Diabetes Wellness Summer 2019

wellness DIABETES

SUMMER 2019 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

DIABETES & THE PERFORMING ARTS • WHAT IS GI? • THE FIGHT FOR VITAL MEDICINES • HYDRATION TIPS WAIKATO’S NEW HEALTH DEGREE • SPORTS ROUND-UP • NUTRITIOUS EDIBLE FLOWERS

DIABETES ACTION MONTH #FINDTHE100K

ATHENA ANGELOU Treasuring Health

measures spoon-for-spoon like sugar Vanilla Cupcakes Preparation 15 mins 30 mins chilling time Cooking 20 mins Serves 12 Ingredients Cooking spray 60g butter or reduced-fat spread ¾ cup EQUAL Spoonful 1 tsp vanilla essence 2 x 50g eggs, lightly whisked 1 cup self-raising flour cup wholemeal self-raising flour cup low-fat milk 140g unsweetened apple puree

Cream cheese frosting 125g extra light cream cheese cup EQUAL Spoonful ½ tsp vanilla bean paste

Instructions

Cream cheese frosting

1. Preheat oven to 170°C (conventional).

Line 12 x 80ml ( cup) muffin pans with paper cases. Spray cases with cooking spray.

1. Put the cream cheese, EQUAL Spoonful and vanilla bean paste in a medium bowl. Using an electric beater, beat until mixture is pale and creamy. Put in the fridge for 30 minutes to thicken slightly.

2. Using an electric beater, beat the spread, EQUAL Spoonful and vanilla essence in a medium bowl until well combined and spread is creamy. Add 1 egg and beat until well combined.

Beat in the remaining egg.

3. Put the flours into a bowl and stir to combine. Put the milk and apple puree in a bowl. Whisk to combine.

Add half the flour mixture and half the milk mixture to the EQUAL Spoonful mixture. Mix until just combined.

Repeat with the remaining flour and milk mixture.

4. Spoon the batter evenly into the muffin pan. Bake for 20 minutes or until a skewer inserted into the centre comes out clean. Transfer to a wire rack to cool.

2. Spread the frosting over the cupcakes.

Tip – Keep the cupcakes in an airtight container in the fridge for up to 3 days.

Nutritional Information Average Quantity Per Serve:  Energy 616kJ  Protein 4.5g  Fat Total 5.6g  Saturated 2.1g  Cholesterol 32.7mg  Carbohydrates 19g  Fibre 1.3g  Sodium 205mg

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 SUMMER 2019 VOLUME 31 | NO 4

4 EDITORIAL

20

24

20 LIFE WITH T1: Macie’s story

5 UPFRONT: Award winners

22 RESEARCH: EDOR – studying New Zealand’s eating habits

6 UPFRONT: Fitbit MoveMeant Challenge

24 TECHNOLOGY: Managing type 1 diabetes – CGMs, FGMs and funding

7 UPFRONT: Step-Up Day for Taranaki youth 8 COVER: Athena Angelou talks health, fitness and diabetes

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28 COMMUNITY: Walking Samoans 30 LIVING WITH T1: Five adventurers share their tips for holidaying with diabetes

10 ADVOCACY: Two important petitions need your support

COVER: ATHENA ANGELOU © TOM HOLLOW

11 LIFE WITH T1: CGMs – Cody’s journey

32 DIABETES ACTION MONTH: It’s about time – raising awareness about diabetes

12 COMMUNITY: Three creative young Kiwis on overcoming life’s challenges 16 NOURISH: What’s GI? The rundown on the Glycaemic Index 18 RECIPE: Yoghurt berry bark

12 34 NOURISH: Your summer hydration guide 36 EDUCATION: A new health programme launches at University of Waikato 38 GROW: Give your diet a lift with edible flowers 40 SPORT: Sophie Devine and Jill Gillette 42 TECHNOLOGY: New diabetes app from Kumanu Care

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THANK YOU TO OUR CHAMPION SPONSORS FOR THEIR ONGOING SUPPORT AND PARTNERSHIP

DIABETES WELLNESS | Summer 2019

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Editorial

F

rom 1 July 2019, Diabetes NZ’s charitable status changed from being an Incorporated Society to a Charitable Trust. This brings about a change in the governance arrangements for Diabetes NZ, with a skills-based trust board appointed to set the strategic direction of the organisation and provide oversight of its activities.

It has been a busy 12 months for the Board and management to bring about this change and I am grateful for the energy that our Chief Executive Heather Verry and her team have devoted to the process.

It has also meant new ways of doing things at a branch level and we are not quite there yet in bedding in new processes and procedures. My thanks also to the branch committees for their support and tolerance. Heather has instigated regular meetings with employees of Diabetes NZ as we begin to provide a coordinated response to supporting all people with diabetes.

Trustees have appointed Simon Watts, a member of the Auckland branch committee, as the branch representative trustee.

Establishing this position on the Trust Board was something that members requested at the last Annual General Meeting, and after receiving and considering three nominations, we appointed Simon to this position. Simon has type 1 diabetes, is currently employed by the Waitematā District Health Board as Deputy Chief Financial Officer, and has clinical experience as a volunteer emergency ambulance officer. I am looking forward to his joining the governance team.

Having one organisation that speaks with one voice for all people with diabetes means greater strength, so it is with great pleasure that, from October, we welcome to the Diabetes NZ family of branches the former Diabetes Help Tauranga Incorporated Society.

We have been discussing with this branch the options for becoming part of a larger organisation for some time.

We are not without our challenges. Sourcing sufficient funds to instigate new programmes, especially from government, continues to be an issue.

As a result of a restructure in the Ministry of Health, the Associate Minister of Health Hon Peeni Henare now has diabetes as part of his delegation, and there has been a change in focus from outcomes to early intervention. That sits neatly with Diabetes NZ’s focus on support at time of diagnosis to self-management and a reduction in the consequence of complications from diabetes.

In this magazine, we update you with what’s happening for Diabetes Action Month this November, and we look ahead to the summer break with advice on hydration; tips for going on holiday with diabetes; and a selection of delicious, healthy summer recipes.

Professor Ben Wheeler explores the range of technology available for people with type 1, and we talk to three performing artists with diabetes about the unique challenges and rewards they experience.

CATHERINE TAYLOR

Board Chair, Diabetes NZ

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DIABETES WELLNESS | Summer 2019

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

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

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

Join today at www.diabetes.org.nz

DIABETES NEW ZEALAND Patron Sir Eion Edgar 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 Coordinator Jo Chapman jo@diabetes.org.nz or +64 21 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion.

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

Upfront

OUR LATEST AWARD WINNERS In October, Diabetes NZ was proud to announce the winners of three awards.

SIR CHARLES BURNS MEMORIAL AWARD

Maurice Myers, of Ashburton, is our newest recipient of this award, which is for Diabetes NZ members who have managed their diabetes for 50 years or more through insulin therapy. The award is named after the first resident doctor to administer insulin to a patient in a New Zealand hospital.

JOHN MCLAREN YOUTH AWARDS

These annual awards of $1,500 recognise the pursuit of excellence by young people with diabetes, encouraging them to achieve their goals across cultural, academic and sporting fields, despite the condition’s daily challenges.

2019 Academic Award winner Kaylee Metcalfe plans to study Health Sciences at the University of Otago next year. Ultimately Kaylee would like

to pursue a Bachelor of Medicine and Bachelor of Surgery. The money will go towards her accommodation.

2019 Sporting Award winner Isobella Burdon is an underwater hockey player whose goals over the next 12 months are to continue her team success in the Underwater Hockey Age Group World Championships in Sheffield and to continue her training for the under-18 underwater hockey NZ TransTasman team in 2020.

Unfortunately, no applications for the Cultural Award were received this year.

AWARDS HISTORY

We are grateful to the late John McLaren who bequeathed a sum of money from his estate to be used by young New Zealanders with diabetes. These funds were used to establish the John McLaren Youth Awards which are managed by Diabetes NZ.

PAST WINNER JOINS TOP TEAM Southlander Hamish Beadle is a previous McLaren Award winner. Now the 21-year-old has been selected for Team Novo Nordisk, the world’s first all-diabetes pro cycling team.

Diabetes Wellness will be following Hamish and the team’s progress. www.teamnovonordisk.com

GIVE THE GIFT OF WELLNESS This Christmas, give a subscription to Diabetes Wellness to someone you care about.

Just $28 a year* Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

*Four issues delivered to your door, and a saving of 12.5% off retail price of $32.00 To subscribe for this special price visit www.diabetes.org.nz and click ‘Magazine Subscription’

DIABETES WELLNESS | Summer 2019

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Upfront

Get ready for the Fitbit MoveMeant Challenge 2020 For two weeks in March, we’re inviting Diabetes NZ branches, families, friends and the wider community to join together, don Fitbits, and get stepping for fun and fitness. Now’s the time to start preparing.

D

iabetes NZ and Fitbit first ran the Fitbit MoveMeant Challenge in 2017 as part of Diabetes Action Month, to create awareness around the importance of movement in managing health and preventing and managing diabetes.

A huge success, it became a standalone event in 2018.

Celebrities, public figures and business personalities across New Zealand were invited to compete for one month. They took the challenge seriously, sharing achievements and progress via social media. We watched in awe as Hamish Walker, MP for Clutha–Southland, who has

type 1 diabetes, stepped up to the challenge by completing an impressive 258,758 steps.

In 2019, the challenge was held over two weeks in May. Previous competitors were quick to sign up in a bid to win the coveted title of Diabetes NZ Fitbit MoveMeant Challenge Champion.

Competition was fierce.

Challengers followed each other’s progress through their Fitbit apps and tried to outdo one another on their daily step targets but, ultimately, the 2019 winner was Richard Chambers, Assistant Commissioner of

NZ Police, who’d come second to Hamish Walker in 2018.

In 2020, back by popular demand, the Fitbit MoveMeant Challenge will have yet another incarnation, as we invite the wider community to take part. We want as many people as possible to participate in the 2020 iteration and step towards living a healthier life.

STAND BY FOR INFO

The 2020 Fitbit MoveMeant Challenge will take place over two weeks in March. You’ll find all the details you need to get involved in the next issue of Diabetes Wellness.

Win a Versa 2 As part of Diabetes Action Month, we’re giving away a prize pack which includes the new Versa 2 Fitbit with Amazon Alexa Built-in.

The Versa 2 makes life easier by letting you set reminders, check the weather and get on-screen answers to your questions just by using your voice. That gives you more time to put its 24/7 heart rate tracking, 15+ goal-based exercise modes and other fitness features to work.

To go in the draw, put FITBIT in the subject line and email your name, phone number and postal address to draw@diabetes.org.nz Or post to: Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Competition closes 31 December 2019.

DISCOUNTED FITBITS FOR MEMBERS Diabetes NZ members are eligible for a special discount offer of up to 20% off Fitbit trackers. Go to https://store-nz.fitbit.com/DiabetesNZ and use your personal ID code.

If you haven’t signed up for membership, you can do so for free at www.diabetes.org.nz/join-us

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DIABETES WELLNESS | Summer 2019

Step-Up Day for young people Taranaki teens with type 1 have benefited from a day run specially for them by the paediatric diabetes team at the Taranaki District Health Board.

T

he team have held Step-Up Day every one to two years since 2011, inspired by a similar event in Auckland.

Nurse Cynthia Seamark, who organised it with colleague Dorothy Larsen, says, “It’s a means of fostering independence for people as they enter adolescence and move toward transition to the adult service. They meet other young people with diabetes and generate a sense of community”.

Drs Yvonne Anderson and Mark Shaw facilitated sessions on puberty, staying safe when driving, and the effects of alcohol on diabetes. Psychologist Kate Treves explained how participants can access psychology support if they need it, and dietitian Jackie Keenan, with Diabetes Youth’s Niamh McCormack, gave a comprehensive run down on carb counting.

Anastasia Andreianova from

KIWI TAKEOVER 2019 For one week in August, Kiwis were privileged to take over Beyond Type 1 and Beyond Type 2’s Instagram pages. Beyond Type 1 have over a million followers worldwide. During our Kiwi Takeover campaign each year, Kiwis with diabetes get global exposure as they share how they #livebeyond and are #beyondpowerful.

Novo Nordisk enthralled participants with a presentation on the history of insulin.

A highlight was cyclist Steph McKenzie’s session. Cynthia says, “She inspired everyone with her story of managing type 1 diabetes whilst representing New Zealand in cycling.”

Feedback from the day was overwhelmingly positive, with participants’ diabetes management confidence scores all stronger by the end of the day.

Yvonne says, “We’re passionate about holding an event for young people to recognise their right to take control of their condition on their own terms. We always learn just as much from attendees as we share.”

ANYTIME FITNESS FUNDRAISER A SUCCESS Thank you to everyone who supported Diabetes NZ by purchasing a copy of the Anytime Fitness NZ 28-Day Winter Kick-Start Programme. More than 400 copies were sold across the country and we raised $8,500, which will go towards supporting people with, or at risk of, diabetes.

As well as raising much-needed funds, the campaign was successful in raising awareness of and interest in diabetes and Diabetes NZ as an organisation.

A huge thank you to our campaign champion Ricky Winikerei (pictured above) who committed to completing the programme in the hope of inspiring those around him to make positive lifestyle changes.

Ricky lives with type 1 diabetes and shared his story and progress with us on social media throughout our campaign. We were inspired by Ricky’s efforts to drive important conversations among his family and friends.

We are also grateful to Māori TV and The AM Show for giving us the opportunity to share the campaign with a wider audience.

Anytime Fitness NZ is proud to work alongside Diabetes NZ to help Kiwis kick-start their fitness and create healthy habits for long-term health, and looks forward to continuing to support such a worthy cause.

DIABETES WELLNESS | Summer 2019

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Cover

THE REAL GOLD For six weeks, Celebrity Treasure Island contestant Athena Angelou raised awareness of diabetes, while entertaining viewers with her energy and warmth. Diabetes Wellness talked with her about the things she treasures most – health and family.

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DIABETES WELLNESS | Summer 2019

W

hen Athena Angelou chose Diabetes NZ as her charity for the popular reality show, she did it for her mother. The Flava host says, “It’s no secret that Mum and me love our sugars. But reality struck when Mum went to the doctor a few years back and was told that if she didn’t make changes to her habits, she could end up diabetic.

“When you’re hit with the thought of losing your mum, or her having to deal with something additional while she’s already suffering health complications, it makes you re-evaluate what really is important and worth the risk.”

Athena and her mother made changes together. “Health and fitness are important. I’ve struggled with weight my whole life by succumbing to unhealthy eating habits. Eventually, I came to the understanding that it’s not only what you ingest, but what you exert physically, and how you balance your mental and physical states.

“If you’re unable to mentally make a positive switch and be

compelled by something meaningful to you, it’ll really always be an uphill battle.

“Sometimes it takes time to focus and internally coach yourself into a new frame of mind where you’re determined and able to transfer your thoughts into actions. But if you are willing to make it work, eventually you’ll change your habits.”

Athena’s mother is proud of her daughter and the challenges she’s overcome: “I’ve made her proud by showing her that no matter how hard things got, I was ready and able to channel her energy to work that much harder,” says Athena.

“Although she set huge expectations, I wouldn’t ask to go back and change a thing. I’ve kept faith and worked my ass off.”

The pride is mutual. Athena says of her mum, “She’s a queen. She’s worked so hard to be where she is today. She’s set a bar for who I wanted to be growing up as a female, and helped motivate me into being independent. I’ve always admired her determination and strong will.

I’ve always thought that whatever she touched turned into gold.”

ATHENA’S LEMON-HERB TENDERLOINS & SALAD SERVES 4

Athena’s favourite healthy meal pairs marinated grilled chicken with low-fat Greek salad, and serves it with warm wholemeal pita bread.

It’s quick, simple and perfect for summer.

TENDERLOINS

1 large or 2 small lemons 1½ tbsp olive oil 2 cloves crushed, grated or finely chopped garlic 1 tsp dried oregano or mixed herbs ½ tsp ground black pepper 750g chicken tenderloins (2–3 per person) Handful of parsley, chopped Grate the zest of the lemon into a bowl, then halve the lemon(s) and squeeze in the juice.

Add olive oil, garlic, herbs and black pepper, and whisk together. This is your marinade.

Place the tenderloins in the bowl, and stir to coat in the marinade. Leave covered for up to eight hours, stirring occasionally if you can. (The longer you leave them the better, but even half an hour will be delicious.)

When ready to cook, preheat your grill.

Throw the chicken on and cook for about four minutes on each side, or until cooked through.

Throw parsley over as garnish.

GREEK SALAD

30g feta cheese (choose reduced salt) 30g low-fat cottage cheese Approx 250g cherry tomatoes, halved 1 cucumber, sliced into half-moons ½ cup kalamata olives, halved ½ red onion, thinly sliced DRESSING

1 tbsp red wine vinegar 1 tbsp olive oil Juice of half a lemon ½ tsp dried oregano Loosely mash together the feta and cottage cheese.

Set aside.

Toss the tomatoes, cucumber, olives and red onion together in a bowl.

Shake the dressing ingredients together in a jar, or whisk together.

Pour dressing over salad veges.

Crumble the feta and ricotta mix over the top.

Toss the salad gently.

PUTTING IT ALL TOGETHER

Have the chicken marinating. Prepare the salad. Cook the tenderloins just before you’re ready to serve. Serve them with wholemeal pita bread, either lightly toasted or wrapped in tinfoil and warmed in the oven.

HINTS

• Cook the tenderloins under the grill in your oven if you can’t throw them on the grill.

• To tone down the raw red onion taste, soak the slices in water for around 10 minutes, then drain before you add to the salad.

NUTRITION PER SERVE: 2535KJ (606KCAL) PROTEIN: 57.6G, FAT: 19.7G, SATURATED FAT: 4.9G, CARBOHYDRATE: 43.8G, SUGAR 7.2G, SODIUM 7.24MG (OR 1.8G SALT)

DIABETES WELLNESS | Summer 2019

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Advocacy

UNITE FOR

IMPROVED HEALTH FUNDING Two important petitions are open for signatures until 20 November. If you’re concerned about access to essential medications for yourself or loved ones, Diabetes NZ urges you to sign them.

DIABETES PETITION

This petition, submitted to parliament by Diabetes NZ, asks that continuous glucose monitors (CGMs) be funded for people with type 1 diabetes, along with a wider range of modern, effective medications for people living with type 2 diabetes.

People with type 1 very often talk about CGMs, along with FGMs (flash glucose monitors) as lifechanging, and research shows that they certainly lead to improved blood glucose levels. Currently, New Zealanders have to self-fund them, and many cannot afford to. For more information, see our article on page 24.

At the same time, the type 2 medications we are asking to be funded are GLP-1 agonists including Bydureon, Byetta, Lyxumia and Victoza; SGLT-2 inhibitors including Forxiga and Jardiance; and DPP-4 inhibitors including Januvia, Onglyza, and Trajenta.

New Zealand lags behind the rest of the developed world in the availability of funded medication for type 2 diabetes. Despite

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DIABETES WELLNESS | Summer 2019

international guidelines, and continuing evidence-based advice from local diabetes researchers and specialists, PHARMAC continues to decline to fund these drugs, all of which are now extensively used in Australia, the UK and Western Europe as important second- and third-line drugs.

New Zealanders with type 2 diabetes are missing out on chances of greater health and wellness by not having access to them.

Sign at: http://bit.ly/DNZPetition REFORM PHARMAC AND DOUBLE THE PHARMAC BUDGET

This petition from patient advocacy group Patient Voice Aotearoa asks that PHARMAC, the Crown agency that funds medications, be allocated a larger budget and be given an overhaul to bring it in line with international standards.

Diabetes New Zealand supports this important petition because, currently, we and other groups that advocate for people living with specific conditions are competing with each other for limited funding.

Malcolm Mulholland, Chair of Patient Voice Aotearoa, says, “The ‘divide and conquer’ strategy is well and truly at play from PHARMAC with different disease and patient advocacy groups wanting their specific drug funded. Because of the severely limited budget that PHARMAC are operating under, that does mean

that certain drugs are funded over others.

“PHARMAC has been chronically underfunded for over a decade, the same period of time that has borne witness to an explosion of modern medicines that work and that mean some diseases which were once labelled terminal are now considered chronic diseases. New Zealand spends only a third of what it should on subsidising drugs, according to the OECD.” As well as this, “the PHARMAC process is deliberately designed not to be transparent and to confuse people into believing that the drug they require may not work, so that PHARMAC can justify not funding it”.

Sign the Patient Voice Aotearoa petition at: http://bit.ly/ReformPharmac

KEEPING PRESSURE ON

Diabetes NZ will continue to advocate for essential therapies, and Diabetes Wellness magazine will continue to bring you information on the subject.

In our next issue, look out for an article giving the run down on medications for type 2 diabetes (those that New Zealanders can access and those that we can’t).

In the meantime, please do sign these petitions if you haven’t already.

Life with T1

Feeling more human “Life-changing” is how people who live with type 1 diabetes often describe the switch to continuous or flash glucose monitoring.

Each of them has a story.

This is university student Cody Brinsdon-Hall’s.

C

ody was diagnosed with type 1 in 2003, when he was five, and all the usual struggles of a new diagnosis were compounded by his phobia of needles and blood.

He remembers dreading insulin injections, but not as much as the pinprick tests that came first. “I despised the finger prick because I could see the blood,” says Cody.

As soon as he could, he insisted on doing his finger pricks himself.

“I can’t stand the thought of someone else controlling how much blood comes out of me.”

It was easier for his parents to do his insulin injections, though; they could do it so that he didn’t have to see the needle going in. They continued to do his injections until he was 10.

His fears remained overwhelming, and he would test his blood sugar the bare minimum.

It meant his blood sugars were often running high. “I was a very wild child. A very angry child. I would lash out.” It became obvious that high blood sugar was a large part of the reason: “That’s how it affects me.”

When he was 10, he attended his first independent Diabetes Youth Camp and forced himself to take another step towards autonomy. “I didn’t want to be embarrassed, so I needed to conquer what had been

this unachievable goal of injecting my own insulin in my stomach.”

He loved that camp, and the ones that followed. “Those were the best times, the most comforting times as a diabetic,” he says. “All of these people around you, all the same as you.”

“Some days on it I’d feel like king of the world.”

Outside of camp, he continued to struggle. Although he could now test his blood sugar and inject his own insulin when he really needed to, the fears around needles and blood were entrenched. “I was never admitting to myself that I was high. I’d try and put off the injection process.” At the same time, he, like many people with type 1, dreaded going low, so he tended to keep his blood sugars high on purpose. That meant spending a lot of time angry.

A DISCOVERY

In October 2018, Cody’s mother told him about a friend whose daughter had type 1. The daughter was at secondary school and had just started using a Freestyle Libre flash glucose monitor. “My mum put a lot of effort into trying to convince me I should try it.”

At first, Cody hated the idea.

Having a sensor with a small needle inserted under his skin for two straight weeks sounded like a nightmare. Then one day the friends came round, and Cody saw it in action.

“As soon as I saw her use the scanner, I thought ‘screw this phobia.’” He realised it would

change everything. His mother got him one straight away.

“I almost passed out the first time I put the sensor on. I was sweaty, out of breath. I had to play music loud, and sing to do it.”

Once it was on, it was worth it.

No more finger pricks. Cody could see where his blood sugar levels were with the swipe of a scanner, as well as whether they were heading upwards or downwards, or staying static. Now he didn’t have to try and stay on the high side all the time to avoid the risk of going low.

“Some days on it I’d feel like king of the world. If you can track your blood sugar levels so you can keep them around five, that is just massive. It has a big effect on happiness. Other people who don’t have diabetes are walking round on five. I finally felt normal, human, like them.” He says that even when his blood sugar is on eight (the upper end of the range that people with diabetes aim to stay within), he feels moodier.

He reflects that most people take their steady, even blood sugar levels for granted. They don’t realise that for people with diabetes, the ups and downs in blood sugar can affect mood and thought processes on a daily basis. Not only does Cody find he’s happier now, and more clearheaded, but “it takes a load off so you can think about other stuff”.

Recently his Libre scanner broke, and he had to finger prick again.

“It was humbling, because of realising what I used to have to do, and what so many diabetics still tackle every day. I feel extremely grateful that my mum convinced me to use the Libre, and lucky she could fund it. It makes me much more positive. It’s almost exciting.”

DIABETES WELLNESS | Summer 2019

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Community

A PERFORMER’S LIFE

WITH DIABETES

PHOTO: © JESS CHARLTON

For performing artists, diabetes brings unique challenges.

Diabetes Wellness talks with three performers who are dedicated to their arts and are overcoming these challenges in diverse ways.

Simon Eastwood and Nova Moala-Knox

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DIABETES WELLNESS | Summer 2019

PHOTO: © JESS CHARLTON

TYPE 1

SIMON EASTWOOD Composer and double bassist

I

n July 2018, Simon Eastwood spent a week canoeing along Alaska’s treacherous Koyukuk River – with six other composers and two guides. After arriving at a lodge in the remote Arctic town of Bettles, the composers had three days to start creating musical pieces inspired by their experiences.

The group had been selected from around the world. Four months later, their works premiered at a concert in New York, marking the 50th anniversary of the United States’ Wild and Scenic Rivers Act. “The river got pretty dangerous,” says Simon. “But our guides were fantastic and kept us out of trouble.”

He’s always enjoyed exploring new places. “Also, as a diabetic, it was a challenge to prove to myself that I could do something like that.”

He thought carefully before accepting the trip. “I said to my endocrinologist, ‘so you’re not going to tell me I shouldn’t go?’ He was like, ‘oh god no.’ He was really encouraging and gave lots of good advice.”

Alexandra Hay, a composer friend of Simon’s who has type 1 as well, suggested Simon get a FreeStyle Libre for the trip. She also suggested carrying glucogels for lows, as they’d be robust through extreme temperature changes, unlike his usual jellybeans.

As it turned out, Simon barely had any lows, and found he took much less insulin than usual. “We were working hard physically. Most of the meals were high protein, then you’d have snack bars for the carbohydrate, and I was really surprised about some of my levels.

“It’s made me think a lot about how in day-to-day life I’m so used

to balancing carbohydrates with insulin, but sometimes that’s the only thing you balance! It made me think a lot about, well, maybe I could just eat less sugar and have less insulin.”

GETTING TO GRIPS WITH TYPE 1

Simon was diagnosed at 19, in his second year of studying for a Bachelor of Music at Victoria University of Wellington. He was majoring in double bass and composition.

Although he’d played various instruments all his life, he’d only recently come to the double bass, excited by its versatility. Determined to prove himself on this new instrument, he was pushing himself hard. “Sometimes I’d practise till 3am and get up again at 7am. Then I got a cold, and I started losing a lot of weight.

“My parents are doctors, so I knew those symptoms. But I was like, ‘that’s crazy, I would not be diabetic’.”

Away on a camp, he grew rapidly sicker. A drummer friend with type 1, Michael Rhodes, was there and realised what was happening. “He tested me with his kit, and my sugars were sky-high. When they took me to hospital, I was close to ketosis. It was very lucky. I owe Michael my life in a lot of ways.”

Simon swam competitively when he was younger, and he says there are similarities between the ways performers and athletes have to deal with type 1. For a start, playing music is physical: “With the double bass, as with many instruments, you’re concentrating hard, breathing in time, and the whole body is really involved.”

There’s also “a certain time frame in which you have to perform in a

certain way, and you want to make sure your diabetes doesn’t interfere with that. You set yourself up as a diabetic before you go into that space, then you come out again.

“Usually I have a little bit to eat before a performance to make sure I don’t go low. There have been a few times performing where I’ve started going low. It usually hasn’t gotten to the point where I’ve had to stop the performance.”

MENTAL HEALTH

It’s becoming more well known that people living with type 1 have higher rates of depression and anxiety than the general population. How does that interact with a life in the performing arts?

Simon says there are two aspects: “Music is therapeutic, but on the other side, being a musician, or any kind of performer, can be stressful.”

The issues are heightened when you’re doing it full time, as he is.

“There’s irregular income. Then there’s that thing of what you do becoming who you are. It can be high pressure and, internally, you also put a lot of pressure on yourself.

You have a goal and because you’ve tied up your self-worth in what you do, if you don’t get that goal ...

A lot of musicians struggle with this. It’s why, even though music itself is good for wellbeing, a lot of musicians have mental health problems.”

Diabetes adds to the mental load.

“Sometimes I deal with it better than others. But I think the main thing is to talk to people if you’re having problems, to be honest and open and part of a community.” www.simon-eastwood.com

DIABETES WELLNESS | Summer 2019

13

TYPE 2

NEV MAAS Drummer

N

ev, a drummer and full-time dad in Ashhurst, near Palmerston North, contends with bipolar as well as type 2 diabetes.

Throughout his life, music has got him through.

“I started drum lessons when I was 12,” Nev says, “and as soon as I was old enough to play in bars I did.” It was the late 80s – a golden age for live music in New Zealand. Bars had bands every Friday and Saturday night. “There was heaps of work, and you got paid good money for it.”

By 1995, this period had come to a close, but Nev managed to continue playing regularly. He’s been in a number of bands over the years. “I was never a full-time musician. I always kept day jobs. I would have loved to do it full time, but it wasn’t going to pay the bills and I knew I didn’t want the uncertainty of that.

“Currently I’m in a covers band, Undercover. We play rock and pop tunes, from Prince, Blondie and Pink to Van Halen, Bon Jovi, Kings of Leon and lots more. Lately we’ve been playing the clubs in Whanganui, and we’ve just got back from New Plymouth.”

Nev’s wife Ingrid works in radiotherapy (radiation oncology).

Nev looks after their two children during the week, and plays in Undercover on weekends.

“RETHINKING EVERYTHING”

He was diagnosed with type 2 in 2005.

“I went to the doctor because I was feeling tired all the time. He did blood tests and said, ‘you’ve got diabetes.’ I couldn’t believe it.

“So I had to rethink everything.

Travelling somewhere for a gig,

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DIABETES WELLNESS | Summer 2019

previously I’d have never thought anything of stopping off at a service station or a drive-through. That’s common practice for most people doing this sort of thing. All that had to stop, and it was like: what do I do?

What do I eat?

“So you have to start organising things yourself. Either bring food with you or know where to go to get something that works for you. It’s pretty hard when bandmates are munching on a nice greasy old burger, and I’m like, ‘oh man!’

“I’m not perfect, and sometimes I still will do that, but I’m very careful about when or how often. It’s an occasional thing.

“I’ve found that if I’m not watching what I’m eating, I can feel quite unwell when my blood glucose gets high. Some people say they don’t notice anything. I always can. I get lethargic and my concentration goes.

That’s not good when you’re traveling or performing.”

He’s recently realised that living with bipolar feeds into diabetes.

“That’s another challenge. If you’re feeling depressed, you go for comfort food. I have to be careful with that. I had a bad run with that last year.

“I’d been doing okay, then last year I lost focus on my health. I went for a check-up, and there had been a huge jump up in my HbA1c. That was a wake-up call. I’ve refocused now on food choices and trying to get exercise. That’s knocked it back, and I’m doing good again.

“That’s another thing. When you’ve had it for so long, sometimes you forget you’ve got diabetes, then all of a sudden it’s like, hang on a minute, I shouldn’t be eating this. So you fall off

the wagon and you get back on again.”

He says he sometimes finds it tough, “but I’m chugging along”.

Support is all important. Nev’s wife Ingrid has supported the whole family in changing to a healthier diet. Nev has another musician friend with type 2 diabetes, and he’s always around to talk to and compare notes with. “He’s 70 now. He’s had it for longer, but he’s really done well with his. It’s good to see how he’s managed it over a long period of time. And like me, he’s fallen off the wagon a few times, then got back and carried on.”

Nev finds his doctor and diabetes nurse to be consistently understanding and supportive, including around his mental health, which also helps.

BODY AND MIND

Nev says, “I can’t begin to tell you how much of a huge impact music has on mental and physical health. Firstly on a psychological level, it really keeps depression at bay. It’s a powerful thing.

“When you’re playing it makes you feel good, and it makes you want to look after yourself. Feeling good makes you want to physically look after yourself as well. And I think when you’re feeling well, you tend to eat better.

“I’ve only just realised in the last 12 months that being healthy isn’t just about the physical side of looking after yourself. It’s the whole big picture: the physiological and the psychological.

You have to look after both to be well. Once, I was totally ignoring the psychological side. But it’s all one package.” www.facebook.com/UnderCoverNZD

TYPE 1

NOVA MOALA-KNOX PHOTO: © JESS CHARLTON

Actor

N

ova’s type 1 diagnosis came out of the blue. She was 13, and was at the doctor for something no one thought was very serious, when a blood test showed that her glucose levels were in the 20s.

That morning she’d been excited: she’d just heard she’d got a callback for a role in a web-series she’d auditioned for. Now, suddenly, along with her mother as caregiver, she was being admitted to Wellington Hospital without a chance to even go home and collect her things.

“I was in shock. I thought it meant the rest of my life was going to be terrible. But I started feeling better there. I felt looked after, and less like my life was going to be terrible, because I started having fun in that environment. I liked the hospital food – it reminded me of my nana’s food. Also they gave me sugar when I thought I was never going to have sugar again!”

Nova was released five days later, still thin, tired and overwhelmed.

There was no time to recover, as the next day she had to attend the callback. The web-series, Bright Summer Night, was a modern reinterpretation of Shakespeare’s

A Midsummer Night’s Dream by a film company called The Candle Wasters.

Nova left the audition feeling that she didn’t have a chance. “I tried to forget about it, but it didn’t work.”

Two weeks later, an email came: “Congratulations! We would like to offer you the role of Frankie!” Nova was over the moon.

“Once we started rehearsing and filming, the Candle Wasters were nice and supportive to everyone.

And they’d worked with another actor with type 1, so they knew about it.”

They regularly checked in with Nova to see if she needed a break, or something to eat, or to test her blood sugar.

A year later, Nova worked with them on a new web-series, playing the lead role in Tragicomic, a modern-day version of Hamlet set in a high school.

COMPARING THEATRE AND FILM

Nova, now 16, also trains and performs with the Wellington Young Actors theatre company.

Type 1 doesn’t often impact on her performance, but “one time I was in a show, and right before I was about to go on stage my blood sugar was going low, so I decided to eat on stage. I didn’t know what the director would think, but I knew that I had to eat, and I thought it could work because my character

was a bit of a glutton. I had nutella sticks backstage, so I walked onto the stage trying to eat them in character. It was hard to chew and say my lines. I was a character who yelled everything, and at one point I was yelling with nutella sticks in my mouth and I nearly choked.”

She says, “Theatre is fun, but I prefer film. They give you different feelings. Acting on stage gives you the feeling of connecting to a crowd, and you have to project yourself and act big. Film is more subtle. You don’t have to focus on the audience in real time, and for me, I feel like I have more time to focus on my character.”

She’s also discovered a love of making films herself, and enters the 48Hours film challenge every year. She also sings, plays bass and would like to pursue music further.

Nova says she doesn’t dwell on type 1, and prefers not to talk about it. “It’s a chore. It’s like having to tell people about brushing your teeth.

I know the public needs to learn about it, but I don’t enjoy the job that comes with diabetes of having to inform people about it. I’d much rather talk about something I’m interested in, like film or music.”

All the same, she sees her diabetes as a positive. “It’s given me new experiences and widened the range of people I can relate to.

That’s really useful in my acting.” www.thecandlewasters.com

If you’re living with type 1 or type 2 diabetes and involved in arts or culture, we’d love to hear your story. Email: editor@diabetes.org.nz

DIABETES WELLNESS | Summer 2019

15

Nourish

What’s GI and why does it matter?

Using the Glycaemic Index can help a lot in managing diabetes.

G

I stands for Glycaemic Index.

The Glycaemic Index was invented in 1981 at Toronto University and is now used worldwide. It provides a way to measure how quickly the carbohydrates in a food are broken down and turned into blood glucose when you eat them.

The index ranks food from 1 to 100. A food is considered ‘low GI’ if it has a GI ranking of 55 or under.

That means the carbohydrates are absorbed slowly. Middle of the range is 56 to 69, and 70 or over is high GI. Pure glucose sits at 100.

A low-GI diet can provide a number of health benefits for people across all stages of life, from

simply maintaining sustained energy, to helping with specific health concerns including all types of diabetes.

For people with diabetes, carbohydrate foods that have a low GI are more slowly digested and produce a more gradual rise in blood glucose levels, helping to sustain more even blood glucose levels overall.

rices will sit lower than white rices on the Glycaemic Index, however, it’s still rare for them to be low GI. In New Zealand, the exceptions are SunRice Low GI White Rice and SunRice Low GI Brown Rice, which both have a low GI rating of 54. These are currently the only guaranteed low-GI rices on the market here, hence our support of these products at Diabetes NZ.

RICE AND GI

FIND OUT MORE ABOUT LOW-GI EATING

Rice is a cheap, simple-to-cook and beloved carb for many of us. If you have coeliac disease or any other condition where you need to avoid wheat or gluten, rice may be even more important to you.

Unfortunately, most rices available in supermarkets here have a middling to high GI rating.

Generally, wholegrain or brown

NZ Nutrition Foundation: nutritionfoundation.org.nz/nutritionfacts/nutrition-a-z/gi-and-gl University of Sydney: www.glycemicindex.com Diabetes NZ: www.diabetes.org.nz/type-1-diabetesfood-nutrition

MOROCCAN CHICKEN WITH LOW GI RICE SERVES 4

This easy one-pan dish from dietitian Lyndi Cohen is quick, balanced and tasty. It’s a great midweek meal that the whole family will enjoy. You can also make a vegan version.

1 cup SunRice Low GI White Rice 1 cup salt-reduced vegetable stock 1 cup tap water 1 red capsicum, chopped 1 zucchini, chopped 1 tin chickpeas, drained (400g) 2 tbsp Moroccan spice mix 500g de-boned chicken thighs, chopped in half or into large chunks 1 tbsp extra virgin olive oil ¼ cup shaved almonds 1 tbsp dates, chopped NUTRITION PER SERVE: ENERGY 2290kJ (547kcal) | PROTEIN 39.6g | FAT 13.6g (SAT FAT 1.7g) | CARBOHYDRATE 62.1g (SUGAR: 6.8g) | SODIUM 1130mg

VEGAN VERSION Don’t use chicken. Instead, use two tins of chickpeas rather than one, plus an extra zucchini and capsicum. Use garlic as well. Coat veges in 2 tbsp of Moroccan spice mix plus grated garlic, before drizzling with olive oil and cooking in the casserole dish.

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DIABETES WELLNESS | Summer 2019

Preheat oven to 180°C/360°F. Put the rice, water and stock into a rice cooker and quickly mix. Turn the rice cooker on.

In a wide casserole dish, layer the zucchini, capsicum and chickpeas. Sprinkle with 1 tbsp Moroccan spice.

Coat chicken all over in the remaining tbsp of Moroccan spice. Place the chicken on top of the vegetables. Drizzle with olive oil. Place in oven for 15 minutes, or until cooked through.

Remove chicken from oven and add almonds and dates. Return to oven for around 5 mins or until almonds and dates are heated through.

To serve, place the cooked rice in a large bowl or on a platter and add the chicken and vegetables on top.

TIP: Note that most ready-to-use Moroccan seasoning contains salt. If you want to reduce the salt, make your own Moroccan spice using 1 tsp each of nutmeg, cumin and coriander spice, ½ tsp each of allspice and ginger, and ¼ tsp of cayenne and cinnamon.

Naturally low in GI. High in yum.

SunRice Low GI rice is just as delicious as the rice you know and love, but is naturally low in GI. Which means now everyone can enjoy the benefit of sustained energy release throughout the day without the worry of blood sugar spikes and crashes.

How clever is that! Look for our new packets in stores now.

Blood Glucose ‘crashes’, causing hunger pangs

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Recipe

Summer treat Diabetes NZ’s own Marsha Mackie shares a favourite summer treat. It’s one of the many delicious, diabetes-friendly recipes you’ll find in the Eat Well Live Well cookbook.

YOGHURT BERRY BARK SERVES 4 | PREP TIME: 5 MINS, FREEZING TIME 3 HOURS MINIMUM

2 cups plain Greek yoghurt (no more than 2% fat) 1 tsp vanilla-flavoured essence ¼ tsp sugar substitute (such as Equal) 35g raspberries 35g blueberries 1 tbsp walnut pieces (approx. 7g)

In a bowl, mix together yoghurt, vanilla-flavoured essence and sweetener to taste and stir until blended.

Pour the mixture onto a flat tray lined with greaseproof paper and smooth out until you have an even surface.

Sprinkle berries and nuts over the top so they are evenly spaced.

Freeze for a minimum of 3 hours.

Cut into shards.

NUTRITION PER SERVE (ONE SERVE EQUALS 150g): ENERGY 430kJ (103kcal) | PROTEIN 9g | FAT 2.1g (SAT FAT 0.4g) | CARBOHYDRATE 9.6g (SUGAR: 9.5g) | SODIUM 107mg

HINTS: • These treats will start to thaw as soon as they are taken out so leave them in the freezer until required.

• Get creative with seasonal fruit for a variety of toppings. Other favourites are mandarin segments, slices of apple or stone fruit, and sliced strawberries with a sprinkling of chia seeds.

Note: It’s important to use Greek yoghurt for this recipe as other natural yoghurts crystallise too much.

A perfect Xmas gift – healthy & delicious eating for all the family!

EAT WELL LIVE WELL 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.

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DIABETES WELLNESS | Summer 2019

Smartphone enabled glucose monitoring1

WITH YOUR PHONE1,2

With a digitally connected FreeStyle Libre system, you can now manage your glucose levels anytime, anywhere with your smartphone1,2. Download the FreeStyle LibreLink app today!

Visit FreeStyleLibre.co.nz to learn more

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC. 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).

1.The FreeStyle LibreLink app and the FreeStyle Libre Reader have similar but not identical features. 2. The FreeStyle LibreLink app is compatible with NFC enabled phones running Android 5.0 or higher, or with iPhone 7 or higher, running iOS 11 or higher.

FreeStyle, Libre, and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. 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-16457 v1.0

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FLASH GLUCOSE MONITORING SYSTEM

Life with T1

MACIE’S STORY Leigh Sharland had a gut feeling about what was affecting her daughter Macie, but the GP wouldn’t listen. Two years on, Leigh recalls the frustration.

M

acie was 23 months old and she hadn’t been herself for a while. I have a best friend with type 1 diabetes and I was starting to recognise the signs in Macie. She was wetting through three to four changes of clothes daily, not sleeping a full night, and eating like she’d never been fed. When I say eating a lot, I mean more than our eight-yearold!

We took her to the medical centre and saw a locum GP. When I expressed my concerns, the locum told me there was nothing wrong and Macie was just being a typical toddler. I asked the locum to do a blood glucose test via finger prick but she refused.

She said that because Macie had just had a muesli bar, her glucose levels would be through the roof.

I thought this was strange so, later, I asked my friend who has type 1. She said the muesli bar

Leigh, David, Macie and Bella

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DIABETES WELLNESS | Summer 2019

wouldn’t do anything if Macie didn’t have diabetes, but her blood sugar would be very high if she did have it.

A week later, Macie’s carer expressed worries that Macie wasn’t herself. My husband David called the medical centre again to see if they could see her. They said they couldn’t. David said in that case, he’d take her to A&E. The receptionist said, “Well, that’s your choice then.”

David and my mum took Macie to Greymouth Hospital and I rushed from work to meet them.

Once we got through to a room, I asked for a finger prick test, again explaining my concerns.

The nurse took the test, but wouldn’t show me the number on the screen. We waited for the doctor, who did another test, and another, and another. Four tests in total. He told us we weren’t allowed to leave and said we needed further tests, but I knew then that it was true. Macie had type 1 diabetes.

We were transferred to the children’s ward where Macie had more blood tests, then we were told we needed to be transferred to Christchurch Children’s Hospital.

We had an appointment booked for Macie with our GP for the following day, so my mum went in to cancel that, explaining that Macie was being transferred to Christchurch due to her diagnosis.

The manager overheard and rang afterwards to apologise. We later laid a formal complaint with the Health and Disability Commission.

Even though I’d suspected it, Macie’s diagnosis was a big shock.

At home we packed our bags, ready to stay at Christchurch

Macie with Jerry the Bear and her cat Sassy

Hospital for the week. It was a threehour drive and Macie was given enough insulin to get us there.

WELCOMED IN CHRISTCHURCH

At Christchurch, the team met us with open arms. They were, and are, amazing. They sat us down and brought in a bag full of supplies and a buzzy bee toy for Macie, which she loved.

They talked us through everything that would happen. We were told that we were lucky we’d had her diagnosed now. If we’d left it longer things could have got way worse.

This was horrible to hear and, of course, made me even more angry with our medical centre.

I stayed with Macie in the hospital, and our social worker booked a room for David and our family at Ronald McDonald House for the week. Like the staff at the hospital, they were amazing, making life that bit easier for us all while we struggled to come to terms with all the changes that would be happening in our and Macie’s life.

After a week, we were released from hospital “on leave”. That meant Macie was still technically under their care, but we were in a home-like environment at Ronald McDonald House in a fully furnished and equipped room to see how we coped.

It was my 30th birthday on the Saturday night, so Macie’s lovely Gaga (Grandad) looked after her while David and I had dinner out and got to relax and be a couple for the night.

On the last night in Christchurch we stayed at David’s cousin’s place before heading off home. Unfortunately, we ended up back in A&E because Macie’s levels were very high and not coming down. Thankfully we were released quickly. We returned to David’s cousins before heading home to start a life like we’d never known before.

Almost two years later, we are still under the Christchurch children’s diabetes team. We have clinic every three months and we’re very lucky that they come over to us.

We still have our ups and downs but overall, Macie is doing incredibly well.

Diagnosing type 1 diabetes

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SYMPTOMS:

• Thirst • Passing more urine • Weight loss • Very tired • Mood changes MAY ALSO HAVE:

• Abdominal pain, nausea, vomiting • Skin infections, thrush • Extreme hunger • Poor concentration and performance People with a blood relative with type 1 diabetes are more likely to develop it. However, type 1 often occurs in people who have no one in their family with the condition.

Diabetes is diagnosed by blood tests which can be organised through your doctor. If you or your child are very unwell, seek medical assistance immediately.

* Waterproof at time of manufacture up to 3.6 meters for up to 24 hours at a time. See MiniMed TM 640G User Guide for a complete description of the waterproof capabilities and proper instructions. Speci�cations and features are in the 640G System User Guide. Section 15 pages 251-265.

Call our friendly Diabetes Team on 0800 333 444 for a free demonstration InterMed Medical Limited Free Phone 0800 333 444 www.intermed.co.nz 71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740 The MiniMedTM 640G Insulin Pump is fully funded in NZ for eligible patients by Special Authority.

Research

EDOR – PUTTING NZ ON THE DIABETES RESEARCH MAP World-leading research on diabetes is being undertaken in New Zealand. We spoke to Professor Rachael Taylor and other researchers about the contribution made by EDOR – the Edgar Diabetes and Obesity Research Centre.

E

DOR was founded by Sir Eion Edgar – also the patron of Diabetes NZ – in 2003. It now maintains a humming office in the Dunedin School of Medicine. Five core staff work there, while 21 other team members are spread throughout Otago University and other academic institutions around the country.

Work is overseen by the EDOR advisory board, chaired by Sir Eion Edgar. That work is prolific, covering areas from gestational diabetes to childhood obesity to the value of flash glucose monitors for teenagers, and more.

EDOR Research Manager Dr Cherie Stayner says, “EDOR is known internationally for its work relating to the role of nutrition in the management and prevention of diabetes.”

Professor Louise Signal has used wearable cameras to document that “Kiwi kids are being bombarded with an average of 27 junk food advertisements a day in their schools, homes and on the streets. And that doesn’t include the advertising seen on television, in dairies and in supermarkets, as there was simply too much of it to count.”

Hunger Training is another exciting area of research for EDOR. EDOR Director Professor Rachael Taylor says “Hunger training may help prevent type 2 diabetes by training you how to listen to your appetite, and only eating when your body needs it.”

In New Zealand and internationally,

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DIABETES WELLNESS | Summer 2019

EDOR members have developed nutrition guidelines for reducing the risk of type 2 diabetes, and also guidelines for the management of diabetes. “For many years, guideline development in Europe was led from EDOR through our involvement with the European Association for the Study of Diabetes. We’ve also been closely involved with the nutritionrelated activities of the World Health Organization, and the provision of relevant advice at the national and international level.”

WHOLEGRAINS RESEARCH

EDOR researchers are contributing significantly to knowledge around wholegrains. Professor Jim Mann says, “Regular consumption of wholegrains is recommended to reduce the incidence of diseases such as type 2 diabetes, cardiovascular disease

and colorectal cancer.” But there’s a problem. “Many of the wholegrainlabelled products that people consume contain largely refined grains.

“Research indicates that the structure of the grain may influence the food’s effect on metabolic measurements and clinical outcomes.”

EDOR researchers wanted to understand this better. Their first Grain Study “tested the effect of wholegrain products with different particle size on the blood glucose control and cardiometabolic risk factors of adults with type 2 diabetes”.

The study’s results were promising, and the EDOR team is building on them with a new project: adults with type 2 diabetes living in Dunedin are participating in a trial. Study lead Dr Andrew Reynolds explains, “Our participants receive wholegrain foods for periods of two weeks, and wear continuous glucose monitors, so we can see how their blood glucose levels respond throughout the day and night. As this short-term trial is nearly complete, next year we will start a 12week trial at multiple sites around New Zealand also looking at wholegrain intake and blood sugar control.”

YOUNG RESEARCHERS

EDOR enthusiastically mentors young researchers. Dr Stayner cites Dr Andrew Reynolds as an example.

“Andrew started as a PhD student back in 2013. His ‘walking after meals’ PhD study received huge publicity worldwide.

“Andrew graduated in 2016 and has stayed with us as a researcher involved with a range of projects on physical activity and diet in the prevention and management of type 2 diabetes. He primarily works with Professor Jim Mann and another EDOR researcher, Dr Lisa Te Morenga, and all work with

My Identity

is proud to create

the World Health Organization and the Diabetes Nutrition Study Group of the European Association for the Study of Diabetes.

“We also have a fantastic group of young researchers and students that we call the DREAM team, who are investigating sleep and sedentary behaviour in children and adolescents.

“Not getting enough sleep doubles the risk of child obesity, most likely by increasing energy intake. Why this happens is uncertain, but understanding how inadequate sleep promotes overeating would provide us with new tools in the fight against obesity.

“We’re comparing dietary intake, eating behaviour, physical activity levels, and changes in parenting when children have plenty of sleep and when they undergo a mild level of sleep deprivation.

“To do this, we’re making use of new technologies such as wearable cameras which record children in their home, school and recreation environments.” The recordings are used “to assess why we eat differently when we’re tired compared to when we feel rested”.

$49 Fashionable Medical ID Jewellery From left: Dr Cherie Stayner, Professor Jim Mann, Professor Rachael Taylor, Sir Eion Edgar, and Associate Professor Kirsten Coppell.

WALKING AFTER MEALS: EXCITING FINDINGS

The EDOR “walking after meals” study prescribed walking to 41 patients with type 2 diabetes in two-week blocks, separated by a month.

The patients were fitted with accelerometers to measure their physical activity, and devices that measured their blood sugar every five minutes.

They were asked to walk either for 30 minutes a day, as advised by current guidelines, or to walk for 10 minutes after each main meal. The results indicated that walking after meals is better at reducing blood sugar levels than taking a single 30-minute walk at any time of the day.

EDUCATION AND PROMOTION

EDOR regularly runs large symposia and public lectures on topics of national importance.

In 2017 and 2018, the Centre joined with the Pacific Rugby Players Association, the Healthier Lives National Science Challenge, and private philanthropists to “sponsor a series of short films starring high profile Pacific rugby players, which incorporate messaging about healthy lifestyles alongside entertainment”.

For EDOR, it’s never enough to simply do the research. The Centre is committed to making sure their findings get out to where they’re needed.

The EDOR team acknowledges funding from a wide variety of sources.

Paying tribute to Sir Eion Edgar, patron of Diabetes NZ and founding benefactor of EDOR – leading research into diabetes and obesity.

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Technology

Managing type 1: current and future technology Technology’s role in diabetes management is growing.

Associate Professor Ben Wheeler looks at what’s here now and what’s coming soon – and explains the acronyms.

I

t’s almost 100 years since Frederick Banting and Charles Best discovered insulin. It was initially heralded as a cure for diabetes, but when treated patients began to experience severe complications, realisation came that the battle was only half won.

Since I first started working in diabetes as a medical student, patients have asked about a cure. I remember predictions made by my professors: it was always “about 10 years away”.

Twenty years later, although research and effort continues, we seem no closer. However, stepping into that void are new diabetes technologies that offer the potential not for cure, but for major improvements in disease control and relief of the disease’s burden.

The technology on offer includes options for glucose monitoring, insulin delivery, and combinations of both. Some of these options are here now and funded by PHARMAC. Others are currently self-funded by people with diabetes and their families, or are still on the horizon.

GLUCOSE MONITORING TECHNOLOGY

Checking glucose levels frequently is strongly linked to overall glucose control and diabetes health. In the past, almost everyone used

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DIABETES WELLNESS | Summer 2019

PHARMAC (The Pharmaceutical Management Agency) is the New Zealand Crown agency that decides which medicines and therapies will be funded for use in the community and in hospitals. finger prickers and meters to check their blood glucose. Now, more and more people use flash glucose monitoring systems (FGMS or simply FGM) and continuous glucose monitoring systems (CGMS or CGM).

CONTINUOUS GLUCOSE MONITORING (CGM) SYSTEMS

These will play a major role in the future of diabetes management.

A CGM system uses a small sensor placed into the tissue under the skin of the arm or abdomen.

Instead of measuring blood glucose, it measures the glucose in the “interstitial” fluid (the fluid between cells). It gives a kind of estimate of current blood glucose.

It also provides trend arrows showing whether the glucose levels are heading up or down or staying steady – a very useful feature.

CGMs have some limitations. For example, most currently need to be re-calibrated every 8 to 12 hours by checking the wearer’s blood glucose levels via finger prick and

realigning the CGM reading with those.

CGMs also exhibit a time lag and some inaccuracy when compared to blood glucose meters. Currently the measurements will generally be within 10% of the blood glucose measurement, but this can become less accurate at very low or high levels.

CGM sensors generally last between six days and two weeks depending on the model. These are not funded for routine use by PHARMAC, but are increasingly used by patients and families who self-fund them. They are also used intermittently by most hospitalbased diabetes teams.

In Australia, CGMs have been funded for everyone under 21 years old since 2017. Diabetes NZ (and many others) are advocating for PHARMAC to fund them in New Zealand.

The two main companies making them available in New Zealand at the moment are DEXCOM® and Medtronic.

The main Dexcom model is the G5, which provides updated glucose data every five minutes. This can be seen on a receiver, mobile device, or on an accompanying insulin pump.

The G5 sensor and the soonto-arrive G6 sensor are also approved for making insulindosing decisions (except for in

TYPE 2 AND TECHNOLOGY Flash glucose meters, such as the Libre, can be very useful for people with type 2 diabetes who are on insulin therapy. However, when it comes to type 2, they are not on PHARMAC’s radar for funding anytime soon. The priorities in funding for type 2 remain focused on new drug therapies which are likely to offer more immediate promise than technology, due to the differing mechanisms of the disease from type 1.

hypoglycaemia). What that means is you can use the glucose value from the CGM and then input it into your pump or as part of your injection calculations to give a glucose correction.

The G6 sensor, when it arrives, will be factory calibrated. This is a major step forward. It will mean vastly reduced finger-prick testing since little or no home calibration is required.

Medtronic CGMs provide similar data, with the added strength of being able to be paired with modern pumps to provide “sensor-augmented pump therapy”.

When the Dexcom G6 arrives, it will pair with the Tandem t-slim pump.

These pairings between CGM systems and pumps represent the immediate future for modern type 1 diabetes management. More information on that below!

The main barrier to greater uptake of CGMs remains cost. The New Zealanders who use them have to self-fund them at a cost of around $4,500 to $10,000 a year.

Meanwhile, in the United States, the first implantable CGM system (currently a small rod surgically implanted under the skin and lasting 90 days) has recently been approved, highlighting just how fast things are moving in this area.

FLASH GLUCOSE MONITORING (FGM) SYSTEMS

FGMs are very similar to CGMs in that they measure interstitial glucose. In fact, an FGM is often referred to as an “intermittently viewed/scanned CGM”. Like the Dexcom G5/G6, it is approved for clinical decision-making, except for in hypoglycaemia. However, it does not provide continuously viewable data.

The model currently approved for use in New Zealand is the Abbott FreeStyle Libre system, where users attach a small sensor to the back of their arm. As with CGMs, for frequent users there is an associated improvement in HbA1c and a reduction in hypoglycaemia.

This system has proven popular in New Zealand, and does appear to reduce diabetes burden by reducing the need for finger-prick testing. There has been a rapid self-funded uptake of the Libre. In some cases, parents are allocating some or all of their child disability allowance to funding it. However, this often means diverting that money away from other disabilityrelated costs.

The newest FreeStyle Libre 2 is not currently being sold in New Zealand (or worldwide), but will arrive at some stage. This will offer additional real-time safety alarms for hypoglycaemia and

hyperglycaemia, which are not available in the currently sold models.

The main advantages of FGM over CGM are: • cost (approximately $2,700 per year) • factory calibrated sensors (requiring no routine calibration by finger pricks), and • a 14-day extended sensor life.

In New Zealand, the Libre is approved for use by people four years old and over.

Nonetheless, their cost still puts them out of reach of many people with diabetes and their families.

As with CGMs, we need to advocate for PHARMAC to fund them.

INSULIN PUMP THERAPY (IPT)

An insulin pump is an alternative to the traditional injection method of delivering insulin. Through a subcutaneous Teflon or steel cannula, usually in the abdomen, pumps deliver continuous small amounts of rapid-acting insulin as a basal rate (background insulin) and bolus (for carbohydrate ingestion correction of hyperglycaemia).

IPT has been shown to improve HbA1c, quality of life, and the frequency of severe hypoglycaemia.

Pumps have been funded by PHARMAC in New Zealand since

DIABETES WELLNESS | Summer 2019

25

CURRENT PUMP FUNDING CRITERIA To get funded for a pump in New Zealand, you generally need to: • have had type 1 for more than six months • combine it with carbohydrate counting • be under the care of a multidisciplinary team skilled in pump therapy.

Once those criteria have been met, current funding caters to four possible scenarios: 1. severe unexplained hypoglycaemia, defined as having had a minimum of four unexplained episodes of severe hypoglycaemia over the previous six months, that require assistance from another person 2. significant glycaemic variability and an out-of-target HbA1c between 65/90 mmol/mol 3. permanent neonatal diabetes (a very rare scenario) 4. other – an option to make an individual case.

Importantly, while access to this public funding is fantastic and makes New Zealand a leader in the area of publicly available IPT, a number of current issues remain.

Firstly, there could be more options for funded models.

Secondly, access to IPT remains an issue, despite public funding.

Adults, and those with very healthy glycaemic control, often struggle to get funded access. Also, those who are more socio-economically deprived and of non-European ethnicity have a slower uptake of IPT. This is an equity issue that needs to be tackled.

Thirdly, funded access to a CGM system is required to realise the full potential of modern IPT, by pairing the two, as discussed below.

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DIABETES WELLNESS | Summer 2019

2012 – if you meet certain criteria.

Unfunded options can cost more than $10,000 for the newer, more advanced models.

Over 30% of children under 15 years old are now using IPT, and this goes up to 50% in some clinics. Adult numbers are also increasing, but more slowly than children due to more difficulty accessing PHARMAC’s funding criteria.

SENSOR-AUGMENTED PUMP (SAP) THERAPY

Hypoglycaemia remains one of the biggest fears for those affected by diabetes, and this is a barrier to healthier glycaemic control, with patients sometimes deliberately keeping their blood sugar levels on the high side. SAP is a partial solution to this issue.

In SAP, pumps are paired with simultaneously running CGMs. That is, the user wears a pump as well as a CGM sensor, and the CGM’s glucose data is transmitted via Bluetooth to the pump.

Older Medronic systems (Veo) suspend insulin delivery when blood sugars are low (based on a predetermined low threshold).

Newer systems (the recently funded Medtronic 640G, and potentially the Tandem t-slim if used with a Dexcom G6) have Predictive Low Glucose Management (PLGM) which can predict the possibility of future hypoglycaemia within the next 30 minutes. If this is predicted, the system will then suspend insulin delivery until glucose returns to safe levels.

When used well, these systems can prevent up to 70–80% of hypoglycaemia.

While the Medtronic 640G pump is currently funded, the sensors to make this work must be purchased privately.

The Tandem t-slim pump also has this capacity (with a software upgrade) but must be used with

the Dexcom G6 sensor, which is currently unavailable in New Zealand. However, this should be available to purchase, we hope, by the end of 2019. Overall, this sort of technology is growing rapidly in popularity, and has good evidence to support it.

FLASH-AUGMENTED PUMP THERAPY (FAP)

FAP is essentially a simpler and cheaper version of SAP. It refers to using an insulin pump along with an FGM system (i.e. the Abbott FreeStyle Libre).

The two technologies, while nicely aligned, are not currently integrated in any way (unlike SAP). Nonetheless, FAP may provide improvements over traditional IPT. This data is yet to be published.

With the current popularity of flash glucose monitoring in New Zealand, many pumpers are now self-funding FAP. HYBRID CLOSED-LOOP PUMP THERAPY (HCL)

HCL is the first step towards the holy grail of a full artificial pancreas, or closed loop therapy.

Only one pump is currently FDA approved to utilise HCL: the Medtronic 670G (although much research activity is occurring in this space). This pump is not on the market in New Zealand, but is on sale in other countries worldwide.

Compared to SAP, when in “auto”, HCL has a more complex and developed algorithm and can both increase and decrease insulin delivery, based on continuously communicated CGM interstitial glucose readings.

Currently, calibration of CGM readings is still required. The user also has to signal whenever they ingest carbohydrates and input the amount. Importantly, when used in “auto” mode, this pump has no basal rate settings

WHAT TECH IS RIGHT FOR YOU? Stanford University School of Medicine, in California, has put together this resource to help people with type 1 choose the right combination of technology for them. Take the quiz here: www.diabeteswise.org/check-up

(for the delivery of continuous basal insulin), as it constantly and automatically adjusts this insulin flow based on the CGM. This has led to improvements in glycaemic control, reduced burden, and reduced hypoglycaemia.

These systems, although far from perfect, are likely to be very popular with patients. This is an area of rapid development, and again, it is anticipated that this technology will be available in New Zealand in the near future.

However, funding may be a long way off. It will likely cost users $15,000 for the first year of treatment.

Inequalities in health care access for currently funded IPT will likely be made even greater by these newer systems.

CLOSED LOOP THERAPY (CL)

This represents the future of diabetes therapy. This is not here yet but researchers are putting a lot of effort into it. Current issues to be resolved include: • the lack of access to an ultrafast acting insulin which these systems need • improving accuracy of continuous glucose sensors • whether or not to incorporate glucagon as well as insulin (dual hormone therapy), and • other issues relating to response time to carbohydrate loads and safety.

HOW TO HELP WITH TECH RESEARCH

We’re extremely fortunate in New Zealand to have multiple enthusiastic teams involved in all manner of research to do with improving understanding of diabetes, and the lives of people affected by it.

In addition, collaboration opportunities and access to diabetes technology research has never been better in New Zealand.

The research is often cutting edge, allowing participants to trial equipment that may be world leading.

Technology trials recently, currently, or about to start in New Zealand include trials investigating flash glucose monitoring in children and young adults, hybrid closed loop therapy including DIY systems, DIY glucose monitoring, and more traditional CGM systems.

If being involved in research to do with diabetes interests you or your family, keep an eye on Diabetes Wellness magazine or the Diabetes NZ social media pages where you’ll often see calls for participants.

Direct contact with researchers is also welcomed. This work is generally based out of universityaffiliated centres: University of Otago (Dunedin, Christchurch or Wellington), University of Waikato (Hamilton) and Auckland University. But smaller centres are participating in research as well. University websites are a good place to look for researchers and research participation opportunities.

YOUR TECHNOLOGY OPTIONS

Technology is playing an increasing role in the management of type 1 diabetes, in New Zealand and worldwide.

Many options are currently available and funded locally, with exciting developments on the horizon. A basic understanding of these issues is now essential for those living and working with diabetes.

To find out more about technology options available to you in New Zealand, talk with your GP or specialist (bearing in mind that many GPs may not yet be up to speed with all the developments themselves), or consider contacting advocacy organisation NightScout New Zealand: www.nightscout.org.nz

HELP GET THE TECH FUNDED PHARMAC is reviewing the possibility of funding for both FGMs and CGMs, and clinicians and patients alike await their decision with interest. Recently PHARMAC has signalled they will further delay the decision. This is disappointing, and advocacy from the diabetes community is vital.

See page 10 for more information on signing an important Diabetes NZ petition to government.

Associate Professor Ben Wheeler is a Paediatric Endocrinologist at the University of Otago and the Southern District Health Board. He can be contacted at ben.wheeler@otago.ac.nz

DIABETES WELLNESS | Summer 2019

27

Community

WALKING SAMOANS

WALK ROUND RAROTONGA The brainchild of Radio Samoa, the Walking Samoans is a walking club with branches throughout the country.

This year the Porirua branch travelled further afield.

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DIABETES WELLNESS | Summer 2019

I

n 2018, the Porirua Walking Samoans walked from Palmerston North back to Porirua to raise awareness of diabetes. With that success under their belts, the organisers – Siaosi Anamani and Rev. Martin Mariota – started looking for something bigger to do in 2019.

Siaosi says, “To our surprise we came across the Round Rarotonga Road Race.”

Every September this international event attracts walkers and runners from around the world for a mix of serious races and fun runs.

Once the Porirua Walking Samoans had confirmed who would go, “fundraising became a priority along with preparing our walkers mentally, physically, emotionally and spiritually for our journey”.

The team, along with supportive family members, aged two to 70, flew to Rarotonga together. “There was a lot of excitement, especially from the kids, and it was a mad dash from Auckland domestic to the international flight. It almost felt like a warm up for us as we were rushing to the gate. Thankfully we all boarded safely.”

They arrived to “a beautiful welcome in Rarotonga with the sun shining and the smash of the heatwave when we stepped out of the plane. The organisers greeted us with flower leis and a bus ride to our accommodation.”

Race day brought an early start.

“We were picked up at 4.30am to get to the start line at 5.30.”

Ten of the Walking Samoans

participated in the main 31km race around the island, and nine in the 10 km walk. “There were light showers along the way,” says Siaosi, “but as a group we always walk in the rain in New Zealand, so the conditions suited us nicely.

“Our unsung hero was Fred Ama, the support person in the van.

He supported our walkers with refreshments of water, food and heaps of encouragement.

“During the event, we met a lot of people who were very encouraging and supportive of the Walking Samoans and complimented us as a team for what we were doing.

“The feeling afterwards was

a great sense of achievement and relief for a feat achieved by all. We attended the prizegiving the day after, and enjoyed great food, entertainment and amazing company.

“It’s still surreal to think that our Saturday morning walks at Aotea Lagoon, Porirua, New Zealand eventuated into walking the Round Rarotonga Race 2019 alongside our families and friends. We feel blessed.”

The Porirua club are already thinking of doing it again next year, and encouraging other Walking Samoans around the country to experience the race for themselves.

The Walking Samoans would like to thank Radio Samoa, Taeaomanino Trust, Pacific Men’s Health Aotearoa, Porirua RSA, F45 Porirua, Lioness Women, Pacific Health Plus, and the many local community organisations, families and friends who supported their journey through prayers, love and support. Ia saga faamanuia le Atua ia te outou uma. Faafetai faafetai faafetai tele lava.

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DIABETES WELLNESS | Summer 2019

29

Living with T1

TAKING TYPE 1

ON HOLIDAY

You can leave the rat-race behind, but type 1 diabetes always tags along.

Katie Doyle asks five adventurous spirits to share top tips for holidaying with diabetes.

F

rom Curio Bay to the Coromandel, New Zealanders are preparing for summer holidays – in some cases to the remotest spots in the country. For thousands of holidaymakers, this will mean bringing along an uninvited guest: type 1 diabetes.

Tramping, camping, swimming ... Whether you’re holidaying with family, with friends, or on your own, every activity presents its own set of challenges for keeping insulin cold and blood sugars in range. But fun can still sit beside safety at the top of the priority list.

PRIORITISING FUN

PREP IS EVERYTHING

Toni Daane and her nearly 10-year-old son, JaylenBlaze, look for every opportunity for adventure from their home base in Invercargill.

“My motto is, ‘kids first!’ because I don’t want diabetes to dictate how Jaylen-Blaze lives his life,” Toni says.

They love trips to the beach, and there the mother-son duo works together: “We prick his toes if his hands are dirty, and we have a chilly bag to keep his pump in while swimming so it stays cool.”

Jaylen-Blaze will reconnect his pump to deliver a quick bolus while Toni monitors his levels so that he can enjoy the day. “He’s running around, playing, and he still needs a bit of insulin, so we just put the pump back on, then take it off again.”

Toni says Jaylen-Blaze is responsible for maintaining his own snack pack when going out on adventures, and he brings along “lots of yummy food to combat the lows of running around and swimming”.

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Whether you’re an adult or a child with type 1, varying activities often equal varying blood glucose levels.

Ana Hutchins says that this is why “what seems like a spur-of-the-moment day out has, in fact, been carefully considered and planned”.

Ana, who has type 1, lives in Ōtorohanga, Waikato, with her four-year-old son Noah and her partner. Before heading off on any trip, she asks: Do I have enough insulin? Pump consumables? Insulin pens in case of pump failure? Hypo treatments to last at least a week?

“We’re just like most Kiwi families and love spending days at the beach, fishing off the rocks in remote locations. The only difference is that I have diabetes.

“Safety is a big factor when Noah and I venture out on our own,” says Ana. “I’ve had to educate him the best I can that his mummy has diabetes, so that if anything happened, he could communicate that to someone and get help.” Maintaining a positive mindset is vital when teaching young children about diabetes safety, as it is in trip planning generally.

SELF CARE

Rachael Hewton, from Invercargill, agrees that holiday planning is essential. Nearly a decade after she was diagnosed with type 1, she and her husband have two boys under four. “I think the key thing for maximum fun is that you’re prepared,” she says. “The old Murphy’s Law says that if you have all the supplies, you won’t need them.”

She adds that, as a parent, making an extra effort to focus on herself is vital. “It’s difficult on trips to make sure that I take care of my diabetes. It’s easy to prioritise the kids’ needs above my own. I have to remind myself that the most important thing my kids need from me is for me to be well.”

A pharmacist and National Girl-led Adviser with Girl Guides, Rachael knows she has to communicate her needs as she juggles family time with diabetes logistics. “It’s really important that partners are a part of your care, as they can often pick up on hypo symptoms a lot faster.”

CAMPING CURVE-BALLS

Sarah Ward’s son Jack was diagnosed with type 1 last year at age six. Adjusting to a new lifestyle didn’t stop the family, who live in Wellington, from camping in Taupō over Easter.

“Camping is something we love to do,” says Sarah. “It’s still possible to camp with diabetes. It just requires a lot more planning and flexibility when diabetes throws you a curve ball.

“A discovery we made in the tent, in the pitch black, is that Jack’s meter doesn’t like freezing temperatures. We did bring two meters, thankfully, and one of them worked.”

Along with bringing extra supplies, Sarah keeps them within easy reach: “We now know how fiddly it is to finger prick and administer insulin in the dark, in a tent, with a child in a sleeping bag, so we keep everything we need all in one easy-to-reach place near Jack.”

CHALLENGES MET

Rebecca Ryan, from Ōamaru, says that adventuring with diabetes makes the end of each day all the more worth it.

“I love taking day trips up the Waitaki Valley or mountain biking up the Ahuriri Valley. I’ve always been pretty outdoorsy, but I have a greater appreciation for the benefits of exercise since being diagnosed nine years ago,” she says. “Hiking is exercise; it’s a challenge; it’s an escape from the day-to-day rush; it fills the soul.

“Sure, having type 1 diabetes means it requires more planning and a few more stops along the way for blood sugar checks and snacks, but that’s all part of the challenge, and makes reaching the summit all the more satisfying!”

Katie Doyle is an American student and adventurer with type 1 diabetes who has travelled through Aotearoa New Zealand and maintains ties here. She loves connecting with other travellers, and spreading hope and confidence that people with diabetes can manage anything they want.

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31

Diabetes Action Month

#FindThe100K #DiabetesActionMonth

Running from 1–30 November, Diabetes Action Month is an awareness and action campaign that focuses on educating New Zealanders about diabetes and the actions that all of us can take in one way or another.

“I

t’s about time” – that’s the theme for this year’s Diabetes Action Month.

It’s about time to raise awareness of all types of diabetes among New Zealanders.

It’s about time those living with diabetes have access to better medication and continuous glucose monitors.

It’s about time everyone supports those affected by diabetes. And it’s about time we find the 100,000 undiagnosed with type 2 diabetes.

As well as the 250,000 Kiwis diagnosed with type 1 or type 2 diabetes, there are an estimated 100,000 undiagnosed with type 2. That’s 100,000 Kiwis who don’t have the support to take care of

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DIABETES WELLNESS | Summer 2019

their diabetes and reduce their risk of complications.

It’s About Time opens up the conversation about early detection of not only type 2 diabetes and risk of complications, but type 1 diabetes, which can cause diabetic ketoacidosis (DKA) if not diagnosed early.

Unlike type 1 diabetes, type 2 risk can be reduced with the right changes and support, but the first step is knowing the risks and symptoms and taking the time to get tested.

Early detection of type 2 diabetes means that those who are currently undiagnosed can receive the information, treatment and support they need.

That will result in the ability to live well with diabetes and potentially prevent hospitalisation and other complications.

When people live a long time with type 2 diabetes without diagnosis, it can have long-term detrimental effects on their health. To break through apathy, family or friends helping educate their whānau may just be what triggers action and a visit to a health care professional for a diagnosis that could save their life.

Diabetes affects the whole whānau. We are encouraging Kiwis to support those who have been diagnosed and urge those predisposed or showing symptoms to go get checked.

FREE TESTING Joining forces with New Zealand’s largest health cooperative, Procare, Diabetes NZ will be visiting markets, workplaces and communities to provide HbA1c tests for those at risk of type 2 diabetes. This will be run as an Auckland pilot for 2019, with the aim to diagnose as many people as possible in the nation’s biggest city throughout the month.

This November, we’re encouraging all New Zealanders to take the time to learn more about all types of diabetes, understand their risk for type 2 diabetes, and support those living with diabetes.

Diabetes NZ is also advocating for improved drugs, funding for continuous glucose monitors and support for those with diabetes during Diabetes Action Month.

“It’s about time we take action to meet this epidemic of diabetes.”

World Diabetes Day falls on Thursday 14 November, with this year’s campaign tagline being “Diabetes: Protect your Family”.

The campaign sets out to highlight how families are greatly affected by diabetes, and the importance of their active role in the management, care, prevention and education of the condition.

Join the kōrero: To see what’s happening this Diabetes Action Month and how you can join in on the campaign, visit www.diabetes.org.nz or Diabetes NZ on Facebook and Instagram.

There’s a giveaway up for grabs, so you won’t want to miss out!

Keep an eye on the Diabetes NZ Facebook page to see how you can get involved.

MR VINTAGE CHARITEE After last year’s sell-out success with Mr Vintage, they’ve come on board with a new design for Diabetes Action Month 2019. Mr Vintage is an online t-shirt store that has been supporting New Zealand charities with its various chariTEEs, for nine years running.

Check out the Mr Vintage website www.mrvintage.co.nz to order your very own, with 25% of all sales going to support Diabetes NZ – don’t miss out!

DIABETES WELLNESS | Summer 2019

33

Nourish

SUMMER HYDRATION GUIDE For those who live with any form of diabetes, staying hydrated is extra important. Dietitian Helen Gibbs has some tips.

W

ith diabetes, there can be days where you’re active, you eat well and you take whatever treatment you need, and yet your blood sugar levels still run high.

The missing piece of the puzzle may well be changes in your hydration level, especially if you notice this happening more on warm days.

HOW DEHYDRATED AM I?

Dehydration is often measured as a percentage of body weight.

If you’re 1% dehydrated, that means you need to top up with an amount of water that’s equal to 1% of your body weight.

For example, someone weighing 75kg who is 1% dehydrated needs an extra 750ml of water.

Someone weighing 100kg who is 1% dehydrated needs an extra litre (1,000ml) of water.

Even when we’re only 1% dehydrated, our body function is altered. This level of dehydration can cause increased anxiety and reduce the ability to think clearly.

For people with diabetes, there’s an added problem. Dehydration pushes up blood sugar. When your blood sugar goes up, you pee more, which leaves you even more dehydrated.

The trouble is, humans often don’t know if we need water. Our thirst mechanism only kicks in when we’re about 2% dehydrated, so if we simply follow our thirst, we could be becoming dehydrated before we realise.

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DIABETES WELLNESS | Summer 2019

HOW DO I KNOW IF I’M DEHYDRATED?

Urine colour is the best measure.

The advice is that urine should be “light straw colour”. The colour shown in the diagram is close to the colour your urine should be.

ARE YOU DRINKING ENOUGH WATER? Check your urine colour against this chart for an indication of your hydration levels.

A TOUCH OF YELLOW Looking good; you’re hydrated.

MID YELLOW Time for water, even if you’re not thirsty.

DARK YELLOW Getting dehydrated. If you think about it you’re probably thirsty.

HONEY COLOURED Drink more fluids – dehydration is probably affecting your blood glucose.

DARK HONEY OR BROWNISH Have plenty to drink, and if your urine remains a similar colour for more than two weeks, speak to your GP so they can check liver and kidney function.

HOW MUCH WATER DO I NEED?

The amount of water you need depends on your size, how active you are, and how hot the environment is.

The rule of thumb of eight glasses a day (2 litres) is a good starting point, but you may find you need more or less than that.

Many people find that if they suddenly increase the amount of fluids they take in, they start to need the toilet more. This usually settles down after three or four days, so keep persisting and you’ll find it gets easier as your body gets used to holding more dilute urine.

WHAT SHOULD I DRINK?

Water is the best choice but not the only choice. Tea, coffee, herbal tea and soup are all sources of fluid.

For people who want to drink soft drinks, having diet drinks is okay occasionally. Juice, smoothies and other sugary drinks will increase your blood sugar, so are not ideal.

Sometimes getting kids to drink enough fluids can be tricky. Making sugar-free ice cubes and ice lollies is a great way to encourage more intake.

It’s important to remember that alcohol is dehydrating. If you plan to drink alcohol, make sure you’re hydrated before you start. When I speak to sportspeople, I recommend non-alcoholic drinks until they start passing pale urine. Or “don’t get pissed until you piss”.

Here’s wishing everyone a happy, healthy, well-hydrated summer!

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Education

NEW DEGREE FOCUSES ON HAUORA In 2020, University of Waikato will run an exciting new Bachelor of Health programme focusing on Māori and Indigenous concepts of wellbeing.

T

he aim is to encourage innovative health leaders, passionate about equity, who can work in many settings.

Lecturer Dr Jordan Waiti says they hope to attract “people who care passionately about the wellbeing of their communities, but are not interested in undertaking traditional medicine degrees”.

He expects a diverse mix of students. Some will already be working in the health system in some way, but without formal qualifications. The degree will open new pathways for them, building on their experience. “These people understand the complexity of the system already and that there are no ‘quick fix’ solutions.”

The programme is stretching the possibilities of the traditional undergraduate health degree, and there’s excitement amongst staff.

This is the University of Waikato’s first pan-university qualification, involving 10 schools.

The programme leader, Associate Professor Kirsten Petrie, says, “We’re getting people to move beyond narrow concepts of health focused purely on tinana (the physical body and the absence of disease), to hauora – a holistic approach that values the interconnection between the physical and meta-physical

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DIABETES WELLNESS | Summer 2019

in ways that nourish and sustain people and their communities.”

She says the degree recognises whakapapa, historical contexts and connections to land.

With that holistic approach come understandings that the health workforce should include more than those in primary health care.

Jordan says, “This perspective also considers ‘Determinants of Health’: housing, education, employment.

The degree focuses on producing graduates who are aware of these.

They’ll be able to advocate for, and implement culturally responsive practices and policy in the workplace, across different sectors.”

Kirsten agrees. “We’re arguing that we need health professionals across all settings if we’re to make an impact.”

TRANSFORMING THE SYSTEM

The government health system is not working for Māori and Pasifika people. “The health system is still largely guided by Western principles,” says Jordan.

“These principles are manifested at decision-making levels and at service-delivery levels. And where providers have made gains with Māori communities, they’re often underfunded or, worse, funding is cut completely.”

Kirsten says the ultimate aim is to “make a significant contribution to transforming the system, so it’s equitable, focused on hauora, and responsive to diverse and changing needs.

“The degree is framed around commitment to Te Ao Māori and Mātauranga Māori, whilst acknowledging that understandings of health from Pacific and other Indigenous and Western traditions also have a part to play in how we understand and enact hauora.”

“Both Western and Indigenous health systems are important,” says Jordan. “The Western system cannot account for all Māori ailments, and vice versa. Both together provide a comprehensive understanding of health. Many Māori working in the health system already combine these perspectives: Western perspectives they learnt through tertiary studies, and Indigenous perspectives often learnt through personal experience and upbringing. When working with Māori, it’s often these individuals who achieve the greatest gains.”

WHAT TO EXPECT AS A STUDENT

Students choose from two degree programmes: Poutū-mārō Biomedical Science and Poutūmanahau Population Health.

They take core papers and choose electives from Chemistry, Community Health, Environmental Science, Management Studies, Health Resource Management, Human Performance Science, Māori and Indigenous Studies, Molecular Biology, Pacific and Indigenous Studies, Population Studies, Social Policy, Environmental Planning, and Human Development.

Say a student aspires to make a difference to type 2 diabetes rates and outcomes. The degree offers plenty of possibilities.

Kirsten says, “Through Poutūmārō, students could explore diabetes in ways that draw from Māori traditions complemented

by Western science, looking at areas such as pharmacology, biochemistry, medicinal treatments, physiological causes, and preventative approaches. They could go on to take up roles as researchers, laboratory technicians, or public health science advisors.”

Alternatively, through Poutūmanahau they could “focus on the historical, social, economic, and cultural determinants that are reflected in high rates of type 2 among Māori. They’d consider how policy, public health systems, interventions and so on contribute. They’d interrogate the colonising ‘fix them’ approaches that many health interventions and practices adopt, which reinforce deficit perspectives and increase moralising behaviours.

Students who take this path may become advocates, policy analysts and leaders in their iwi relating to holistic and preventative approaches.”

Jordan says it straight: “In terms of type 2 diabetes, telling Māori to eat better and exercise more is not enough and reflects a colonial approach of ‘our way is the best way’.

Instead, we need to allow Māori to define, determine and decide their collective approach to addressing the ‘lifestyle’ diseases that appear more prevalent amongst our communities. Moreover, we must draw on traditional Māori practices and pastimes.”

To find out more about the degree, see www.waikato.ac.nz/study/ qualifications/bachelor-of-health

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DIABETES WELLNESS | Summer 2019

37

Grow

Summer is the season of flowers, and the edible ones make bright, nutritious additions to anyone’s diet. Johanna Knox gives the run down.

Dietary flower power

Y

ou can buy gourmet edible flowers at markets or from some supermarkets – often heavily encased in plastic to protect their petals. But it’s cheaper, more fun and kinder on the environment to gather your own from gardens and local green spaces. Some of the plants with the most delicious flowers are weeds, so you’re doing everyone a favour when you pick them.

Many of us eat a few flowers

Onion weed

already: broccoli and cauliflower are large flowerheads with their buds still closed. However, the plant foods we usually eat are fruits, seeds, tubers, roots, stalks and leaves. Time to eat more flowers?

A 2017 study* found that edible flowers are full of nutritious vitamins, minerals and polyphenols, just like other plant parts. A garnish of bright petals can visually lift a meal from plain

to special. Flowers offer a subtle flavour boost, too. A rule of thumb for edible flowers is that if a plant’s leaves have a strong flavour, its flowers will likely contain that same flavour, but in a milder form.

You can explore the exciting world of edible flowers through a growing number of books and websites on the topic. Here’s some information and inspiration for starters.

Nasturtium

Dandelion

Fennel

Rosemary

ONION WEED

NASTURTIUM

Onion weed is a problem weed, but every part of it is highly edible, including the white flowers. These add a delicate onion flavour to salads, soups and any other dish you care to experiment with.

Bright nasturtiums have a soft mustardy flavour that complements many savoury snacks and dishes.

FENNEL Wild fennel grows rampantly around some parts of Aotearoa and it flowers through summer. The pollen is considered a delicacy in some countries – sought after by chefs. In this country, you can gather it easily yourself.

Pick the big yellow flowers when they’re fully open and place them upside down in a paper bag. Give them a good shake and the pollen will fall to the bottom. With a sweet aniseedy flavour, fennel pollen is wonderful sprinkled across both sweet and savoury dishes. If you collect enough, you can save it in a jar for future use.

ROSEMARY Rosemary flowers, which taste like rosemary leaves but much more faintly, work with both sweet and savoury dishes. And if you’re already flavouring a dish with rosemary as a herb, why not decoratively scatter rosemary flowers across it?

DANDELIONS & THEIR COUSINS Dandelion flowers and their close relatives, which all look very similar, range from sweet to bitter in taste. They’re all edible. You can use them whole or pull them apart to scatter their small yellow petals across or through a dish.

*“Edible flowers: A review of the nutritional, antioxidant, antimicrobial properties and effects on human health”. Journal of Food Composition and Analysis, Volume 60 – Jul 1, 2017

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DIABETES WELLNESS | Summer 2019

Ideas to try • Float a scattering of petals or a single large flower in a soup, perhaps atop a swirl of olive oil.

• Mix edible petals or small whole flowers through a salad.

• Scatter petals or small whole flowers across an open sandwich, or layer them inside a sandwich.

• Add flowers or their petals as a garnish to crackers and spread – or to other party finger foods.

• Freeze flowers in ice cubes for cool summer drinks.

• Add whole flowers into rice paper rolls so that the flowers are inside the translucent rice paper, but facing outwards so they can be seen.

• Sprinkle the petals of sweetly aromatic flowers across puddings or desserts, or add a single flower or sprig of flowers as a garnish.

FIX D RY, CR AC K ED HEEL S, FAS T • • • •

Results within 5 days Non-greasy No Parabens, petroleum or lanolin Diabetic friendly

Stay safe Make sure you follow a few simple rules when foraging for edible flowers.

DO … … make sure you know for sure what something is before you pick it. … wash your finds gently.

DON’T … … gather from beside roads or driveways where plants are coated in exhaust. … gather where pesticide has been sprayed. … eat flowers from florist shops which have very likely been treated with pesticide. (New plants from garden centres may have been, too.)

Available at selected pharmacies and supermarkets nationwide

Sport

CRICKETER SOPHIE DEVINE SUPPORTS NEW TYPE 1 APP

W

hite Fern Sophie Devine, who has type 1 diabetes, has used the FreeStyle Libre since it became available for adults here in 2017. The FreeStyle LibreLink app, launched in October this year, has helped even more.

This app lets users swipe their smartphones over their Libre sensor just as they do with the Libre reader. However, it also offers extra features, including the ability to add notes to track food, insulin use, medication and exercise.

Sophie says, “It’s really important to record any trends during my training, as well as what food I’ve eaten, so the note-taking feature has

been really useful.”

FreeStyle LibreLink app users have the option to share their information with their health care professional through LibreView – a secure, cloudbased diabetes management system.

Sophie says, “For me, who is away a lot and trying to track down dates to meet with my endocrinologist, them being able to access my data wherever I am in the world is very handy.”

The FreeStyle LibreLink app can be downloaded free of charge for both iPhone and Android. It is compatible with NFC-enabled phones running on Android OS 5.0 or higher and with iPhone 7 and higher running iOS 11 and higher.

JILL GILLETTE TAKES SILVER AT THE WORLD BOWHUNTER CHAMPS

I

n our spring issue we featured Jill Gillette, who has type 1 diabetes and is New Zealand’s national women’s bowhunting champion.

Now she’s won a world medal.

When we last spoke to Jill she’d just been selected for the New Zealand Black Arrows team, and was preparing for the World Bowhunter Championships in Yankton, USA. The event involved four gruelling days of trekking across difficult terrain, shooting at 28 targets per day. Jill says the biggest challenge was the weather. “Temperatures were in the high 30s with 80 to 90% humidity, which is a killer hiking up and down hills. Water intake was crucial.”

Jill took an early lead in her category, but says she struggled with concentration on the third and fourth days. However, the leaderboard was changing constantly, and “at the end of the

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DIABETES WELLNESS | Summer 2019

last day on the last arrow I knew I’d taken the silver medal, even with archers still to arrive back to base”.

Jill is immensely proud of the Black Arrows team. “Every one of them medalled, and four of us out of the six have medical conditions which are challenging, but are never used as an excuse.” Team spirit was crucial. “There was a group cheer before going onto the course, and none of us left the range until all team members had returned.

Debriefs at the hotel bar inspired us to get out there the next day and do better. Evenings after each shooting day were spent sharing stories and having a laugh.”

Jill uses the FreeStyle Libre, which makes competing much easier.

However, “the heat, humidity and physicality of this course, combined with a rain jacket which kept pinching on the Libre’s sticky pad, loosened the sensor on the third

day, and I’d left my cover stickers at home. I was reliant on my sensor, taking blood sugar readings every 10 minutes. It was scary to feel it loosening with four hours of competing ahead of me. But we got there!”

Home again, Jill is “relaxing after the high of competing internationally, and enjoying coaching at our new Franklin County Indoor facility. I get such a buzz from seeing first-time archers picking up their bow and watching the sense of achievement they get from hitting the spot.”

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TECHNOLOGY

BRANCH CONTACT LIST 2019 DIABETES NZ NATIONAL OFFICE

KUMANU CARE PLANS NEW DIABETES APP

A

s the parent of a child diagnosed with type 1 diabetes seven years ago, Auckland technologist and entrepreneur Diego Nieva (pictured) has spent a long time wishing there was a simpler way to cut through the confusion and overload of information that comes with the condition. Now, using artificial intelligence and machine learning, he hopes to create the solution himself.

“The vast amount of information that has to be acquired in the first few months is the single biggest challenge my wife and I faced.”

His project, named Kumanu Care, aims to make diabetes management easier and more intuitive by giving people an app that can answer their questions conversationally, in plain language.

“As you know,” says Diego, “clinic visits are separated in time enough so the forgetting curve strikes right after we cross the clinic’s doors.”

He adds that doctors can only see so many people a year, and only for a short time, and patients and caregivers alike often go home with more questions. He notes that people in the regions and non-urban areas struggle especially to get information and timely care.

With Kumanu Care, patients and caregivers would have access to something that combines the immediate accessibility of the internet with the more personal and dynamic approach of a human nurse or doctor.

And for Diego this is only the beginning. “The dream is to integrate with every existing piece of technology we have today – or the most commonly used.” He says the service could “integrate with other services like clinic appointment reminders, and pharmacy/chemists integration for just-in-time procurement of supplies.

“The list is long and I could spend hours talking about the dreams we have as a team. Our Chief Technology Officer Max Gianesini and I are extremely excited for the possibilities surrounding this … and at the same time I have the biggest motivation right here at home with me.”

He is working to launch a usable prototype and urges anyone interested in being a beta tester, or simply in following his updates, to go to the website and sign up to Kumanu Care’s newsletter: kumanucare.com

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DIABETES WELLNESS | Summer 2019

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 Horowhenua 06 368 9475 | diabetesnzhorowhenua@gmail.com www.diabetes.org.nz/branch-horowhenua Taranaki Area* PO Box 896, Taranaki Mail Centre, New Plymouth 4340 06 758 7873 | diabetesnztab@xtra.co.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

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