy drinks, flavoured milks, and juices especially, but also sugary tea and coffee) are the single biggest contributors to the sugar in our diets. On average, New Zealanders are consuming at least two or three times more sugar a day than the recommended daily allowance.

The damage this is doing to our individual and collective health is massive.

But giving up sugary drinks can be tough, especially when we’re constantly bombarded with advertising messages telling us to consume more of them and when they’re so easily accessible in every supermarket, dairy, and petrol station.

Cutting something out of your life without finding a satisfying replacement for it is always tough.

That’s where infused waters come in. Use all the hacks to make the change work for you.

Have a big jug of chilled infused water at the ready in the fridge at home or at work, so that it’s easier to reach for that than anything else.

RESOURCES

For more on how much water you should be drinking, see our hydration guide by dietitian Helen Gibbs in the Summer 2019 issue of Diabetes Wellness.

For exact details on the whopping amounts of sugar in soft drinks (and more), see the infographics at www.nutritionandactivity.govt.nz/ nutrition

EAT WELL LIVE WELL

Tasty and easy diabetes-friendly meals everyone will love Eat Well Live Well is chock-full of diabetes-friendly recipes from well-known Kiwi chefs. Each dish is quick and easy to prepare and great for the whole family.

Head to www.diabetes.org.nz for your copy – $33.00 including delivery – or purchase it directly from your local Diabetes NZ branch, Whitcoulls, PaperPlus and The Warehouse.

All profits go towards supporting Diabetes NZ’s work.

Your Diabetes NZ

Diabetes Action Month, November 2020, was a hugely successful campaign that raised awareness and encouraged positive action for people with all types of diabetes.

Kei whakawā. Me aroha.

LOVE DON'T JUDGE With the theme Love Don’t Judge, we encouraged New Zealanders to be kind and to “wear their heart on their sleeve” for diabetes.

This message was strongly encouraged by well-known New Zealanders through the campaign video, including Dr Ashley Bloomfield, Mike McRoberts, Mike Puru, Dave Letele (AKA Buttabean), Jazz Thornton, and the Mai FM Morning Crew. They were joined

by Diabetes NZ Auckland branch’s Susan Moala’eua and Iliana Fusitua.

Diabetes NZ is grateful to those who volunteered their time to be part of the campaign video and spread this important message, and to everyone who wore their heart on their sleeve for Diabetes Action Month.

2020 Emotional Wellbeing Survey In 2020, for the first time, Diabetes NZ took a deep dive into the emotional wellbeing of people living with diabetes. We distributed a survey widely through our networks and found out just how prevalent diabetes distress, burnout, and mental health concerns are in our community. We also discovered that Covid-19 had increased diabetes distress, stigma, and discrimination.

Diabetes NZ CEO Heather Verry was interviewed about the survey results, diabetes distress, and Diabetes Action Month on One News, Newshub at 6, Newstalk ZB, Radio New Zealand, and TV3’s The Café. Additionally, stories about diabetes and diabetes distress were reported on Stuff.co.nz, NZ Herald, Mai FM, and local news outlets around the country as part of this campaign.

Thank you to everyone who took part in the survey and bravely shared your feelings and experiences. This helped us understand more about how diabetes affects your everyday life and informed the development of our new Diabetes Distress resource.

SURVEY RESULTS • 81% of people surveyed had experienced diabetes distress • 69% had experienced diabetes burnout • 44% had been diagnosed with a mental health disorder (for example, depression, anxiety, or an eating disorder) since being diagnosed with diabetes • 56% felt concerned about their risk of severe illness from Covid-19 • 45% experienced an increase in diabetes distress as a result of Covid-19 • 14% experienced increased stigma or discrimination due to Covid-19

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DIABETES WELLNESS | Autumn 2021

“Negative attitudes and a lack of understanding of diabetes are big factors in the emotional wellbeing of people living with diabetes. In fact, there is so much misinformation out there that many people with diabetes keep their condition a secret. If we can’t tell people about diabetes for fear of prejudice and stigma, how are we going to get support for the huge emotional burden people living with diabetes are facing?”

DIABETES NZ CEO HEATHER VERRY

DIABETES DISTRESS RESOURCE We now know that 81% of New Zealanders with diabetes have experienced diabetes distress – the emotional burden of living with and managing diabetes.

If you are experiencing diabetes distress, you may feel overwhelmed by the demands of living with diabetes, concerned or afraid that you are “failing” with your diabetes management, sad about living with diabetes, worried about your risk of long-term complications, frustrated and angry that you can’t predict or

“control” diabetes from one day to the next, or guilty and ashamed when your diabetes management gets “off track”.

Our new resource is designed to help if you or a loved one live with this common condition, with tips and tricks to help you get through.

Visit the Diabetes NZ website for more information and to download the resource: www.diabetes.org.nz/resources-1

Facebook Live Diabetes Action Month 2020 also saw our first Facebook Live sessions take place. The four live interviews focused on diabetes distress and mental health concerns related to diabetes.

We were fortunate to have incredible health and diabetes psychology specialists join us for the sessions – including Anna Friis, Kiralee Schache, and Jane Speight of the Australian Centre for Behavioural Research in Diabetes.

Special guests Ruby McGill, Brett and Angel Rennall, Emily and Eddie Writes, and Madeleine Lord shared their own experiences with diabetes and emotional health, and our very own Matire Ropiha from Diabetes NZ Taranaki, Natalie Hanna from Diabetes Auckland Youth, and Diabetes NZ’s Liz Dutton added their expertise and experiences to the conversation.

If you missed the sessions, you can still view them on our Facebook page, YouTube channel, or website.

DIABETES WELLNESS | Autumn 2021

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Your Diabetes NZ

Diabetes Action Month Events Our local Diabetes NZ branches hosted awesome events around the country throughout Diabetes Action Month.

Kei whakawā. Me aroha.

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iabetes NZ Otago branch held their annual Do Blue Day, with children from local schools dressing in blue to raise money for diabetes. Meanwhile, Diabetes Tauranga Youth entered a team into City to Surf as a fundraiser for their Family Camp 2021, and Wanganui branch held a Market Day and Collection Day, also selling raffle tickets.

Diabetes NZ Auckland branch hosted Diabetes and Whānau Fun Days in Ōtara and Ōtāhuhu. They also held a spectacularly successful Challenger’s Cup dinner with special guests from the Challengers Series – Jimmy Spithill, Sir Ben Ainslie, and Dean Barker. You can read more on page 8.

Right: Auckland Diabetes Youth come together for World Diabetes Day

WAIKATO EVENTS Waikato branch took part in a number of events, including the Waikato-Tainui Whiikoi Mate Huka, the Round the Bridges Fun Run, and the Morrinsville Pakeke Lions Fundraiser.

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DIABETES WELLNESS | Autumn 2021

TARANAKI STEELFORMERS AROUND THE MOUNTAIN RELAY On 6–7 November, Taranaki Youth branch once again raised awareness for type 1 diabetes by entering a team into this annual event.

WORLD DIABETES DAY Rotorua Branch celebrated World Diabetes Day, 14 November, with a fundraising raffle and morning tea. Rotorua East Lions donated $500 worth of prizes.

Meanwhile, Auckland Diabetes Youth celebrated with a trip to Auckland Zoo, proudly sporting their Love Don’t Judge tees.

Thank you!

A huge thank you to everyone who participated in Diabetes Action Month. Whether you answered the survey, joined a Facebook Live, shared the video, attended an event, bought a Mr Vintage ChariTee, or shared the Love Don’t Judge message with friends and whānau, we appreciate your efforts to raise awareness for diabetes. We would also like to thank Mr Vintage for raising $2,400 for Diabetes NZ.

DIABETES WELLNESS | Autumn 2021

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Move

LOOK AFTER THOSE KNEES! PART 1

Our knees are large, complex joints, and knee troubles can be a major barrier to staying active.

Fitness consultant Craig Wise advises.

W

e often don’t consider how wonderful our body is and what it can do, until we’re forced to stop because of injury or pain in some area. Recently, I injured my knee. I’d like to say I was rescuing puppies from a burning building, but in reality I just misplaced my footing and twisted my knee. It forced me onto crutches for a couple of weeks and slowed me down for much longer.

Over the years, I’ve come across many people with knee issues, from injuries to niggly arthritic pains to patella femoral syndrome (where the kneecap doesn’t track correctly as it moves over the knee). Each injury and pain is unique, but some general principles can be applied.

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DIABETES WELLNESS | Autumn 2021

COMMON PROBLEMS

The two most common types of knee pain are worn cartilage and bursitis. Worn cartilage leads to inflammation that can cause persistent swelling, stiffness, loss of range of movement, and osteoarthritis. Bursitis is caused by inflammation of the bursa, a small fluid-filled sac in front of the knee.

It’s usually intermittent and mild at first, but it can become persistent, severe, and difficult to alleviate, so prevention is key.

For some people, these knee issues stem from being overweight; excess weight bearing down on the joint can cause premature wear and tear on the joint cartilage, leading to inflammation and pain.

These issues can also arise if you subject the knees to excessive high impact by running on hard surfaces, playing racquet sports such as squash, or engaging in other activities that cause sudden jolting impacts in the joint.

PRINCIPLES OF KNEE CARE Watch your weight

This may seem like a no brainer, and something that we should all be doing anyway, but it’s even more important if you suffering from some form of knee discomfort.

Eat a diet high in antiinflammatory foods

Foods such as almonds, avocado, broccoli, many berries, and oily fish such as salmon, mackerel, sardines, and fresh (not canned) tuna contain anti-inflammatory properties that may ease the joint pain caused by arthritis.

Bring the heat

If your knees are prone to stiffness, you may wish to use something like a warm towel wrapped around the joint to warm it up slightly. The warmth will increase the blood flow in the joint, making it feel more comfortable and ready for action.

Warm up

No matter what activity you’re doing, it is important to warm up first. Exercising with stiff cold muscles can cause joint pain or worsen any existing conditions.

Make sure that you can move your knee joint through its full range of motions and take a mental note of when you feel any discomfort as you move.

Build the muscle

For many people, knee discomfort can be caused by weaknesses in the muscles, especially the quadriceps.

Strong muscles in the legs can help provide support for the knees. This support may alleviate pressure and strain on these joints.

Variety is the spice of life

Whatever exercise or activities you are participating in, it’s important to ensure that there is a variety so that no muscle is being over worked at the expense of another.

Choose supportive footwear

Wearing appropriate, comfortable footwear can ensure proper alignment of the joints in the legs and make a huge difference to knee discomfort. Footwear is extra important if you’re one of those people whose feet do not distribute your weight evenly, and you tread more heavily either on the outer edge of your foot (called “pronation”) or inner edge (“supernation”).

Appropriate footwear with plenty of support and cushioning is also especially important if you’re participating in a highimpact activity such as running or jumping.

Consider knee braces

You may also wish to consider a knee brace or patella support, depending on your activity.

Many knee braces are specifically designed to provide support in the right place. Discuss which knee support is the correct one for you with your pharmacist or whoever

you’re buying the brace from.

They should be able to advise on correct fitting and the right brace for your needs.

Don’t ignore the aches and twinges

It’s amazingly easy to ignore discomfort in the knees when it first appears, but any pain in the knees, whether it’s only while you’re exercising or is more persistent, needs to be taken seriously. Today’s niggly ouch can soon develop into tomorrow’s debilitating pain. If you feel a twinge when you exercise or perform a particular activity, don’t dismiss it. Too many people have chronic knee issues that have come about from believing that it will eventually go away.

I’m always careful to talk with my clients about the importance of listening to their bodies and learning to recognise the good pain and the bad pain. Pain in the joints is never one that you should carelessly push through, as this will most definitely come back to haunt you.

EXERCISES – THE GOOD AND THE BAD

Good knee exercises include partial squats, step up exercises (either on an aerobic step or just using the steps in your home), standing calf raises, and laying leg raises.

Then there are the bad guys.

(Boo! Hiss!) While I do not like to label any exercise as bad (except crunches), some are definitely not so good if you have dodgy knees. These include deep squats, weighted leg extensions, high step ups, and deep weighted lunges.

This is by no means an exhaustive list, but they are the most common. If there are any other exercises that you find are painful for your knees, then add them to the bad-guy list as well.

In the next issue, we’ll take a closer look at exercises to help your knees. In the meantime, look after those precious patellas!

Allow recovery time

Regular physical activity helps maintain knee joint function, including strength and range of motion, which is always a high priority. However, if you do participate in high-impact activities such as running, or activities that include a lot of jumping or pivoting (such as netball), then think about allowing time for recovery.

If you run, don’t do it every day, do it every second day.

It’s also a smart move to mix up your activities, so if you run three times a week, do something low impact – such as bicycling, Pilates, swimming, or using the elliptical machine – on the in-between days.

Remember, too, that as you get older you may find you need more recovery time than you once did.

ARE YOU SUFFERING KNEE PAIN NOW?

If you’re experiencing chronic joint pain now, and you haven’t already had it checked by a health professional, then it’s vital that you do. Even if it’s something that can be easily fixed, get on to it early and avoid the complications that could come later if you leave it.

DIABETES WELLNESS | Autumn 2021

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Community

TOUGHING IT OUT Aucklander Tim Haslop, who has type 1 diabetes, entered the ASB Auckland Marathon and hated almost every minute of the run. But he raised mlore than $2,500 for diabetes and says the wider experience was among the best of his life.

Above: Sheena Duffy Vakatale, Diabetes NZ Auckland Branch Manager, presents Tim with a fitbit. Along with Chris Hanna, Tim was Diabetes NZ's top fundraiser in this marathon.

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DIABETES WELLNESS | Autumn 2021

T

im Haslop had always been more of a sprinter, playing sports that involved short bursts of intense speed, such as tennis and football. That was until Auckland’s second lockdown. Tim says, “I couldn’t go to the gym or play sport, so I started going on long runs just to do some exercise and de-stress.

“I wasn’t enjoying them. I was still thinking, ‘this is hell.’” But he liked how he felt afterwards. So much so that he set his sights on running a marathon. “And then I thought I may as well commit and use it for something good, rather than just do it for myself.”

He knew exactly what charity he wanted to fundraise for. At the

start of 2020, he’d volunteered on a Diabetes Auckland Youth Camp, and loved it. “Diabetes NZ’s the only charity where I actually have skin in the game, and I want there to be those camps. It’s a cause I really think is awesome.”

BECOMING A VOLUNTEER

Tim had been on a short break between study and full-time work when he heard Diabetes Auckland Youth was calling for camp volunteers.

He liked kids, and he’d enjoyed coaching tennis in the past. He also vividly remembered being a newly diagnosed 13 year old himself. “My confidence took a massive hit, without my even realising it at the

time. And I’d think, ‘This sucks.

No-one else has to deal with the stuff I do.’ At that age, sometimes it’s like: why can’t I just be like everyone else?

“But I had a family friend who I played tennis with – Scotch. He was an awesome guy, a couple of years older than me. I didn’t know he had type 1 until I was diagnosed.” Tim remembers how much that helped.

“I thought, ‘This guy is actually like me and he’s going through what I’m going through.’”

As an adult, Tim liked the thought that maybe he could help kids on the camp in the same way Scotch had helped him. “Even just letting them see that people do live a good life with it.”

He was glad he did. “Honestly, volunteering at camp was one of the coolest things I’ve done.

They’re cool kids there. Everyone’s so nervous at the start. Some of them are terrified of stuff – for example, they don’t want to go in the kayak ... And then, by the last day, they’re all doing everything.

They’re all mates. I was so stoked.”

FINDING SUPPORTERS

After choosing the ASB Auckland Marathon as his event, Tim set up a fundraising page on Everyday Hero.

He aimed to raise $1,000, but he’d underestimated the support that was out there.

“I posted on Facebook, and my friends were awesome. I thought maybe two or three would get on board, but heaps of people were, straight away, giving good money … young guys giving 50 bucks, friends from uni, from sport, from school …”

He decided he’d see if his 10-person team at work would donate. He baked ANZAC biscuits and brought them along for morning tea, thinking he’d suggest to the team that, if they liked the biscuits, they could also visit his Everyday Hero page.

He left the biscuits in the kitchen when he arrived at work, and, unbeknown to him, someone from another work team on the same floor sneaked one. “Next thing, she sent a message to the whole floor asking, who baked these and

why? My team’s 10 people, but the floor has more than 150 people.

So I replied to the whole floor with the link to Everyday Hero.” All of a sudden, many more people from his work were donating.

Tim suspects he knows at least one reason why his fundraising was so successful. “I think if I was a marathon runner doing it for fun, I might’ve got a bit less traction. The whole point was to do something I actually hate. People probably appreciate when you’re actually putting yourself in the pain cave and doing something that you wouldn’t otherwise do.”

TRAINING SAFELY

Tim trained intensively. He found that, during the slow burn of a marathon, his blood sugar behaved differently from when he played sports like football. “And it’s not actually very easy to eat food while you’re running. You’re dehydrated, and so it’s hard to eat. But those little dextrose tablets were really good.

And I used sports gels. They really picked me up.

Order our free Diabetes NZ information pamphlets Go to www.diabetes.org.nz and download, or fill in the online pamphlet order form (a postage and handling fee applies)

ALSO AVAILABLE FREE TO HEALTH PROFESSIONALS

DIABETES WELLNESS | Autumn 2021

21

“Honestly, volunteering at camp was one of the coolest things I’ve done ... I was so stoked.”

— TIM HASLOP

“AN ART TO IT” Tim crosses the finish line at the Waitomo Trail Run, in the lead-up to the big one: the ASB Auckland Marathon.

“I never did trail runs by myself. I always made sure I was either with someone or running on well-lit streets with people around.” He worried about having hypos, and “I thought I’m not going to die for this. I’m not going to go out in the middle of the woods and have a low blood sugar and kill myself.”

He finally caught up. “And then she was like, ‘Oh, sorry. I didn’t want to give you jelly beans because you’re in a diabetes shirt.’

“I thought, ‘Are you kidding?

That’s exactly what I need right now.’ But always people mean well.

People are just trying to do the right thing.”

SURPRISES ON THE DAY

THE LAST HOUR

Tim wore his pump, with a reduced basal rate for the run. However, it wasn’t enough. “I – probably naively – thought I’d have less blood sugar problems than I did during the actual run.”

He hadn’t run more than 30km during his training, and his low blood sugars had been easy to treat.

But the race was 42km. He says, “For the last 10km, I was going low kind of all the time, which was stressful.

“One funny story … For the run, I was wearing a diabetes shirt and this woman on the sidelines was handing out jelly beans. She was handing them out to people in front of me, but as I got closer to her, she turned and started running away from me. I was like, what is this person doing? I knew I needed some sugar, and she kept running away.”

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DIABETES WELLNESS | Autumn 2021

Tim says, “The whole last hour, I was pretty much just trying not to go low, which was easier said than done. I was thinking about it, though. Making sure that I didn’t do anything stupid and just blindly run.

“I was like, I am not going to kill myself for this. At the time, I thought about whether it would be embarrassing if I didn’t finish the race, having said I was going to do it. Then I thought, nah, it’ll be 10 times more embarrassing if I pass out and go to hospital. Literally, embarrassment was the first thing I thought of.

“There was one point where I was starting to feel dizzy. I stopped for a bit, walked, ate heaps of food, and started feeling a little better.

I managed to run the last two or three kilometres.”

Looking back, Tim says, “It was harder than I expected to get the blood sugars all good, but still doable. Definitely doable, and I’d be better at it, I think, if I did it again.

There’s definitely an art to it.

“I’d eat before going low, and make sure I was eating during the run.

And I’d stop to test more, rather than waiting until I felt a bit crap. If I’m going a bit high, I’m going high, but at least I’m not going to be passing out on the side of the road.”

So, are there more marathons on the horizon for Tim? “As much as I’d love to say it’s no harder for someone with type 1 to run a marathon than for anyone else, it is – definitely. There’s things you’ve got to think about and physical things you’ve got to do to keep yourself alive when you’re doing it.”

He doesn’t think he’d run another marathon any time soon. On the other hand, “I’d definitely love to do a half Iron Man … that’s obviously the natural progression …”

Then again, he thinks he also needs to give his friends a break from donating. “Maybe later this year or the year after … ” He’d recommend the experience of fundraising to anyone. “Just literally do it, because you’ll feel better having done it. It was a highlight of my year.

It’s not all about you when you’re fundraising, but you actually will have a good experience from it.”

Community

Hayley McDonald reflects on two years of running her medical jewellery business My Identity – and on a partnership with Diabetes NZ that has gone from strength to strength.

NEW YEAR, NEW INITIATIVES

W

“People have said to me they knew they needed to wear one, but didn't want to until now ... If you like something, you wear it.”

e first met Hayley McDonald and her daughter Payton (who has type 1 diabetes) in our Summer 2018 issue.

Hayley wanted her medical jewellery business to give back, so, early in 2019, she began codesigning medical ID bracelets with a range of prominent personalities in the diabetes community and donating all the profits from these designs to Diabetes New Zealand.

To date, she has co-created eight stylish and practical fundraising bracelets, which you can see over the page. (And they’re still available!)

Hayley loves this project.

“What has struck me most about working with all the codesigners is their willingness to help in any way they can to assist the diabetes community.

I’m just happy we can draw attention to it and keep people as safe as we can.”

Recently, Hayley and Diabetes NZ have been hatching an exciting new plan.

WEAR WHAT YOU LOVE

Payton’s type 1 diagnosis was the trigger for Hayley, a web designer with experience running an online retail shop, to start My Identity.

She realised that there were

probably numerous people out there who should be wearing medical bracelets, but weren’t, because they didn’t like the look or feel of them.

She set to work to make stylish and comfortable medical jewellery widely available. “I'd run an online retail business before and it was hard, but it's easier when you're passionate about something.”

Once she began the business, her hunch proved correct. “Lots of people have said to me they knew they needed to wear one but didn't want to until now. And now they're wearing it with pride.

They really like it – and if you like something, you wear it.”

I have had people online saying that medical ID jewellery shouldn't be pretty; it should be functional. I just ignore it. As long as you've got that medical symbol, then you can give people a chance at least.

“We want to give you the best chance that someone can help you when you cannot help yourself. And so it’s really important for them to be very clearly marked with the medical symbol as well as looking good.”

DIABETES WELLNESS | Autumn 2021

23

THE PERSONAL TOUCH

As My Identity has grown, Hayley says one challenge is maintaining a personal touch. “I don't want to lose that.”

The quality of the engraving is also important. “I’ve got an amazing engraver. And it's laser engraved, so it will never come off. It goes really deep and has a lifetime guarantee.

Hayley tries to have jewellery for everyone. Although she thinks bracelets are usually the best option, they’re not always suitable. “I've had a lady who can't wear anything around her wrists because of arthritic hands.

But she can wear a necklace.”

Hayley says she’s learned a lot about different conditions over the past two years. More and more, people are beginning to tell her their stories. “One lady had a child with allergies who was with their grandparents for the day.

Something happened, and they'd eaten something, and they called an ambulance, and the bracelet could tell the ambos what the grandparents couldn't.

“There was another man who was allergic to bee stings – a gardener. He got a bee sting, and his face swelled up, and he couldn't talk when he went

to A&E. But he just turned his bracelet over and showed them.”

Through the My Identity website, Hayley invites people to send naming suggestions for particular pieces of jewellery.

“All sorts of people have wanted something named after them, and often they give me a little story to go with the name as well. That's cool because it’s also helping normalise their conditions.”

Hayley knows that when it comes to her own daughter, she’s very glad of the bracelets. “She's about to go to a much bigger school. The nurse there is good.

But she’s hitting intermediate, going on a bus, getting more independent, wanting to go to the mall with her friends.”

A bracelet is peace of mind.

Payton doesn’t have a massive wardrobe of medical jewellery – just a few favourite pieces.

“She’s found the ones that work best for her and her current age and stage. The current favourite is the Kimberly. It’s robust for a sporty, busy 11 year old. Petra is another favourite. It’s a little more dainty. She also likes our essentials range, and I can see as she gets older she’ll want to change out the bracelets according to outfits.

A TIGHT FAMILY

Like many households, Hayley’s struggled during lockdown.

Work slowed, and her My Identity business came to a standstill. She puts it down to uncertainty and concern about finances. For many people, buying a medical ID was low on the priority list. Perhaps, also, there was an element of people not going out much, and spending more time with loved ones, so not feeling like they needed a medical ID so much.

“But the flip side of that,” Hayley says, “was that we had plenty of time to delve into areas where we could save.

“Another silver lining was the amount of time we spent as a family. And I think it was also good for the kids to have us both around, to realise that we had to continue working, and to understand the financial implications of lockdown and what we could all do about it as a family.”

Now the business is thriving again, and Hayley’s children – Payton and her older brother Brody – take an interest, and help out with jobs such as packing.

ruby

aimee fleur

LEE

SIR EION

TESS

AUTUMN 2019

WINTER 2019

SPRING 2019

SUMMER 2019

AUTUMN 2020

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DIABETES WELLNESS | Autumn 2021

My Identity

is proud to create

WHAT SHOULD MY MEDICAL BRACELET SAY? Hayley advises everyone to get these key pieces of information engraved on their medical jewellery: • Name • NHI number • Condition • An ICE (in case of emergency) number – someone to call if something were to happen to you.

A NEW INITIATIVE

After donating $4,200 to Diabetes NZ through sales of her co-designed diabetes celebrity bracelets, Hayley’s now embarking on a new collaboration.

Diabetes NZ Nelson Youth branch first had the idea to gift medical ID bracelets to newly diagnosed children in their region. Now Diabetes NZ is rolling out this brilliant idea nationwide. In 2021, a voucher for a medical ID bracelet will be included in all Newly Diagnosed Packs. Each year, Diabetes NZ gifts about 300 Newly Diagnosed Packs to hospitals all around the country.

Hayley and My Identity will be creating these bracelets – which are a new sporty style that have the writing on the outside.

When redeeming the voucher, the recipient can choose from black, pink, or blue for their bracelet band.

The bracelet is also available for sale, and that’s where the public comes in. You can choose to buy one and donate one, helping ensure that 300 newly diagnosed children will get a very special extra gift – and potentially a lifesaver – in their Newly Diagnosed Pack this year.

$59 Fashionable Medical ID Jewellery Buy a LIVE BRAVE MANA ORA bracelet for yourself, and My Identity will gift one to a newly diagnosed child with type 1 diabetes.

This gift will be included in the Newly Diagnosed Pack distributed

by Diabetes NZ, and make a real difference to the child who receives it and their family.

Shop now for a beautiful piece of jewellery and support our community

EDDIE

EMILY

SOPHIE

WINTER 2020

SPRING 2020

SUMMER 2020

LIMITED NUMBER AVAILABLE

DIABETES WELLNESS | Autumn 2021

25

Move

MOVING MORE, EVERY DAY To boost your health, build more incidental movement into your day.

You can get creative with how.

“P

urposeful exercise” is going for a walk or run, working out, playing a sport, or anything else where you spend a period of time deliberately increasing your physical fitness.

Then there’s “incidental exercise” or “incidental movement”. This is where you’re doing a task that just happens to involve moving your body, so you’re getting some exercise along the way.

A growing body of research shows that increasing incidental movement in your day can improve health and wellbeing.

WHAT’S THE EVIDENCE?

In 2018, the Physical Activity Guidelines for Americans from the US Department of Health and Human Services was updated to say that any amount of physical activity that you accumulate during your day counts towards your total goal. Every little bit – even just a few minutes – gives you benefits.

These are a few of the other relevant recent studies: • A 2017 South Korean study showed that twice-weekly gardening sessions of about 50 minutes improved blood pressure and cholesterol levels, and reduced inflammation and oxidative stress in women over 70.

• A 2017 US study found that, in adults over 65, doing any amount of incidental exercise, such as housework, gardening,

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DIABETES WELLNESS | Autumn 2021

and home maintenance, as well as spending a lot of time walking and standing, reduced stress levels and improved sleep quality.

• A 2019 Canadian study had sedentary young adults vigorously ascend a three-flight stairwell (60 steps), three times a day, three days a week, for six weeks. At the end, their cardiorespiratory fitness had improved.

• A 2020 Scandinavian study found that after incidental activity (such as climbing stairs), adolescents generally felt better and more energised.

• Numerous studies have found that interrupting sustained periods of sitting down with brief repeated bouts of lightintensity walking reduces insulin demand, improves glucose uptake, and can also improve blood pressure and other indicators of health.

STEPS TO FITNESS

One of the most commonly suggested ways to get incidental exercise is to avoid lifts and escalators and take the stairs instead. This is sound advice, and you can customise it.

If you have the opportunity, start with one flight, once a day, and build up over time, setting yourself goals if that helps. Remember that walking down flights of stairs works different muscles from walking up and is also beneficial.

You might want to use the rail to pull yourself up, with either one hand or two. That way you work your upper body, too.

You can also try “interval training” – moving at a slow or

moderate pace for a time, then putting on bursts of vigorous activity.

Do keep a hand on the railing if you’re worried about balance.

Watch your posture and think about your knees and hips when climbing stairs. If you feel pain in these joints while climbing or are concerned about anything else, stop. Check with a medical professional before doing any more.

MORE WALKING, LESS DRIVING

Wherever you’re travelling to, get off the bus a stop or two early, or park your car some distance away from where you’re going so that you walk the rest of the way. The same goes for taxis and rideshares – give them a drop-off point that is a little distance from your real destination.

You can play with this concept.

Psychologically, does walking at the end of a trip or at the start work better for you? Maybe, instead, you want to do the walking part first, and then hop on a bus or into a taxi and go all the way when you’re done.

Or perhaps you’re always in too much of a rush to take the extra time to walk? If so, think about your schedule. Consciously build some extra time into your day for walking wherever it works best and you’re most likely to use it.

CLEANING UP

All the regular housework, gardening, and household maintenance you do is good for you, and these tasks work many parts of your body at once.

You could think about increasing the intensity of some of them sometimes: sweep, vacuum, scrub,

or weed with extra vigour, even just for a few minutes. Aim to make yourself puff.

You could also set your sights on a hard-to-reach task you’ve been putting off – mopping a ceiling, scrubbing into some tiny corners, sweeping cobwebs from your porch, or washing a high window.

Having a double purpose – getting the job done as well as giving yourself a workout with extra bending and stretching – is often a good motivator.

Then there’s the rest of your neighbourhood. Why not take a bag and do a litter clean-up around your street, or a local park or beach? You’ll get a walk, as well as the extra movement involved in picking things up, and you’ll be doing everyone else a favour at the same time. Maybe a friend or family member would join you.

WALK AND TALK

Research from Stanford University in 2014 showed that, while walking, people were more energised and had more creative ideas.

In 2015, a Miami University pilot study put this to use and tested how useful and feasible walking meetings were in the workplace.

It turns out that the walking made small meetings more productive and promoted staff bonding – as well as giving everyone some exercise.

Why not suggest it at your own work or for another project you’re part of?

The university developed protocols for walking meetings that can be easily followed: • These meetings work best with groups of two or three people.

• Half an hour of walking or slightly longer works well.

• Arrange the meeting in advance.

Don’t spring it on anyone, and ensure people are free to say no.

• Make sure everyone has comfortable walking shoes,

Wherever you’re traveling to, get off the bus a stop or two early, or park your car some distance away from where you’re going so that you walk the rest of the way. water, and anything else important – for example, sunblock, sunglasses, a hat, or a jacket.

• End the walk at a place where discussion can be wrapped up and paper work done – and where there won’t be tempting high-calorie food.

• As with a traditional meeting, make sure everyone knows the meeting’s objective before you start, and take a printed agenda if appropriate.

EXTRA TRICKS

• If you’re meeting a friend for coffee, see if they’d like to get takeaway and go for a walk while you catch up.

• Working in the city and buying your lunch? Instead of going to your usual nearby favourite, walk to somewhere new that’s further away.

• When you go to the supermarket, do a few extra laps with your trolley or basket while you’re there.

• When you unload groceries at home, give each one a few extra lifts before putting it away.

• Pace while you’re on the phone.

• Walking a dog or playing fetch is great exercise, but cats can help too. It’s easy to forget that many older cats still like to play. Make or buy a cat toy or two, and see whether they’ll chase it.

• Any time you’re waiting for something (for a kettle or pot to boil, for your microwave to go ding, for washing to finally finish, for ads to be over …) you’ve got a ready-made timer going, just waiting to be used for exercise. See what you could fill that short time with. Jogging on the spot? Star jumps? Squats? Stretches? Seeing how many laps you can do of the house? Tell yourself: Just do it and it’ll be over in no time.

• Some researchers have dubbed short bursts of exercise “exercise snacks”. If this makes them feel more appealing to you, then think of them this way.

REFERENCES Physical Activity Guidelines for Americans. From

the US Department of Health and Human Services: Cardiovascular Benefits and Recommendations. doi.org/10.1161/CIRCOUTCOMES.118.005263 Relationships between incidental physical activity, exercise, and sports with subsequent mood in adolescents. doi.org/10.1111/sms.13774 Daily Well-Being Benefits of Physical Activity in Older Adults: Does Time or Type Matter? doi. org/10.1093/geront/gnw250 Do stair climbing exercise "snacks" improve cardiorespiratory fitness? doi.org/10.1139/apnm2018-0675 Gardening intervention as a low- to moderateintensity physical activity … doi.org/10.21273/ HORTSCI11232-16 Intermittent walking … in inactive middle-aged men. https://doi.org/10.1016/j.jsams.2016.08.012 The effects of stair climbing … in postmenopausal women with stage 2 hypertension. doi.org/10.1097/ GME.0000000000001072 The Walking Meeting (WaM): Pilot Study, Miami, 2015. dx.doi.org/10.5888/pcd13.160111

DIABETES WELLNESS | Autumn 2021

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Care

TREATING HYPOS

THE LATEST LOW-DOWN Knowing how best to treat a hypo isn’t always easy – sometimes it feels hit and miss. However, New Zealand-based researchers have done groundbreaking work on hypo treatment methods.

F

or people living with type 1 diabetes, keeping blood sugar under tight control with insulin is all important. But this inevitably brings a risk of hypos – hypoglycaemia – when blood sugar drops too low.

Likewise, people living with type 2 diabetes may find themselves dealing with hypos if they’re on insulin therapy or sulphonylurea tablets.

When you go low, you need a hit of glucose fast, to bring your blood sugar into target range again. But it’s easy to undertreat the low, which can mean your body keeps desperately craving food. You cram in snacks, and, before you know it, you’ve eaten enough to send your blood sugar high again – a “rebound high”. You need more insulin to bring it down, but it’s even harder to know how much you need this time. Next thing, you’re on a blood-sugar roller coaster until you finally find the right balance.

For the past decade, a small team of New Zealand researchers have been investigating the optimum treatments for hypos. Diabetes Nurse Specialist Lindsay McTavish has spearheaded the research, working with endocrinologists Esko Wiltshire,

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DIABETES WELLNESS | Autumn 2021

Lindsay McTavish, Diabetes Nurse Specialist

Jeremy Krebs, and Brian Corley, and geriatrician Mark Weatherall. It’s research the whole diabetes community can benefit from.

WHICH HYPO TREATMENT WORKS BEST?

Ideally, a hypo treatment works as quickly as possible – not just so you can function normally again fast, but to calm your body’s food cravings and make sure you don’t end up consuming more sugar than you need and going high. What works best for that?

Lindsay McTavish realised that most hypo treatment guidelines were based on expert opinion rather than solid evidence.

In 2008, with Esko Wiltshire, Lindsay conducted a trial at a national diabetes youth

camp. With the permission of children, parents, and camp leaders, they tested four commonly used treatments when children had hypos: glucose tablets, jellybeans, orange juice, and fruit Mentos.

In the end, 52 hypos were treated with glucose tablets, 45 with jellybeans, 44 with juice, and 48 with fruit Mentos. Blood glucose was measured at 0, 2, 5, 10, and 15 minutes.

The conclusion? Glucose tablets, juice and fruit Mentos all gave similar quick results.

However, jellybeans produced a lower, slower response.

HOW MANY CARBS DO YOU NEED TO TREAT A HYPO?

Until recently, most guidelines around the world, including in New Zealand, recommended giving a standard amount of carbohydrate (usually 15g for adults and less for children) to treat a hypo. (Although sometimes weight-based protocols were used for children.)

Lindsay and his coresearchers had used a weightbased method in their study at the children’s camp – treating hypos in each participant with 0.3g carbohydrate per kg of body weight. This had been effective.

Lindsay suspected that weightbased hypo treatments could also be more effective for adults with type 1.

They recruited 34 adult participants with type 1 who had frequent hypos and tested three different protocols on them: • Treating hypos with 0.2g glucose per kg body weight • Treating hypos with 0.3g glucose per kg body weight • Treating hypos with a standard 15g glucose.

The glucose was in the form of Dextro glucose tablets.

The results showed that, for adults with type 1 diabetes, a weight-based hypo treatment of 0.3g of glucose per kg of bodyweight is superior to a standard 15g treatment and avoids rebound highs.

HYPO TREATMENTS FOR PUMP USERS

Lindsay and his co-researchers turned their attention to insulinpump users – adults and children – to see whether the benefits of the weight-based protocol would hold for them, too.

Sure enough, the weightbased treatment based on 0.3g of glucose per kg of bodyweight was more effective in resolving hypos than a standard treatment amount, and did not result in excessive rebound highs.

WHAT ABOUT TYPE 2?

In 2018, the researchers launched a study, funded by Diabetes NZ, to see whether weight-based protocols for treating lows were effective for adults with type 2 diabetes who use insulin.

The results were not so clear cut as those for type 1. However, using 0.3g of glucose per kg of body weight was effective, as was a standard dose of 30g of glucose.

KEY POINTS

• For children and adults with type 1, whether using pumps or not, a hypo treatment of 0.3g of glucose per kg of body weight is generally most effective, with the least risk of a rebound high.

• For children with type 1, glucose tablets, juice, and fruit Mentos are equally effective hypo treatments.

Jellybeans are less effective.

• For adults with type 2, a hypo treatment of 0.3g of glucose per kg of body weight is effective, as is a fixed dose of 30g glucose.

• Glucose tablets and juice have the carbohydrate content in the nutritional information panel, allowing you to calculate the exact dose of carbohydrates.

Fruit Mentos don’t have this information on the roll packets, but each regularsized Mentos lolly contains 2.8g carbohydrates.

• See the latest type 2 guidelines here: t2dm. nzssd.org.nz/Section97-Management-ofhypoglycaemia REFERENCES Effective treatment of hypoglycaemia in children with type 1 diabetes (2011). http://doi.org/10.1111/j.13995448.2010.00725.x

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 250,000 New Zealanders with diabetes to live full and active lives.

Weight-based hypoglycaemia treatment protocol for adults with Type 1 diabetes (2015). doi.org/10.1111/dme.12730 Weight-based carbohydrate treatment of hypoglycaemia in people with Type 1 diabetes using insulin pump therapy (2018). https://doi.org/10.1111/dme.13576 Optimizing the management of hypoglycaemia in individuals with type 2 diabetes (2018). doi.org/10.1111/ dom.13231

For a confidential discussion, please contact Nicky Steel admin@diabetes.org.nz or 04 499 7145

Life with Type 1

When Jody O’Callaghan told her type 1 diabetes story on a national news site, she was unprepared for the huge response.

GETTING REAL

A

s a stuff.co.nz journalist, Jody is well versed in writing about other people’s struggles. But putting her own story out there, about a lifechanging event in her own family, was new.

To mark Diabetes Awareness month, Jody wrote about the day in mid-2020 when she was hit by a sudden, severe blood-sugar low while at home in Christchurch with her two preschool daughters.

She collapsed, unconscious, on her kitchen floor, with a cake cooking in the oven.

Her daughters spent nearly two hours trying to wake her up every way they could think of, to no avail. Then, says Jody, “By a strange twist of life-saving fate, my husband decided for the first time ever to come home from work early that day.”

Her husband Ben remembers, “I knew something was up right away when my two-year-old came rushing into the garage, literally as I was driving in. She was hysterical, asking me to get inside, saying, ‘Mummy fall over, mummy fall over!’

“When I found Jody on the floor, I knew straight away it was a low.”

He called an ambulance, then Jody’s mother. “I had no idea how long she’d been out for, so I went straight into getting sugar into her.” He was desperately scared, but trying to remain calm for his daughters. “It took ages for Jody to come to, and the ambo was taking a while.” In fact, Jody’s mother,

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DIABETES WELLNESS | Autumn 2021

who lived 45 minutes away, got there first.

By then, Ben’s efforts had roused Jody, but she’d been unconscious and sweating for so long that she’d become hypothermic and had to be taken to hospital.

A NEW LEAP

A few days later, Jody was back at work and helping a colleague with a medical story. She offered to ring a health professional she had known since her diagnosis with type 1.

Jody says, “He asked, ‘How's your health?’ and I told him about the incident. He said, ‘no, that's not good enough’.”

Soon after, she trialled the Freestyle Libre. Jody had been interested in diabetes technology for years, but this was the first time she’d had the opportunity to try anything out.

“I used the Libre for a month or so, and it was great. But, at the end of the day, it didn't do the one thing that we needed for peace of mind, which was sending bloodsugar alerts to my husband and anyone else when I’m home with the kids.”

The Libre was already an extra financial outlay, but Jody and Ben decided that, because they were able to, it was worth it to take the leap, pay more, and get a Dexcom G6 instead.

The Libre is a flash glucose monitor (FGM): it gives you instant blood-sugar readings with the swipe of a scanner. The Dexcom

G6 is a continuous glucose monitor (CGM): it automatically reads your blood sugar every five minutes and sends those readings to any device you have it linked to.

Crucially, it can also be set to send out customisable alerts when your blood sugar is heading out of your target range.

Jody, Ben, and Jody’s mother now all have access to Jody’s alerts. Jody says that on more than one occasion she’s had to reassure her mother over the phone. “I go for a run or I'm doing exercise, and it starts to go low, and she calls me. I’m like, it’s okay mum, I'm just trying to get on top of it.”

She laughs. “Mothering doesn't stop!”

She sees the occasional overworry that others might have about her as all part and parcel of the new security the Dexcom has given her. “It’s a huge relief.”

She also admits she could imagine doing that kind of worrying herself if either of her own children had type 1. “It’s that parental thing. You want to take it away from your children, don’t you – take their suffering away …

I still remember Mum and Dad blaming themselves when I was diagnosed, silly as that sounds.”

Her concern for her own health is also deeply tied to her role as a parent. Looking back, she thinks she had a “she'll be right, it's fine” attitude about her hypos. “You get used to it being just a reality, which is awful, but you kind of dismiss it.

“Probably the best control I ever had was when I was pregnant, because you're trying to do the best for your baby's health. But then, after that, you’re like, oh, the baby's out. It's only my body. It's not the baby anymore. You let it slide.

“But after the incident where I collapsed, I thought, you know what? This is scary what could have happened. It’s not about me anymore.”

The combination of parental instinct and living with type 1 diabetes flows through to family life in other ways, as well. “I’m always on the watch because, technically, there’s a higher likelihood of my having kids with type 1. So, it could be something silly like they’re just peeing a lot in a day and I’ll finger prick them and they think I'm trying to hurt them.

‘Why are you doing this to me?!’

“I guess it's made me an apprehensive Mum, a wee bit. I watch their health like a hawk.”

TOUGH DIAGNOSIS

Jody was diagnosed with type 1 when she was 14.

“Because I was so newly diagnosed, I didn't really understand what my body was doing. Also, when you're a teenager, you want to fit in as much as possible; you don't want to be different.

“I remember sitting through school exams and not knowing why I was just staring at a page or writing squiggles and feeling funny.

“And I was sporty – that was my thing. I was in a touch team, and we always went to nationals. We were competitive.

“You don't want to stop a game or run off the field because you're going low … There were times when I didn't actually know I was going low. But I also remember a national final, and someone threw me the ball right on the try line, and I dropped it. I felt so low, but I was embarrassed, and I wanted to hide it.

“If I’d had something like a Dexcom, my parents on the sidelines would have known to get me off the field and deal with it.”

Thinking back now, she says there are “just all these little things that I know would have changed my life completely. There are so many times during my life where I was just hanging by a thread … but that's your reality.”

Jody dreamed of becoming a marine biologist but realised her science marks wouldn’t be high enough to get her there, so she changed tack and trained as a journalist. “I haven't looked back. I absolutely love it.”

A REPORTER’S LIFE

“It’s people, really,” says Jody.

“That's the reason I do it. I’m grateful every day that people tell me their stories. Sometimes you’re sitting in someone's house, and they’re telling you the most amazing story, and you're like, Gosh. How lucky am I? You know?”

DIABETES WELLNESS | Autumn 2021

31

The life of a reporter is notoriously high-stress and allconsuming, and Jody says that, especially in the early days, it could be challenging to manage her diabetes while working.

“When you're a junior reporter, you’re pretty much sent out to do whatever. So you could end up getting sent out to, for example, a shooting, where you’re literally out all day standing on the street.

“That definitely had its challenges in the past … realising that you've been sent out with no food, no lunch, and then you're expected to stay there all day. If you don’t think fast enough to grab a snack and put it in your bag, then you can get into a tricky situation.

And I have the kind of personality where I’d rather just push through and not make a big scene, which can get dangerous as a diabetic.”

She found that letting her workmates know about her diabetes was all important.

“I was at the Manawatu Standard when I was in my early 20s. I remember having a really bad low in the middle of a meeting and I started jabbering and stumbling around, and everyone was like – what's going on? But a colleague who knew me quite well ran and got some sugar. If they hadn't known, that could have gone quite awry.

“I was a court reporter as well.

That used to be a bit of a challenge because in the middle of a court session you can't eat, so I used to have to sometimes get up and leave.

“I remember covering a really intense murder trial for quite a period of time, and they came to talking about a crucial part of evidence, and I was just scribbling on the page, not even with it. I had to stumble out of the courtroom and try and deal with that.”

In the end, she began staying in the courtroom and subtly eating Mentos to raise her sugars.

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DIABETES WELLNESS | Autumn 2021

BETTER CARE NEEDED

Jody is on the Advisory Council for Diabetes New Zealand, and says that, despite everyone’s advocacy and campaigning, “I have found it frustrating to see the complete lack of government interest in CGMs. “But then, I sort of feel like this has been the frustration right from day one of my diagnosis. My mum has forever been banging her head against a wall advocating for me, and it’s not changed.

“I remember, in 2002, the movie Panic Room came out. Jodie Foster is in it and her daughter has type 1 in that movie. We're talking 20 years ago – and she has a watch telling her what her blood sugar is!

“I remember watching that at the time and thinking, wow, that's so space age. How cool is that? And I was all excited because I thought, that's obviously going to come to us soon.

“How long have we been waiting now? And it’s still not readily available to kids. It's just really disappointing. As much as we have a great health care system, when it comes to long-term illnesses, the technology and funding is minimal.”

Jody supports calls from organisations such as Patient Voice Aotearoa to reform Pharmac and allocate more money to pharmaceuticals in this country. “I know that there are so many other illnesses battling to get life-changing funding, as well.”

“But why is it taking so long for technology to come? I mean, we can jump on a plane and be in America in a matter of hours, and yet the amazing technology they’ve had at their fingertips for diabetes, for 20-something years, has never become readily available here. Why is that, and why is that okay?

“Being on the Dexcom has made me learn so much about my own body that I'd never known in the previous 20-plus years of having diabetes. Even just with my husband, I'd get grouchy with him, and

he would be like, where did that come from? Now I know that I can correlate it to blood sugars. When my blood sugars are high, I'm a little bit irrational … It's such important information.

“I’ve also learned a lot during my time on the Advisory Council, and on Facebook groups, about type 2 diabetes. It’s easy to grow up feeling like type 1 is being ignored and all the government funding goes into type 2 preventative measures and campaigns. But now I realise that people living with all forms of diabetes face similar challenges.

“It’s time the Government and Pharmac do what they can to make living well possible for all of us – type 1 and type 2.”

TELLING HER STORY

It was with all these thoughts and feelings in mind that Jody finally decided to give the general public a warts-and-all glimpse of her life with type 1 diabetes and tell her story on Stuff.

Responses poured in. The messages of support included people telling her they’d never understood what it was like before – even people close to her – and others, who themselves lived with diabetes, saying that it had been affirming to see their experiences reflected, and that she’d inspired them to take advocacy action.

“It’s been overwhelming actually.

I never expected it. Like I say, you kind of have this blasé attitude about your own illnesses. It's reality and you accept it, and you try not to think much of it. But when I wrote that down and saw people's reactions to it – that's when I realised the magnitude of it ... Sometimes, it's not until you see other people's reactions to what happens to you that you realise how serious it is.”

SOURCES www.stuff.co.nz/national/health/300153315/mypreschoolers-spent-two-hours-trying-to-wakeme-from-a-diabetic-coma http://letskeepmoving.org.nz/

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Technology

Digital monitoring for diabetes: what’s acceptable?

The use of digital technologies – for example, sensors that monitor glucose levels and apps that use artificial intelligence to adapt insulin treatment to food intake – are revolutionising diabetes management.

But just how much digital and remote monitoring is acceptable, and who should your data be shared with?

I

n winter 2019, Diabetes NZ amplified a call for participants in an important international study. More than 1000 people living with type 1 and type 2 diabetes from 30 countries, including

New Zealand, assessed the acceptability and perceived intrusiveness of 36 different digital monitoring scenarios.

The study was led by researchers at the French National Health Institute Inserm (France) and Mayo Clinic (USA).

Now the results are out, in a study entitled “Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management”.

The study found that extra digital food monitoring and receiving real-time physician feedback were considered among the most intrusive scenarios by participants. People worried that digital food monitoring would attract unwanted attention in public, and expose them to criticism. They also wanted control over monitoring settings, such as limiting which data they share with their physician.

Additionally, participants were concerned about the use of their data for purposes other than health care, such as marketing by private-sector companies.

Many considered private-sector handling of their data very intrusive.

However, participants were more likely to adopt technology they considered intrusive if it was much more effective at reducing hypoglycemic episodes than the systems they were currently using.

The researchers hope these findings and more will guide developers in designing minimally intrusive health technologies and incite physicians to use shared decisionmaking to prescribe digital tools that fit each patient’s life.

The researchers say, “Identifying patients’ views is the key to make digital health not only effective, but also effortless.”

The findings are reported in two articles published in Mayo Clinic Proceedings and JAMA Network Open. See doi:10.1001/ jamanetworkopen.2020.33115 For more information, contact: Theodora Oikonomidi, theodora. oikonomidi@inserm.fr

DIABETES YOUTH: GROWING UP For many young people living with diabetes, the new year will be a time of transition: starting secondary or tertiary study, finding a first job, maybe moving to a hall of residence or going flatting for the first time. It’s important to have the right information and resources to negotiate these major life changes.

Diabetes NZ provides a comprehensive set of resources for young people with diabetes – on subjects including going out, driving, employment, puberty, sex, tattoos and bodypiercing, travel, exercise, and emotional wellbeing.

See www.diabetes.org.nz/resources-young-adults

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DIABETES WELLNESS | Autumn 2021

Care

HYPOS AND ORAL HEALTH Every hypo treatment involves a hit of sugar, so how do you take care of your teeth at the same time? We approached New Zealand Dental Association (NZDA) spokesperson Rob Beaglehole for tips.

I

f you have type 1 diabetes, or you have type 2 and use insulin or sulphonylurea tablets, hypos – low blood sugars – are likely a part of life. Rob Beaglehole says there are a number of ways that you can look after oral health at the same time.

MINIMISE CONTACT WITH THE TEETH

To keep tooth enamel strong, says Rob, minimise the amount of time the teeth are in contact with sugary substances.

One of the best ways to do this is to treat hypos with juice drunk through a straw. The straw keeps the juice away from your teeth.

Single-serve juice boxes are a popular hypo treatment: they’re quick to consume in an emergency, and you know exactly how much sugar you’re getting in a serve. If these are your favourite treatments, rest assured that they’re also one of the better options for your teeth.

A glass of juice, while it takes a little more effort to measure out, will also be relatively easy on your teeth if you drink it through a straw.

Fast-acting chewable glucose tablets (for example, Dextro Energy tablets) are another good option. In general, your teeth will

thank you for hypo treatments that can be chewed quickly. Rob says, “If you're sucking on something over a long period of time, it's going to be worse for your teeth than getting it in fast.”

Meanwhile, the news is bad for jellybean fans: “Jellybeans are probably the worst things, because they stick in your back teeth.”

RINSE WITH WATER

Rob says there’s one particularly important step to take for your oral health: “After any hypo treatment, have water. Rinse the mouth out with water.” The goal is to make sure that sugar and acid aren’t lingering on your teeth.

So should you also brush afterwards? Rob says, “No, water is enough.”

DAY-TO-DAY ORAL CARE

The same general oral-care guidelines apply to people living with diabetes as to others but can be extra important. “Ideally,” says Rob, “you brush your teeth once in the morning and once at night.

You don't need to keep brushing throughout the day, because you can actually wear your teeth out, particularly if there's acidic food or drink in your mouth.”

Rob says it’s important to use a fluoride toothpaste, especially if you’re among the 40% of people who live in an area of the country that doesn’t have fluoridated water.*

When you brush, “Put a timer on for two minutes, then spit but don't rinse.” That way the fluoride in your toothpaste remains on your teeth and protects them.

CHECK-UPS

Regular check ups with the community oral health service or your dentist are vital to catch any problems early.

In general, people living with diabetes may be slightly more prone to oral health issues than the general population, partly because of hypo treatments and partly because of sometimes needing to eat more frequently.

Rob suggests, if possible, getting a check more often than you would if you weren’t dealing with diabetes: “If you normally would go once every year, you may want to go every six months, for example.”

If you’re working on tightening your control over your blood sugar or reducing the number of lows you have (a different journey for everyone), do bear in mind that this will help with oral health along with the other benefits.

RESOURCES Treating hypos for type 1: diabetes.org.nz/ type-1-diabetes-hypoglycaemia Treating hypos for type 2: diabetes.org.nz/ type-2-diabetes-hypoglycaemia Oral health resources from the NZ Dental Association: nzda.org.nz

* If you would like to know more about your access to fluoridated water, Massey University has produced this information sheet: ehinz.ac.nz/indicators/drinkingwater-quality/access-to-fluoridateddrinking-water

DIABETES WELLNESS | Autumn 2021

35

Quiz

Test your diabetes knowledge How many of these questions can you get right?

The answers are on page 38.

1.

Which cells in the pancreas manufacture insulin?

A. Alpha B. Beta C. Creatinine

2. What could you use to treat hypoglycaemia (blood glucose under 4)?

A. Trim milk B. Three slices of bread C. Fruit Mentos 3. What is the kupu Māori (Māori word) for diabetes?

4. Type 2 diabetes can change into Type 1 diabetes.

True or false?

5. What can your brain not live without a steady supply of?

A. Sugar and iron B. Iron and oxygen C. Oxygen and sugar D. Oxygen, iron, and sugar 6. What type of insulin would you put in an insulin pump?

A. Rapid acting B. Short acting C. Long acting D. Mixed 7. Your HbA1c result reflects your blood glucose levels over what period of time?

A. Two to four weeks B. Four to six weeks C. Two to three months D. Four to six months

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DIABETES WELLNESS | Autumn 2021

8. People with diabetes are at no more risk of getting Covid-19 than anyone else.

True or false?

9. Māori-led research is investigating which three rākau rongoā (healing plants) for their antidiabetic potential?

A. Karamū, kūmarahou, and kawakawa B. Ngaio, harakeke, and kawakawa C. Kūmarahou, kōwhai, and harakeke D. Karamū, kōwhai, and ngaio 10. What type of food are noodles?

11. If you get a Microalbumin Creatinine Ratio test, what does it show?

A. Whether protein is leaking into your blood B. Whether your blood sugars have been high over the past year C. Whether your ketones are high 12. What does a podiatrist look after?

13. What is the Freestyle Libre?

A. An insulin pump B. A continuous glucose monitor (CGM) C. A flash glucose monitor (FGM)

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Visit FreeStyleLibre.co.nz to learn more Why prick, when you can scan?* The FreeStyle Libre Flash Glucose Monitoring System is indicated for measuring interstitial fluid glucose levels in people (aged 4 and older) with insulin-dependent diabetes. 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. Always read the instructions for use. The sensor must be removed prior to Magnetic Resonance Imaging (MRI). *Scanning the sensor to obtain glucose values 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. †Data based on the number of users worldwide for the FreeStyle Libre system and compared to the number of users for other leading personal use sensor-based glucose monitoring systems. | 1. In a study conducted by Abbott Diabetes Care, 91% of patients surveyed (n=123) agree that the sensor was easy to wear due to its small size | 2. Sensor is water-resistant in up to 1 metre (3 feet) of water. Do not immerse longer than 30 minutes | 3. The FreeStyle LibreLink app is compatible with NFC-enabled smartphones running Android OS 8.0 or later and with iPhone 7 and later running iOS 13.6 and later.

FreeStyle, Libre, and related brand marks are marks of Abbott. Information contained herein is for distribution outside of the USA only. For more information call Customer Service on 0800 106 100.

Medi’Ray New Zealand, 53-55 Paul Matthews Road, Albany, Auckland 0632 www.mediray.co.nz NZBN 9429041039915 ADC-32183 v1.0

Quiz

BRANCH CONTACT LIST 2021 DIABETES NZ NATIONAL OFFICE

Test your diabetes knowledge: Answers 1.

B. Beta cells. Type 1 diabetes is an autoimmune disease where the body’s immune system attacks its beta cells and damages them. In type 2 diabetes, the beta cells become worn out from producing too much insulin.

2. C. Fruit Mentos. See our article on page 28 for the latest New Zealand research into effective hypo treatments.

3. Mate huka. Type 1 diabetes is mate huka tuatahi, and type 2 diabetes is mate huka tuarua. Gestational diabetes is mate huka hapūtanga.

4. False. This myth may have come about because type 1 is sometimes known as “insulin-dependent diabetes” and many people living with type 2 also need to take insulin. However, this doesn’t mean that the type 2 has turned into type 1.

5. C. Oxygen and sugar. Your blood constantly supplies your brain with the glucose it needs for energy. This is why low blood sugar temporarily affects your thinking.

6. A. Rapid-acting. By using rapid-acting insulin in a pump, you get immediate control of your blood glucose levels as the pump works. Short, long, or mixed insulin would be much slower to work if at all in a pump.

7. C. Two to three months. HbA1c is the measure of how much glucose is stuck to the outside of the red blood cells. A red blood cell lives for two to three months, so the HbA1c test is best done three monthly. This captures new glucose without glucose from the previous three months’ cells.

8. True. Covid-19 can be caught by anyone if you are in contact with someone who has it, whether you have diabetes or not.

9. A. Karamū, kūmarahou, and kawakawa. See our Summer 2020 issue for an article about research led by Dr Jonni Koia (Waikato-Tainui) at Waikato University.

10. Carbohydrates. Carbohydrates convert to sugar and enter the bloodstream when you eat them.

11. A. Whether protein is leaking into your blood. This can be an early warning sign of kidney damage. If the results are raised, it’s important to take medication that helps protect the kidneys from further damage.

12. Your feet. Regular foot check-ups are important for those with both type 1 and type 2, as elevated blood sugar, cholesterol, and blood pressure can cause foot issues over time.

13. C. A flash glucose monitor (FGM). FGMs and continuous glucose monitors (CGMs) both use sensors inserted under your skin to read sugar levels in the fluid between your cells (which indicate what your blood sugar is). CGMs can send glucose readings to your monitoring device every five minutes.

FGMs give you readings only when you swipe a scanner over your sensor.

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DIABETES WELLNESS | Autumn 2021

For general enquiries 0800 DIABETES (0800 342 238) PO Box 12441, Wellington 6144 04 499 7145 | admin@diabetes.org.nz www.diabetes.org.nz

* Have youth teams and/or representatives UPPER NORTH ISLAND Auckland* 55 Hugo Johnston Drive, Penrose, Auckland PO Box 13 578, Onehunga, Auckland 1643 09 622 0551 or 0508 DIABETES (0508 342 238) office@diabetesauckland.org.nz www.diabetesauckland.org.nz Tauranga 174 11th Avenue, Tauranga | PO Box 15 219, Tauranga 3144 07 571 3422 | tauranga@diabetes.org.nz www.diabetes.org.nz/branch-tauranga Gisborne PO Box 1029, Gisborne 3801 06 867 7341 | admin@diabetes.org.nz Rotorua* 17 Marguerita Street, Fenton Park, Rotorua 3010 07 343 9950 | info@diabetesnzrotorua.org.nz www.diabetes.org.nz/branch-rotorua Taupo Refer to Rotorua Waikato* Life Unlimited Building, 20 Palmerston Street, Hamilton 3204 07 853 9854 | diabetesw@xtra.co.nz www.diabetes.org.nz/waikato-branch LOWER NORTH ISLAND Taranaki* Pinnacle Midlands Health Network PO Box 8196, New Plymouth 4342 027 246 1600 | Matire.ropiha@diabetes.org.nz www.diabetes.org.nz/branch-taranaki Wairarapa refer to National Office Wanganui PO Box 102, Wanganui 4541 Level 1, Community House, 60 Ridgway Street, Wanganui 06 281 3195 | wanganuidnz@gmail.com SOUTH ISLAND Nelson Youth dnznelsonyouth@gmail.com www.diabetes.org.nz/branch-nelson-youth Otago* 135 Frederick St, Dunedin 9016 03 474 0240 | noeline@diabetes.org.nz www.diabetes.org.nz/branch-otago South Otago 34 Lanark Street, Balclutha 9230 03 418 2681 Southland* Cnr Gala and Jed Streets, behind the MS rooms – entrance off Jed Street | PO Box 1122, Invercargill 9840 03 218 3422 | diabetes.southlandfo@xtra.co.nz www.diabetes.org.nz/branch-southland

Type 2 diabetes is not a choice.

But, finding a different treatment option is.

Do you have type 2 diabetes and high blood pressure?

If you are between 22 and 70 years of age and not taking insulin for treatment of your diabetes, YOU may be eligible to participate in a new clinical trial.

The clinical trial involves an investigational procedure to help treat your diabetes without new medications. The catheter based investigational procedure will require an overnight stay. The study includes 4 follow-up visits that may take up to 6 hours per visit.

If you would like to know more, please visit deliverstudy-nz.com.

This study has Ethics Committee approval.

deliverstudy-nz.com Doc No. 1746 Rev1

HELPING TO MANAGE YOUR DIABETES

FreeStyle Optium Blood Glucose and Blood Ketones Testing FreeStyle Libre Flash Glucose Monitoring System The FreeStyle Libre Flash Glucose Monitoring System is a glucose monitoring device indicated for detecting trends and tracking pattern in persons aged 4 and older with insulin dependent diabetes Diabetes Care mellitus, without the use of lancets.

Silesse™ Sting Free Skin Barrier Spray

Niltac™ Sting Free Medical Adhesive Remover Wipes

• 50ml • Quick drying silicon film • Protects skin from damaging effect of adhesives

• Pack 30 wipes • 100% Silicon Free • Hypo-Allergenic

• FreeStyle Optium Neo Meter Kit • FreeStyle Optium Blood Glucose Test Strips 100’s • FreeStyle Optium Blood Ketones Diabetes Care Test Strips 10’s

Glucology® Sensor Patches Glucology® Sensor Patches are a blend of latex-free Cotton and Spandex which provides unique elastic qualities to ensure flexibility, durability, and maximal comfort.

Compatible with Libre Sensor.

Frio Cooling Wallets • • • • •

Keeps Insulin cool and safe Refrigeration not required Simply activate with cold water Reusable, light and compact Available in five sizes and six colours

Hypo-Fit Glucose Gel • Two flavours – Orange and Tropical • 18gram sachets, 13.4grams Carbohydrates HYPO-FIT • Gluten-Free D I R E C T- E N E R G Y

MedActive Carry Cases Diabete-Ezy Accessories • • • • •

Ezy-Fit Carry Case (Blue, Pink & Green) Multi-Fit Carry Cases (Black & Red) Test Wipes Starter Pack Test Wipes Refills Diabete-ezy™ Comfy Pump Belts

A selection of convenient carry cases for medical supplies.

• Easy Bag Single • Easy Bag Classic • iCool Weekender • iCool Prestige • iCool MediCube transforming lives

medactiv

Dextro Energy Glucose Tablets • 24 sticks per carton (12 tablets per stick) • Available in four flavours Orange, Blackcurrent, Lemon, Tropical • All with added Vitamin C

Order Online: www.mediray.co.nz Freephone: 0800 106 100 Address for Correspondence: PO Box 303205, North Harbour, Auckland, New Zealand