Diabetes Wellness Summer 2023 by Diabetes New Zealand

wellness DIABETES

SUMMER 2023 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

BARRY DOES RALLY • HELPING THE HAPŪ • GOING OUT WITH DIABETES • BIKE IT, YOU'LL LIKE IT SCRUMMY SAPASUI AND OKA I'A • EYES ON DIABETES

SUMMER OF WHEELS CYCLING THE OLD GHOST ROAD

FOOD WITH A SAMOAN TWIST

Contents SUMMER 2023 VOLUME 35 | NO 4

4 EDITORIAL

5 DIABETES ACTION MONTH: Eyes on diabetes 9 CARE: Saving your vision, saving your life 10 LIFE WITH T1: Sue Paterson bikes the Old Ghost Road 12 MOVE: Cycling for fitness

14 RESEARCH: Amy Maslen-Miller, Samoan scientist

28 ADVOCATE: Hauora Kaimahi Marianne Parker

31 RESEARCH: LEAPS at Healing our Spirit Worldwide 32 ADVOCATE: Major parties promise shelter from diabetes tsunami 34 LIFE WITH T1: Nicole Silver, Dexcom warrior

37 YOUR DNZ: 2023 award winners 38 RESEARCH: A roundup of diabetes research news

18 NOURISH: Recipes with a Samoan twist

20 YOUR DNZ: Healthy plates resource COVER: SUE PATERSON

22 CARE: Going out with diabetes 24 LIFE WITH T1: Rally car driver Barry Gibbs

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Editorial

ia ora koutou. Longer daylight hours and warmer temperatures are upon us, which also means Diabetes Action Month has landed too. I have watched this campaign grow from a day of activities for groups across the country into a full month’s engagement and awareness programme, involving nationwide exposure, fundraising, and opportunities to bring communities together. There are multiple opportunities for us all to be involved, so I hope that each of us will take the opportunity to educate, support, enjoy, and advocate for our diabetes whānau. As I hunt for ways to pay for CGMs that help both of the type 1s in my whānau live their best, healthy lives, I am grateful, firstly, that I have the opportunity to even consider covering the cost ourselves. More importantly, I am beyond grateful for the many years of advocacy by Diabetes NZ, medical professionals, and other groups that have made funded CGMs a likely reality. Thank you to the many individuals who have shared their personal stories, challenges, and vision to inform the government, opposition parties, medical professionals, and anyone who will listen. So many studies have made the case for significantly improved health outcomes for people with diabetes who have access to appropriate technology. Not to mention the inevitable savings for the health system! I look forward to sensors being equitable standard diabetes management practice. This has been a challenging year for many. I’d like to acknowledge the challenges that our diabetes whānau across the country have faced due to weather events. Thank you to those who are helping meet their diabetes needs. As the CGM campaign shows, our diabetes communities can do amazing things together. This Summer edition of Diabetes Wellness should really be named Diabetes Wellness on Wheels, as we meet Barry, a successful rally driver from the Bay of Islands, Nicole, an artistic roller skater, and Sue who last summer biked the infamous and difficult grade five Old Ghost Road. Our regular contributor, Craig Wise, reminds us of the large choice of bikes to be hired – a perfect past-time while on holiday. We also meet Amy Maslen-Miller – the ‘Samoan Scientist’ who is researching the link between traditional Samoan foods and type 2. Happy and safe holidays everyone! LYNDAL LUDLOW

Advisory Chair, Diabetes NZ

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. Across the country, Diabetes NZ has staff and volunteers who help people live well with diabetes. Join us today at www.diabetes.org.nz

DIABETES NEW ZEALAND Patron Professor Sir Jim Mann 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 12441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Email info@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Instagram instagram.com/diabetes_nz

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

ADVERTISING & SPONSORSHIP Head of Business Development Jo Chapman Email jo@diabetes.org.nz Telephone 021 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p

DIABETES WELLNESS | Summer 2023

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.

Diabetes Action Month

Running right through November, Diabetes Action Month 2023 has the theme Eyes on Diabetes. Diabetes Action Month is Diabetes NZ’s annual public health and awareness campaign that aims to encourage all Kiwis to take action for diabetes.

iabetes is the leading cause of preventable blindness in Aotearoa New Zealand, and everyone living with diabetes is at risk of losing their vision. The good news is there are steps we can take to lower our risk of eye damage, including having regular eye checks. Eye problems cause less damage when detected and treated early. Diabetes NZ CEO Heather Verry says this Diabetes Action Month is all about educating New Zealanders with diabetes on how to look after their eyes, to prevent losing their sight. ‘Poor vision can have a huge impact on your quality of life, including your physical and mental wellbeing. When you’re living with diabetes, so much of your life relies on your sight. This includes checking your blood glucose levels, changing a pump site, and injecting insulin. So looking after your eyes can not only save your vision but your life,’ says Verry. This Diabetes Action Month, Diabetes NZ is urging Kiwis to

get their eyes checked to avoid preventable blindness. Throughout November, we will join with our local teams, sponsors, supporters, and eye health experts. We will be educating New Zealanders with diabetes, and their whānau, on the importance of regular eye checks and self-care to reduce the number of people developing diabetes-related eye problems. Of course, we will continue to raise awareness and encourage prevention through healthy lifestyle choices. There will be a number of Diabetes NZ initiatives taking place during November, including the launch of a new diabetes eye health resource and educational video, Facebook Live sessions, local events, and the return of Sneaker Friday. Check out the Diabetes NZ Facebook page and www. diabetesactionmonth.org.nz for updates. WHEN WAS YOUR LAST DIABETES EYE CHECK?

We’re calling on New Zealanders who are living with diabetes to get their eyes checked. There may be no symptoms in the early stages of eye problems such as diabetic retinopathy, making it even more important to have regular eye checks so it can be detected and treated early. Eye tests are free! Your doctor can refer you to your local Diabetes Retinal Screening Programme.

People with type 2 should have their first screening as soon as they are diagnosed, and people with type 1 should have their first screening done five years after diagnosis. DIABETES EYE HEALTH RESOURCE

This November, Diabetes NZ is launching a new eye health resource for people living with diabetes to better understand eye health. You will find tips and tricks for looking after your eyes and the symptoms of eye disease to look out for. We hope this resource will help educate people about the impact diabetes can have on your eyesight and reduce rates of preventable blindness. This resource will be available on our website during DAM.

DIABETES WELLNESS | Summer 2023

FACEBOOK LIVE We love running our Facebook Live sessions during Diabetes Action Month and watching people from across the country tune in. This year, we will be hosting two Facebook Lives on how to look after your eyes when you have diabetes. We will be joined by eye health and diabetes specialists, who will be able to answer your questions and provide top tips for lowering your risk of eye damage. To find out more about these sessions, check out our Facebook page www.facebook.com/diabetesnz

WORLD DIABETES DAY – 14 NOVEMBER The theme for World Diabetes Day 2023 is Access to Diabetes Care. This World Diabetes Day, the International Diabetes Federation is calling on policymakers to increase access to diabetes education to help improve the lives of the half a billion people with diabetes worldwide. This is particularly important in Aotearoa, where 300,000 people are now living with diabetes. Head to www.worlddiabetesday.org for more information and great resources.

SNEAKER FRIDAY Sneaker Friday is back on 17 November! This fundraising event is your chance to step up for diabetes by wearing sneakers to work, school, or out and about on Sneaker Friday. To take part, simply donate $5 to Diabetes NZ and wear your sneakers on Sneaker Friday. Diabetes NZ’s mission is to support all New Zealanders to live well with diabetes, but we can’t do this without the help of generous, supportive, and helpful Kiwis like you! To learn more, visit www.diabetesactionmonth.org.nz.

Ngā mihi nui

We are so grateful to the amazing sponsors who help make Diabetes Action Month happen. Thank you for your support and all you do to help Kiwis live well with diabetes.

DIABETES WELLNESS | Summer 2023

ADVERTORIAL

Keeping an eye on the diabetes community

Each locally owned and operated, Specsavers practices nationwide are dedicated to caring for the eye health of the diabetes community. Specsavers New Lynn Co-owner and Optometrist Philip Walsh says raising awareness of the impact a diagnosis of diabetes can have on an individual’s eyesight is critical and is urging people living with the disease, or with pre-diabetes, to talk early to their GP about how best to manage the condition and associated risks, such as vision loss. “Diabetic retinopathy is a complication of diabetes that affects the eyes. It is caused by damage to the blood vessels in the retina at the back of the eye. While symptoms may be harmless, they can also indicate potentially sight threatening changes to the back of the eye, so no changes to your eyes or vision should be taken lightly,” he says. “Worryingly, for many people the condition does not cause any noticeable symptoms until it is too late so early detection is key to managing diabetic retinopathy. The best way

to ensure your eyes are healthy is to book in routine eye tests.” Diabetes NZ and GPs typically refer people to their local Diabetes Services Retinal Screening Programme as soon as they are diagnosed and every two years from then, or sooner if indicated. “It is critical for everyone to understand the importance of a regular eye test with their optometrist as other coexisting conditions could be detected also.” It is recommended that everyone gets their eyes tested at least every two years. At Specsavers, an advanced OCT 3D eye scan is included as part of every eye test, which allows the detection of eye conditions earlier. At Specsavers across the country, AA members can claim a free eye test every two years and Supergold Card Holders can obtain half price eye tests. Visit www.specsavers.co.nz to book your appointment or for more information.

Care

SAVING YOUR VISION, SAVING YOUR LIFE

MY DIABETES JOURNEY… A FRIEND IN YOUR POCKET!

Diabetes can damage your sight. But there is a lot you can do to lower your risk of diabetes eye damage. You may even be able to halt existing damage.

hether you have type 1 or type 2 diabetes, it is very important that your doctor refers you to your local Diabetes Retinal Screening Programme. Every region has an eye screening service, and it is free for people with diabetes. SO WHAT DOES A DIABETES EYE CHECK INVOLVE?

This is a simple procedure that takes approximately half an hour. A specially trained health professional will look at your eyes. They may photograph the retina, which is a disc of cells within the eyes that captures light and transmits information to your brain. You may be given eye drops at the beginning of the appointment. The drops dilate (open up) your pupils so the specialist can see the back of your eyes. These can leave your eyes sensitive to light, so remember to take your sunglasses. It is important that you be prepared to wait for your vision to return to normal, so don’t drive. Ask someone to accompany you if you have to drive.

Remember: In the long-term, diabetes can lead to eye problems, so having regular eye checks should be your go-to.

If any issues are detected, your eye health professional will advise you of treatment options. FOR MORE INFORMATION AND SUPPORT

• Call Diabetes NZ on 0800 342 238 • Visit www.diabetes.org.nz • Download the My Diabetes Journey App • Speak to your GP or diabetes health professional.

We know that managing diabetes is a journey and we all need a little extra support sometimes. With helpful tips, information, and inspiration, the new My Diabetes Journey app truly is like a friend in your pocket! It’s totally free, so download it today. • Food diary • Space to record and track movement goals and emotional wellbeing • Diabetes resources • Recipes • Nutrition tips DOWNLOAD IT TODAY

Life with T1

BIKING THE OLD GHOST ROAD There is a particular breed of people that enjoys biking 85 kilometres, slogging it out over three hot days on advanced grade five trails. We meet Sue Paterson who did such a trail last summer.

ifty-five-year-old New Plymouth local Sue Paterson says she never thought she would do the Old Ghost Road. She knew it was infamous for being a difficult and technical track, but also appreciated that it was set within a glorious part of the West Coast. Situated in the Kahurangi National Park, the track starts at Lyell, an old gold mining town where the only remaining marker is the cemetery. The track itself is a long-forgotten gold miner’s road that has been revived as a mountain biking and tramping trail, administered and maintained by a non-profit organisation. It takes two to three days on a bike and four to five days by foot.

Each year, Sue and her husband Dean take their campervan from New Plymouth down to the South Island for an explore. On one of those trips, her husband cajoled her into biking to the first hut of the track so she could see how beautiful the area really is. Sue spent the first three and a half hours almost continually heading uphill, but once she arrived and recovered something clicked, and before too long the couple had booked their hut accommodation for the following year. THEN CAME THE PLANNING

Already fit, Sue thought she would do an internet search on the best exercises for cycling and it came up

If you are new to multi-day bike journeys and would like to embark on one, then remember to first talk to your specialist doctor or nurse.

DIABETES WELLNESS | Summer 2023

with ‘core’. If you hold your centre, it makes for more efficient cycling as well as taking the strain from your back. Sue found a challenging class at her gym and set about strengthening her core. Sue wasn’t new to cycling. Living in New Plymouth, her backyard offers many opportunities to enjoy a spectacular bike ride. She sought out as many steep hills as she could find, biking up one side, down the other, and then repeating. As well as core work she also did some extra training in the gym. The couple didn’t load their bike with panniers, instead they spread the essentials-only load between a handlebar bag, a rear carrier, and a light daypack. A number of businesses support those who bike and tramp the Old Ghost Road, so Sue and her husband hired sleeping bags that were waiting for them in the hut in order to cut down on the bulk they needed to haul. Keeping their packs to the minimum, Sue and Dean chose to eat freeze-dried meals: beef bourguignon one night and mediterranean lamb and black olives the other. Toast and coffee made up breakfast, and lunches were peanut butter sandwiches. Some fruit was included as well as some ‘just in case’ food, which proved useful when she discovered a weka had opened the small bag on the front of her bike and nicked off with her scroggin and brunch bar. Then of course there was diabetes to include in the trip. Over the three-day trip, she took two insulin pens in case her pump was damaged, a blood testing kit in case her CGM was not working, a spare insertion set in case it was ripped out, and Glucagon. With technology being such a game changer, she needed to be prepared, so had her pump and reader fully charged, and she also brought along a charger pack as a backup.

‘YOU CAN DO THIS’

For safety and comfort, Sue wore an arm band over her CGM to give it more protection. Biking through the bush meant brushing past bush and she says she didn’t want a branch to yank it out.

EPIC RIDE

Sue says the whole trip was an epic ride but that every day was challenging in its own way. The first half of day one involved reliving that three-and-a half-hour climb her husband had conned her into doing the year before. On day two, the initial part of the track turned into an expert grade five ride. There were tight switch backs on the edge of a bank, which she says you wouldn’t want to take too quickly or else you’d go over the edge. This is when her nerves kicked in and her blood sugar levels rose accordingly. Sue credits her smart watch for ease of checking her levels. Being able to check numbers in a glance with a wee turn of the wrist meant not having to take her hands off the handlebars or continually stop the bike to do a blood test, do a scan, or check her phone. If you are exercising six to eight hours a day, blood sugar levels can drop afterwards and continue through the night. At the end of the day, the pair stayed in the main trampers huts, but sleeping closely to others meant Sue was keenly aware of trying not to rustle bags when she needed to find a top-up in the middle of the night.

The second day provided time to get off their bikes and push. One of the highlights of the track is the Skyline Steps: a 60-metre plummet via 300+ steep steps. This involved carrying their bikes down, another good reason to not have their bikes weighed down with panniers and non-essential gear. After coping with these stairs and a few other steep downhill areas, the couple’s hands and shoulders were well exercised. The final day was only 17 km, and Sue says by that third day of biking she felt great. The uphill climbs eventually came to an end, making it all much easier and stress-free, and this also allowed Sue’s blood sugar levels to be at good levels. Two hours later, they were out and tumbling into an open-air riverside shower for a well-earned wash. Asked if Sue has any extra advice for those with diabetes wanting to do a hard ride, she says, ‘Don’t let diabetes be an excuse for not taking on a challenge – you do need to plan more and make necessary adjustments to factor in the diabetes – but there is a sense of accomplishment knowing that you can overcome a challenge despite being someone with diabetes. ‘There certainly was a feeling of accomplishment when I crossed the finish line. I knew it was going to be hard but the whole way I just kept telling myself, “You can do this. You are doing this. You are going to finish.”’

CYCLING THE OLD GHOST ROAD

• Day users are free, but you do need to book if you are staying out for the night. • You can book private sleepouts, hut bunks, or tent sites. • For bookings and more info, go to oldghostroad.org.nz.

DIABETES WELLNESS | Summer 2023

Move

BIKE IT, YOU'LL LIKE IT! Photos: Miles Holden

I You don’t have to be in great physical shape to enjoy cycling. If you haven’t been on a bike since you were a kid, then there are many gentle ways to get back into it. Craig Wise takes us through the benefits of getting into the saddle. 12

DIABETES WELLNESS | Summer 2023

f you are looking for a fitness activity that is reasonably low cost and gentle on the body, then cycling is up there, alongside walking and home-based bodyweight exercises (such as core exercises seen in the previous issue of Diabetes Wellness). Possibly the most under-rated benefit of cycling is its positive effect on mental health. Cycling, as well as being outdoors, stimulates the release of endorphins, serotonin, and adrenaline. Many people have cited cycling as being crucial to their mental health journey when dealing with depression, anxiety, and confidence issues. Regular cycling stimulates and improves your heart, lungs, and circulation, reducing your risk of

cardiovascular diseases, including stroke, high blood pressure, and heart attack. Cycling not only strengthens your heart muscles but lowers your resting pulse rate and reduces blood fat levels. Cycling is great on your joints as well, helping you smoothly move your hips and knees without excessive stress. It is an ideal exercise if you have osteoarthritis as there is little impact on the bones. Cycling can be done at very low intensity to begin with, which makes it ideal for those who haven’t straddled the saddle since they were a kid or who are recovering from injury or illness. It can be built up to a satisfying, demanding physical workout over a very short period of time.

VARIATIONS

The easiest way to get into biking is on an exercycle. These machines are predictably steady and can be hired or purchased readily. Some measure your rides, some your revolutions per minute, and you can heighten or lower the pedal resistance as necessary. If stored in a covered outdoor space or even near a window or door, you can still get the fresh air benefits of cycling outdoors but with the advantage of privacy. In colder days, it can be set up in front of the tv, making it a great way to get in some exercise and watch your latest series. If you want more structure and variation, then finding a spin class could work well. You

can find these classes at gyms, community pools, and free online. You can see how ‘fast’ you are going and what gradient of ‘hill’ you’re battling, giving you numbers to outdo in the next session. Another way to ease into cycling is to hire a bike. This is an excellent activity to do on holiday, with or without company, where you can explore the local waterfront, lakefront, riverside, or flat roads around vineyards. Many centres have companies that hire everything from road bikes, mountain bikes, e-bikes, even adult tricycles, and the familyfriendly ‘crocodile’ bikes. Changing up a gear, there are numerous companies that hire and guide people along multi-

day trips, along ex-rail trails, beaches, and national parks. Companies transport your gear, cater, and set you up in top notch accommodation, so all you only need to concentrate on is pedalling from one destination to another while enjoying the views. Cycling is a great way to boost both your physical and emotional health, but remember if you are planning on cycling on the road then get a good fitted helmet and hi-viz vest before you set out. For some great cycle hire options, check out www.newzealand.com/ int/cycle-hire.

Cycling is a fun way to get fit – the sense of adventure gained from being outdoors, the thrill of coasting down a hill, coupled with the physical and emotional benefits make it an ideal activity for all.

Aotearoa New Zealand is scattered with many businesses that hire out wheels. If you want to own your own, then a brand-new bike can start at around $150 or cheaper if you buy second hand. Invest in a good fitting helmet, and a lock, and the world is your bike track.

DIABETES WELLNESS | Summer 2023

Research

THE SAMOAN SCIENTIST We meet Amy MaslenMiller, who is researching the traditional Samoan diet of the 19th century to see if it can play a part in addressing the onset of type 2 diabetes among Samoan New Zealanders.

DIABETES WELLNESS | Summer 2023

my Maslen-Miller is in the second year of her PhD. She is part of the team at University of Auckland looking at how genes unique to Māori and Pacific people affect the way energy is stored and used and how this might link to type 2 diabetes, cardiovascular diseases, gout, and cancer. ‘My research is trying to address type 2 diabetes by learning more about our genes so our people can live healthy and longer lives.’ Known as the Samoan Scientist on social media, she posts regularly, hoping to widen the reach of her research as well as

show that science doesn’t have to be scary. Currently, she is looking to recruit 200 women in the 18 to 50 age range who identify as Samoan, so she has taken to social media to find participants. PODCASTS, TIKTOK, AND INSTA

Amy has been making her own podcast for the last four years, before she even embarked on her PhD. Passionate about science, she hopes her example will encourage other Samoans to pick it up. She has been making short videos, introducing potential participants to her workspace. Aware that science can be seen as

PHOTO: OLIVIA RENOUF

‘When I think about our knowledge today, we will be ancestors for our people 100 years from now. So I believe it is important for us to share and document our knowledge for the next generation.’

Samoan foods that were common during the 19th–20th century: Ufi (yam), Talo (taro), Ulu (breadfruit), Fa’i (banana), Nui (coconut), and I’a (fish)

Before she embarked on her PhD, Amy’s background study was in biological science. For two years, she worked in Samoa, studying the taro leaf blight – a fungi-like organism which can destroy the leaves of the taro plant in days, potentially leading to a 30-40% crop loss.

scary, Amy ‘walks’ people through the clinic, showing what her team is doing and introducing the tools of measurement, such as those that measure body composition, resting metabolic rate, They are also shown the mixed meal tolerance test as well as how blood samples are prepared for long term storage. Each time a video goes out, she will get an influx of 20–30 people who want to help, but then it will go quiet. She says this has been a bit of a challenge since Covid-19 landed in our lives. Amy says that, with misinformation about viruses and vaccines swirling around, some people are cautious but relax once they understand what she is researching. She hopes her transparency encourages people to come through, have a go, and see the friendly side of science. INTRODUCING CREBRF

A part of Amy’s study is to understand a particular gene known as CREBRF. Common in Māori and Pacific populations, it has been painted in an unfavourable light in the past, with some references labelling it the

‘obesity gene’. But Amy says this is a Palagi misunderstanding and unfortunately is not uncommon when it comes to a lot of health topics that involve Indigenous peoples. Rather than viewing the gene with a negative lens, Amy is investigating whether CREBRF is actually protective. Paradoxically, CREBRF is associated with a lower risk of type 2 diabetes, yet higher body mass index (BMI). ‘It’s not fat the gene is associated with. We know the gene is associated with a higher BMI, but you are less likely to be diagnosed with type 2, which is not what you would expect. This could be good for our people, so we want to know more about this gene.’ SEARCHING FOR RECORDS

Like Aotearoa, Samoa has a strong oral tradition. So because the culture had no early written language, Amy is relying partly on the early Christian missionaries’ accounts of village life. Arriving in Samoa from the 1830s onwards, they made records of the everyday life they had been allowed access to. These records are limited,

which is why Amy has also been investigating what knowledge has passed down through Samoan families. She has discovered that, while banana, breadfruit, taro, yam, coconut, and fish were the commonly eaten foods, very little meat was eaten, and when it was it was only as a ceremonial food. Obvious markers are that there has been a big change in food preparation since the 1830s. Missionaries wrote that Samoans primarily used the umu – an earth oven where the food is cooked on rocks. Similar to a hāngī, but built above the ground, it is a simple but labour-intensive way of cooking meals. Then there was a timetable for mealtimes. Early Samoans had a tradition of eating just two times a day. The first was a brunch, consumed after working in the plantation, and the second meal was in the evening before the sun went down. This, mixed with a more physical lifestyle, meant that most people had to work for their food, had fewer food choices, and cooked simply.

DIABETES WELLNESS | Summer 2023

TALANOA is ‘talk’ or ‘discussion’ in Samoan, Fijian, and Tongan, and is a Pacific island form of dialogue that brings people together to share opposing views without any predetermined expectations for agreement. Talanoa participants set the parameters for their discussions: inclusion, reconciliation and mutual respect. TALANOA

‘If you have knowledge and experience of Samoan traditional foods/ceremonial foods/harvesting and planting practices about Samoan food, I would love to talanoa with you.’ Amy hopes this is where the Samoan population of Aotearoa can help her find a connection to oral or unrecorded history. As well as clinical measurement, she is wanting to talk to different generations of Samoan women to understand their perspectives and memories around traditional foods. Amy hopes her research can increase knowledge about traditional Samoan food. ‘I’m just reclaiming what our grandparents, parents knew from living in Samoa. I feel that it’s really important to

have this knowledge in terms of when it comes to health.’ When her PhD is completed in a couple of years, Amy will gift the resource of knowledge back to Samoan communities so that they can have a deeper and even more appreciative relationship with food, and see the significance of it within the Samoan culture. Amy says, ‘First-generation-born Samoans, even second-generationborn Samoans, will learn more about their culture through these stories about Samoan traditional food. Some of their families don’t have that knowledge at all. ‘I thought this was important to contribute to academia but also for our community, so we can document these stories and pass them on for the next generation.’

CREBRF STUDY

University of Auckland has one of the few research centres in the world to explore gene variants in Māori and Pasifika people to address metabolic diseases such as type 2 diabetes, through the CREBRF study. To take part in the University of Auckland CREBRF study, visit tinyurl.com/CREBRFstudy Eligibility criteria: • Aged 18-50 years • Identify as Māori or Pacific Islander. • Are generally healthy (no preexisting/long-term diseases) If you participate in the CREBRF study, you get a free health check-up, free parking, and a $200 voucher. You can find Amy on X @ScientistSamoan Instagram @samoan_scientist TikTok @samoanscientist Youtube Samoan Scientist Podcast Samoan Scientist Podcast Facebook /samoanscientist

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AND NOW DIABETES NEW ZEALAND APPROVED

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Nourish

SAMOAN twist

As summer approaches, we bring you three recipes that can be whipped up in no time. These recipes definitely aren’t traditional – instead we are giving these traditional meals a Samoan influence.

Our recipes are always checked over by our dietitian. She not only provides us with our nutrition information panel but also advises on the healthiest ingredients to use. Sometimes this will mean swapping out an ingredient or cutting down on salt, sugar, or oils. All this is in order to provide our readers with not only tasty but healthy recipes, suitable for those with diabetes.

A WORD FROM OUR DIETITIAN

‘I used these recipes to teach my new diet assistant about delicious diabetes-friendly food. Many people when they hear diabetes think it is ‘all about the sugar’. Instead, we think about the whole and aim for less saturated fat, salt, and sugar. I would like to thank the people I worked with in South Auckland and the dietitians I know for helping me modify some original recipes. This is an example of the whakataukī, “Nāu te rourou, nāku te rourou, ka ora te manuhiri” (with your food basket and my food basket, the people will thrive) in action.’

COCONUT RICE WITH WATERMELON JELLY TOPPING SERVES 5

This dessert has a rice pudding base and a fruity jelly tip. Although the recipe calls for watermelon, I used frozen strawberries as, at the time of print, it wasn’t quite watermelon season yet, so I couldn’t find any in the shops. A squeeze or two of lime just before serving adds a lovely tropical zing. 1 cup of short grain white rice 2 cups of water ½ tsp salt 1 tbsp of brown sugar ½ cup light coconut milk ½ cup of trim milk

TOPPING 1 cup watermelon flesh, pulped to a juice 1½ tsp gelatine (use agar if it needs to be vegetarian) ¼ cup boiling water

Mix all ingredients together, simmer, stirring occasionally until rice is well cooked and crushes with a spoon (around 30 minutes).

While rice is cooked, dissolve the gelatine in the boiling water. Stir mixture into the pulped fruit. Spoon half-cup servings of rice into individual serving cups. Allow to cool slightly, then pour over watermelon jelly mix and allow to set for an hour in the refrigerator.

DIABETES WELLNESS | Summer 2023

SAPASUI

OKA I’A

SERVES 4

SERVES 2

Also known as Samoan Chop Suey, this dish migrated to Samoa via early Chinese settlers. Commonly, this dish is heavy with the soy sauce, making it a high sodium meal, so we have dialled that back without losing the flavour. If cooking this for vegetarians, swap the meat for firm tofu or plant-based meat strips, or omit the meat and go to town with extra vegetables.

Also known as ceviche, Oka I’a is basically a cooled, marinated raw fish salad that you can have with a side of taro, rice, or fresh bread. The fish is ‘cooked’ by the lemon juice, then joined by some coconut cream, before being accompanied by crisp cucumber, tomato, and onion. To bring the fat levels down a notch, we have halved the amount of coconut cream, swapping in some low fat natural yoghurt instead. Although yoghurt is not a traditional Samoan ingredient, its tang surprisingly works a treat. (Remember to keep the raw fish covered and refrigerated until served.)

125g vermicelli noodles 1 tbsp oil 1 onion, chopped 1 cloves garlic 1 round of fresh ginger, about the size of a 20 cent coin 400g chicken breast, cut into strips 1 carrot 1 head of broccoli 150g green beans 2 tbsp reduced salt soy sauce (1 salt-reduced stock cube) 2 tbsp lemon juice ½ cup coriander leaves Cover noodles with hot water and leave to stand. In a large pan, sauté onion in the oil until soft. Add chopped garlic and ginger. Add in meat (or meat substitute) and cook until just done. Add in the noodles and half a cup of the liquid they were soaking in. Add in broccoli, beans, soy sauce, and lemon juice. Be careful not to stir this dish too much or the noodles will become mushy. Cover and simmer for a couple of minutes. Sprinkle coriander over and serve.

125g raw fish ¼ tsp of salt 1 tbsp of lemon juice ½ tomato, chopped ¼ cup of chopped cucumber ¼ medium onion, finely chopped 50ml light coconut cream 50ml low fat natural yoghurt Cut the fish into evenly sized pieces, about 5mm thick, and place in a glass or ceramic bowl. Pour over lemon juice, add salt, and leave, covered, in the fridge for an hour. The fish will turn opaque. When ready, add in chopped tomato, onion, and cucumber. Pour in coconut cream and yoghurt, and mix well. Garnish with chopped coriander. PER SERVE: ENERGY 966kJ (230kcal) | PROTEIN 30.5g | FAT 7.2g (SAT FAT 3.5g) | CARBS 9.3g (SUGAR 8.5g) | FIBRE 2.7g | SODIUM 636mg

DIABETES WELLNESS | Summer 2023

Your DNZ

HEALTHY PLATES A key part of healthy food management is portion control. To help with this, we have created the Diabetes NZ Healthy Plate, a sturdy, cardboard, plate-sized guide which uses both images and words to gently demonstrate healthy portion sizes.

Our handy tool is available in te reo Māori, Samoan, Tongan, Hindi, Punjabi, Chinese, Cook Island Māori, and English. Soifua I se soifuaga Maloloina, noo‘anga Ora‘anga matutu, mo‘ui ‘oku lelei, kia ora te noho! These phrases all roughly translate to ‘living life well’ – a perfect aspiration. The plates come in packs of 20 and depict a meal divided into ideal portions. A quarter of the plate dedicated to protein, a quarter to carbs, and the remaining half to vegetables. Each plate is dedicated to a language but

DIABETES WELLNESS | Summer 2023

also depicts common foods of each culture. For example, taro and green banana feature on the Pasifika plates, and rice, pulses, and paratha are on the Indian ones. GPs and other health organisations purchase Healthy Plates for demonstration and to give to patients. Individuals also purchase a set to give to members of their own whānau as well as friends. They are also a great resource for schools and carer organisations working with people with diabetes.

To order Healthy Plates for your organisation, please visit www.diabetes.org.nz/healthyplates-ordering. If you wish to order more Healthy Plates than our website allows, please contact us directly on pamphlets@ diabetes.org.nz or place your order and a member of our team will be in touch.

My only focus is improving yours Diabetes Eye Health Checks Experienced optometrists Latest technology Locally run

Going out

WITH DIABETES With the summer and party season heading our way, there are some things people with diabetes need to think about before heading out and/or drinking alcohol. The better prepared you are for a night out, the more you can focus on having a good time.

DIABETES WELLNESS | Summer 2023

oing to parties, bars, or events can be a lot of fun, but be aware that alcohol affects diabetes control. There’s a high probability that you might need to do things differently to manage your blood glucose on a night out. We’ve compiled some info to check out, but we also recommend you discuss how your particular body might handle alcohol with your GP or Diabetes Specialist Nurse.

PHOTO: ISTOCK.COM

Care

BE PREPARED

It is important that you check your blood glucose before, during, and after drinking alcohol. This will help you learn how different drinks might affect you. • Our judgment can be affected when we drink, and it is easy to not realise this when experiencing a hypo. • Always carry hypo treatment with you as you never know when you might need it. • It’s important to wear your diabetes ID and tell those you are out with that you have diabetes. This can be a lifesaver because others might mistake a hypo for being too drunk. SIGNS OF HYPOGLYCEMIA AND INTOXICATION ARE VERY SIMILAR

The signs of hypoglycemia can look a lot like being drunk – drowsiness, unsteady movements, slurred speech, feeling weak or tired, etc. A severe hypo can lead to mental confusion, unconsciousness, or seizures, which can all be extremely dangerous to your physical wellbeing and ability to treat the low yourself. This is why it’s especially important for your friends and family to know the risks of drinking alcohol with diabetes and the signs of low blood sugar. Teach your friends – if you are ever vomiting or showing the signs of hypoglycemia, they should encourage you to check your blood sugar with your BGM or your blood glucose levels with your CGM. And they should call 111 if they are concerned. HYPOS WITH ALCOHOL

If you go hypo due to alcohol, your body’s ability to help itself is severely reduced. • Alcohol can lower your blood glucose hours after it is drunk – even through to the following morning! If you go low when you

drink, your insulin may need to be withdrawn. • If drinking spirits, use diet sodas as mixes, not ‘ready to drink’ premixes. RTDs are very high in both alcohol and sugar. Discuss with your diabetes team how you might manage this. • Don’t inject insulin when drinking alcohol (even with sugary drinks) unless you have spoken with your diabetes specialist or local healthcare team. EATING AND DRINKING

If you are going to eat before you go out and drink alcohol, you may need to change your insulin dose. Discuss all of these scenarios with your diabetes team. • You don’t have to drink alcoholic drinks all night. Alternate between non-alcoholic and alcoholic drinks. • Make sure you eat some foods containing longer-acting carbohydrates before and after drinking, such as wholegrain bread, or curry and rice. UNDER 18?

Te Whatu Ora provides the following advice: • For people under 18, the safest option is not drinking at all • For people aged 15-17, the safest option is to delay drinking for as long as possible. Delaying or avoiding drinking can go a long way to preventing a range of risks for young people. This is important because: • Alcohol has impacts on brain development for people under 20. • Young people have a lower tolerance for alcohol than adults. They are at higher risk of hurting themselves when intoxicated. • Someone who starts drinking at a younger age is at higher risk for drinking harmfully later in life.

ALCOHOL INTAKE GUIDELINES FOR ADULTS

Remember, you don’t have to drink alcohol to have fun. If you are drinking alcohol, follow the Te Whatu Ora guidelines: • Two standard drinks* a day for women and no more than 10 a week • Three standard drinks* a day for men and no more than 15 a week • Have at least two alcohol-free days every week. And if you want to reduce your risk of injury on a single occasion, drink no more than: • four standard drinks for women on any single occasion • five standard drinks for men on any single occasion. Finally, for those who are pregnant, or who are planning to be: • Health professionals strongly recommend no alcohol use at any stage of pregnancy. *O ne standard drink is 100 ml wine, 30 ml spirits or 300 ml beer. This is less than most glasses will hold. For guidelines on standard drinks, see www. alcohol.org.nz/help-andsupport/advice/standarddrinks-and-legal-limits/

For information about alcohol in general, visit www.alcohol.org.nz For information about Type 1 and drinking, visit https://beyondtype1.org/ alcohol-and-diabetes-guide/

DIABETES WELLNESS | Summer 2023

Life with T1

When rally driver Barry Gibbs found out he had type 1 diabetes, not knowing much about diabetes he had burning questions, ‘Will it affect my licence? Can I still drive?’

Photos: Matt Smith Photography

FAST AND FURIOUS 37

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‘I

t was a full-on afternoon,’ is how Barry Gibbs describes his time at a medical centre in 2014. He had already felt awful for weeks, but had woken up feeling even worse, so he rang his GP and was told he could have an appointment at the end of the week. Barry had an inkling that he needed to see someone as soon as possible, so the Northland local was booked into a different surgery in the next town. In the time leading up to that day, Barry remembers always feeling really thirsty, so he had been drinking lots of orange juice, hoping that would perk him up. The doctor did the finger prick test, and it was 37 mmol/l. The normal range is between 4 and 8 mmols/l, meaning Barry’s blood glucose was extraordinarily high, and the nurse told him, if he’d waited until the end of the week he would’ve found out in hospital instead. Barry’s finger prick numbers worked their way down fairly quickly after his diagnosis, from the extreme 37 to 10 over a couple of hours. Because he felt so awful with plummeting of blood sugar levels, the diabetes nurse told him that this would give him an indication of what a low could feel like, even though it wasn’t low. Barry’s only understanding of diabetes was of an uncle who had type 2. He had progressively lost first his foot, then his lower leg, then his other leg. Naturally, this led to Barry being petrified of the new diagnosis. Later, he found out that the uncle hadn’t been great at managing his condition. The diabetes nurse put Barry at ease, telling him that if he looked after himself he could well avoid what his uncle went through. TIMING

The day before the diagnosis, Barry had competed in his third ever rally event, racing his beloved Ford Escort MK2, whom he

affectionately nicknames Doris. Barry spent a lot of time around rally as a kid and teen, with his mother and uncle taking him to meets. But as he wasn’t from a wealthy family, he realised if he wanted to race then he’d have to build the car himself. At 17, he went looking for an Escort around the country and ended up finding one on his back doorstep, just a few streets away. His grandmother paid for Doris, then he set about building her up from

‘I DIDN’T REALISE IT WAS SOMETHING I WAS GOING TO LOVE’

During his first meets, Barry discovered he had a natural talent for driving fast and with accuracy, coming in third at his very first event and landing in the top 10 for that day. The first time he raced, it was a day of excitement and he was supported by his family. ‘I had in my mind that I could drive a car at a decent pace, but it was a bit of a surprise how competitive I was. It cemented that that was what I wanted to do as a hobby.’ The day proved he had some natural talent that just needed honing. THEN, OF COURSE, THE DIABETES

‘The car’s barely attached to the ground – that’s what it feels like. High speed and floating the car corner to corner and it’s just wicked when it all comes together.’ the original workings, replacing everything apart from her good looks and strong bones. Barry chose to train and work in the automotive trade, then moved over to agriculture. He made the switch to marine when he started working on his own car so that he wouldn’t get bored continuing his day job into most evenings and weekends. Working in Opua, in the beautiful Bay of Islands, means there is always plenty of work within marine automotive. He manages the marine division of Bay of Islands Auto and Marine and is currently teaching a small team. His work, he says, has been amazingly supportive with his health, as well as his racing career.

Barry’s co-driver in life and play is his wife Nikki, and she is the one who pushed for Barry to get a CGM. He has a monitor that reads his CGM and sends the data to both his phone and his wife’s, useful for when Nikki’s not in the car with him. Barry used to finger prick but found it difficult to find the time when racing, as competitors quickly go from one stage to another. ‘If you are a little bit late for the next stage of the event, then I didn’t have time to do it. Being able to glance at your phone and see the numbers makes things much easier.’ Barry says he wouldn’t be without his set up and regrets his past management. ‘When I look back, it’s probably quite silly of me to be like that. To this day, I’ve never gone low when racing. But looking back it was pretty silly not to be testing all the time. Any time I had a chance, I should’ve focused on that rather than what else I was doing which wasn’t as important as being low in a racing car.’ Barry and Nikki met at a rally sprint at Port Waikato. She was

DIABETES WELLNESS | Summer 2023

ROAD/RALLY — WHAT’S THE DIFFERENCE?

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on. No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 300,000 New Zealanders with diabetes to live full and active lives.

According to Barry, almost everything. In a rally car, the roll cages, seating, and seatbelts are all purpose built. The suspension is a lot harder as well. Whereas a road car is made for a smooth comfortable ride, a racing car is a lot harder so the vehicle doesn’t move around as much. ‘You’re making everything stronger: the steering or anything that’s going to get beaten up by driving over a lot of gravel. You want a lot of reliability. Strengthening everything up is also safety. You don’t want steering or suspension components breaking.’ The average rally event is split into six to eight stages, and each of these is timed, so the driver is racing the clock, not other drivers. Each stage can last between 10 and 15 minutes, and at the end of the day the earned points are tallied up to find the winners. co‑driver for another team but before long started driving with him. While the drivers have control of the car – getting it from A to B – co-drivers are the eyes ahead of the action, calling the severity of each upcoming corner. In the last four years, Barry has clocked up quite a few wins and trophies, including as historic champion at both the 2016 and 2021 Northern Rallysprint Series, and historic runner up in 2017. In 2021, he won the Northland Car Club Hillclimb. ‘Historic’ is the class of car where most parts have to be pre-1982. THE BUZZ OF IT

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

Barry’s favourite thing about rally is the buzz of it. It offers a little bit of danger. He says he doesn’t like doing other things that are dangerous, like bungy jumping or adrenaline sport. ‘It’s more being able to produce that car, setting it up, and then driving it to compete. Getting a sense of achievement to

produce that car and then be able to pedal it quite quickly as well.’ Barry says, as with most things in life, if you want to give rally a go – give it a go. There are many car clubs where he says you can join and do the most basic event, which is ripping around in a paddock. There you will get a feel for it and see if you’re going to enjoy it or not. He says he’s seen all sorts starting out. He’s seen many guys come in and be happy to tottle along in last place while they learn and get used to everything. He’s seen others never get better but still enjoy it. Some come in but fall down the order. ‘Before they get a chance to get better, they realise they don’t like losing, so they give up.’ He says the biggest person to talk you out of it is probably yourself. ‘If your brain tells you it’s too expensive or that you’re not good enough, just find a way. Just start at a low level.’

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Advocate

We continue our travels around the motu, meeting each region’s Diabetes Community Coordinator. In this issue, we meet Marianne Parker, our Hauora Kaimahi for Northland.

HELPING HER HAPŪ

irst known as Te Tai Tokerau, the area that Marianne Parker covers is vast. ‘From Whangārei, we go up both coasts, and all the way up. That’s my playground,’ she laughs. She splits her time between roles with Diabetes NZ and Te Hau Ora O Ngāpuhi, the iwi-run community health and social services provider, based in Kaikohe. When Marianne (Ngāti Korohue/ Te Uri Taniwha) first saw the job of Diabetes Community Coordinator advertised, she knew the role was for her. She had moved from Auckland to live in Kaikohe after her father’s passing in order to pick up on the work he had been doing for their hapū within the Treaty

claims area. Her father had wide connections with iwi and hapu, and Marianne has inherited these links. She says this can be a bonus when it comes to approaching those giving and receiving diabetes care. ‘I’m quite fortunate that I whakapapa quite well in the North.’ She says people relax a bit once they realise she has a connection to them. Working as a bridge between clinical staff and patients, Marianne is passionate about helping her own. She says her concentration is focused on pulling iwi and hapū back to making better decisions for their health.

Marianne, front right, at a Diabetes NZ all-staff hui held in Rotorua in August.

DIABETES WELLNESS | Summer 2023

‘It’s not a Tribunal thing. It’s not a claimant thing. It’s not a hapū thing. It’s a love for my whenua and our people. That’s why I’m doing this job.’ DESIRE TO HELP

Nine years ago, when Marianne lived in Auckland, she found one day that she had lost feeling in her right leg. ‘I rang up my GP and said, “I don’t know what’s wrong with me, but my leg’s not working.”’ She wasn’t able to take any weight on it, and, if she tried, her ankle

would give way. The GP sent her to the Emergency Department at Waitakere Hospital, where she was asked if she had any other symptoms. ‘I said I feel drunk all the time.’ Marianne wasn’t a big drinker and certainly wasn’t drunk when she was experiencing the leg weakness, but she still felt weird. The following day, the ward doctor told her the results of the tests showed she had type 2 diabetes and that this was due to not eating properly, not looking after herself, and not exercising. To top it off, Marianne was accused of having alcohol issues. ‘The only issues I have around alcohol is I can’t afford it!’ This news cut hard. Marianne, who at the time had three tamariki, says she started questioning herself, wondering what sort of mother she was. She was now thinking she had put her children in danger of losing their māmā. ‘I was really down on myself.’ Her HbA1c was 175. (A glucose level above 160-180 mg/dl is considered hyperglycaemia.) But the hospital’s diabetes team, feeling that something wasn’t right, said they would test her for something else. Meanwhile, the ward doctor returned, discharged Marianne to the diabetes team, and advised her to get some help for her drinking. The next day, back at work and feeling glum, Marianne got a call from the team, saying she had been misdiagnosed and could she come back in as it’s urgent they see her. Marianne remembers the diabetes nurse being kind. She was told she wasn’t type 2, but type 1, and that having any kind of diabetes was not her fault. MEDICAL RECORDS

Fast forward six months after receiving the diagnosis, and a car shunted into the back of Marianne’s. Because she had

Marianne (second from left) with her collegues from Te Hauora O Ngāpuhi, commonly known as THOON. From left: Caroline Turner, Marianne, Shayne Rurehe, Hector Nafatali.

bruised ribs, she had to get checked out in hospital. Among the questions asked were ‘how’s your diabetes going?’ Marianne told the doctor she was feeling ok and had been taking the medications. Then she was asked if she’d had anything to drink today. She hadn’t but was still asked to do a breath test due to her health records stating she had ‘alcohol issues’. ‘The diabetes team helped me fight to get that taken off my health record. They said every time something takes you to hospital, that will be there.’ Marianne says this is why the role of Hauora Kaimahi stood out for her. ‘I don’t want anyone to feel like I did, sitting in that hospital bed. Type 1, type 2, gestational, any – it’s not their fault. There are other factors, but no-one should ever be told it’s their fault.’ She wants to support whānau so that they never have to feel like that, to be that voice for people who don’t yet have the knowledge to help themselves. ‘I’ll be next to

them saying, “stand up and back yourself”.’ MARIANNE PARKER, ADVOCATE AND (ALMOST) LLB

Marianne’s background is in law. She was persuaded into the field by her father, who was keen on one of his five tamariki taking it up in order to help with his hapū Tribunal claim. All going well, and studying part time, Marianne hopes to graduate by the end of next year. She hasn’t completely settled on which area of law to work in but is considering environmental or within governance. Having this legal background, as well as lived experience of diabetes, is what makes Marianne a successful Kaimahi Hauora. She has an understanding of receiving a misdiagnosis, a desire to help whānau, and a wish to support those who have mistrust in the ‘system’. ‘The system is a scary thing for them.’ She says some people feel almost like they are being colonised again.

DIABETES WELLNESS | Summer 2023

‘All I’m asking of whānau is to have a bit of a walk around your house. Work in your garden. In your garden have fresh veges. Because of the price of living right now, we can’t afford the veges, the fruit… The exercise of looking after your own garden is going to give you some kind of relief until you have more trust in the system.’

PHOTO: ISTOCK.COM

It’s a battle of wills that she’s willing to fight. She’s noticed a resistance to taking medications, due to a misunderstanding of what diabetes is and how it affects the body. ‘People think diabetes is just having too much sugar. They don’t realise that carbs is the thing that will spike the blood sugar.’ Marianne works hard to educate whānau on the powers of what makes up our food and how exercise can help. ‘All I’m asking of whānau is to have a bit of a walk around your house. Work in your garden. In your garden have fresh veges. Because of the price of living right now, we can’t afford the veges, the fruit… The exercise of looking after your own garden is going to give you some kind of relief until you have more trust in the system.’ Another challenge is reminding some kaumātua and kuia to keep up with their three-monthly HbA1c test to see how they’re tracking along. ‘A high HbA1c, constantly, is going to open you up to infections. That’s what I’m pushing – that if they don’t have faith in the system, to have faith in that test. Showing that is a good way of starting the conversation.’

DIABETES WELLNESS | Summer 2023

‘It’s not about race, but, to be honest, diabetes is a thing of our DNA rejecting colonisation. Our lives were so different, then we were colonised and our DNA hasn’t been able to handle it. That’s why we have high rates of diabetes and cancer. ‘Our DNA hasn’t had time to accept that lifestyle change. That’s why Pasifika and some Asians have high diabetes rates. It’s a different life. Europeans have had sugars around for generations, whereas Māori have, at the most, three generations. We lived on vegetables, fruit, tuna, fish. We need a helping hand to be level with other cultures. There isn’t a politically correct way to say this.’

DIABETES ACTION PLAN

Earlier this year, Marianne was invited to join others in Wellington to help nut out the refreshed Diabetes Action Plan. The Plan has been developed by Manatū Hauora – the Ministry of Health, along with consumers, Māori, Pacific peoples, and the health sector. We are awaiting the final plan to come out with its recommendations. Marianne remembers a conversation arising where the suggestion was made to change nurses and doctors to Māori names. She says she appreciates the genuine effort being made to make medical staff more relatable. However, if not properly thought out, with the right people, she says this could end up being a distraction. ‘My recommendation was that when a patient walks into a room and you see their name and you can’t pronounce it, a simple thing would be to ask, “before we get started, how do you pronounce your name?” That makes you more relatable than changing your name to Hone from John. It’s understanding the patient. Changing the system to suit the patient. Not changing the patient’s thinking to suit the system.’

Research

LEAPS In the second of the series, we catch up with LEAPS’ Dr Grace Walker, who is just back from the Healing Our Spirit Worldwide conference, held in Vancouver in September. Here the team got to present their work to an international audience.

ealing Our Spirit Worldwide (HOSW) is the ninth official gathering of Indigenous healthcare professionals from many nations. Held every three years, the week-long conference is a celebration of the healing power of traditional Indigenous knowledge and cultures. The Gathering drew approximately 5000 people and featured keynote speakers from Australia, Hawaii, north America, and Aotearoa. Grace Walker says she pushed for the LEAPS team to apply to present at the conference. ‘It’s the one place you can showcase all the Indigenous solutions to Indigenous problems.’ They saw it as a perfect opportunity to do two things: to investigate how other Indigenous healthcare groups were dealing with similar situations, then for LEAPS to show how they were engaging with Indigenous communities in academic spaces. This is not an area where many Indigenous people tend to be, Grace says. LEAPS is the acronym for Low-cost Equitable Artificial Pancreas System.

The LEAPS team at Healing Our Spirit Worldwide: Dr Grace Walker, Lucy Jessep, Dr Jake Campbell, Dr Jennifer Wong, and Sr Lalitha Mukundan.

The LEAPS team submitted two abstracts to HOSW, and both were accepted. The team’s Masters student, Lucy Jessep (Ngāi Tahu) was the first to present her work, including the kaupapa Māori methodology she is following within it. She is investigating common themes and threads and narratives of what people experience. Part of her research has been investigating the experiences of Māori communities. She looked at the barriers and enablers they face when trying to access diabetes technology. The presentation went down well with the audience, and the team was expecting questions at the end. Instead, they found the First Nations audience echoing that they had had almost identical experiences to those people have in Aotearoa. ‘Everything we talked about was escalated,’ Grace explains. While we would have heard of some in rural New Zealand needing to drive a couple of hours to get to a GP, they heard reports of how in Canada that, due to its size, and because a lot of Indigenous people live

remotely, it’s sometimes easier to fly than to drive for hours. ‘Because the roads are in a worse state than in New Zealand, it can be a three to four hour drive, one way.’ Fellow LEAPS member Dr Jake Campbell presented the second abstract, alongside Grace. Their view was understanding the differences in the way people view technology in cultural settings and how this can help with design. Grace gives an example is that the design for their insulin pump they had 12 months ago is different to the design they’re going with today. ‘It’s all due to talking to people, hearing how they live day to day, understanding their user needs. We’ve altered our design to ensure that they’re better suited, rather than what an engineer thinks is suitable.’ Both presentations were well received by the international audience as well as our own contingent. The team was met with enthusiasm by a number of heads of organisations, which included an invitation to present their work at Melbourne medical school. Find out more at: https://leaps.nz.

DIABETES WELLNESS | Summer 2023

Advocate

MAJOR PARTIES PROMISE SHELTER FROM DIABETES TSUNAMI In early September, we held our Diabetes Matters Forum in Auckland, where the Health spokespeople from National, Labour, and the Greens participated in a panel discussion on how New Zealand can turn the tide on the diabetes epidemic.

ith Guyon Espiner moderating the evening, National’s Dr Shane Reti, the Greens’ Ricardo Menédez March, and Labour’s Michael Wood all fielded questions from a crowd consisting of clinicians, people with diabetes, as well as parents of children with diabetes. Members of the audience asked all three politicians what they would do to support the near 300,000 people in New Zealand estimated to have diabetes. Particular pressure came on why CGMs are not funded. A common experience of parents was shared – having to spend $100 a week on a monitor for their child. Diabetes NZ CEO Heather Verry said she and her organisation had been ‘shoved off’ by the government over the past six years and wanted to know why Pharmac’s funding model couldn’t take future savings into account. Reti and Menédez March had an opportunity to share what their parties would do if they led the government. Wood, however, was in the difficult position of defending Labour’s performance

DIABETES WELLNESS | Summer 2023

while also promising it would do better, as well as defending the role of Pharmac. ‘This is one of the wicked problems that we face in our roles… there’s always a situation where we often know that there are things that we can invest in that will have positive long-term impacts, and if you are just looking at it through a fiscal lens will pay off – but you’ve still got to pay for it now … set against all of the other things that are coming through as priorities.’ Reti said specific health targets would be revealed in the following week. He said the projected rise of diabetes in New Zealand was like an oncoming tsunami that we were not prepared for. His main solution was fixing gaps in diabetes-focused workers in the workforce, but he didn’t provide a clear answer on how a National-led government would do this. He said datagathering needed to be bolstered to make sure targets were accurate. Menédez March emphasised the inequitable social landscape that had led to New Zealand’s high level of diabetes. ‘This is a disease of poverty, and particularly relative poverty and inequality in developed nations, and so I think we need to make sure that any work to develop better datagathering doesn’t slow down the work we know we have to do.’ He said the problem wasn’t going anywhere without proper funding of core public services, and he took the debate back to the Greens’ star policy this election – tax reform. All three spokespeople found areas to agree as well as disagree on. On the taxing of sugary drinks, all three agreed there were better, more targeted measures to employ or said their policy work hadn’t

been done. They again agreed there were barriers to access at the primary healthcare level, and there was no disagreement on the gravity of the problem. For Dr Rosemary Hall, however, there wasn’t much to get excited about. She said responses from all three seemed cagey and ultimately failed to deal with the issue of stigma. ‘You can call people up and raise money for cancer,’ she said. ‘But just try that with diabetes and people will say, “oh well, they should just get off the couch”. ‘It’s that kind of public perception’, she said, ‘that’s made it hard for people to speak up and agitate for increased funding … It’s not a sexy illness.’ And in a system where the squeaky wheel gets the grease, she fears the problem of diabetes is not being addressed. Michael Wood agreed, saying, ‘you don’t treat people’s illnesses with a veil of moral judgement’. Source: Matthew Scott, Newsroom

Watch the Diabetes Matters Forum on the Diabetes NZ YouTube channel www.youtube.com/ watch?v=rkIHTyIi0U8&t=35s

ADVERTORIAL

Isey Skyr earns Diabetes NZ approval Isey Skyr is excited to announce that our products have been approved by Diabetes New Zealand to carry the Diabetes NZ Choice logo. Isey Skyr is a good alternative to many yoghurts that contain high levels of sugar. It’s also high in protein and low in fat, making it a good choice for a healthy diet. The Diabetes NZ Choice logo will start appearing on our range of products very soon. A traditional favourite of Icelanders, Isey Skyr is the only skyr in New Zealand and the world that contains original Icelandic skyr cultures. It’s also made in New Zealand, with New Zealand dairy, using the original Icelandic recipe that dates back 1,100 years. The recipe contains three to four times more milk (skimmed milk) than typical yoghurt.

It makes a perfect snack for healthy and active Kiwis, whether that’s after the gym, on-the‑go, at work or as a healthier dessert. It is also delicious added to a nutritious breakfast bowl, in a smoothie or used in baking. Isey Skyr is available in six delicious and unique flavours – Baked Apple, Creme Brulee, Strawberry, Blueberry, Vanilla and Natural. These can be found in the chiller section at selected New World, Countdown, Pak’nSave, Farro, Four Square and Fresh Choice supermarkets nationwide. It’s available in 170g pottles in all flavours, and a larger Viking size 500g in selected flavours.

Chicken and Avocado Salad SERVES 2 200g chicken (cooked) 1 medium-sized avocado 1 tbsp chopped red onion 3 tbsp natural Isey Skyr Rind and juice from 1 lime 1/2 tsp black pepper 1/3 tsp salt 1/3 tsp garlic powder 1 tbsp fresh coriander 1 Chop the chicken into small pieces and place in a bowl. 2 Chop the red onion into small pieces and add to the bowl. 3 Add the Isey Skyr and mix well together. 4 Grate the rind of the lime over the bowl and then squeeze the juice from it into the bowl; mix together. Season with salt, pepper and garlic powder. 5 Cut the avocado into small pieces and add it carefully to the mixture. 6 Shred the coriander leaves and add them; it can also be used as a pretty garnish. Serve with a thick slice of sourdough bread per serve for a complete light meal. PER SERVE: ENERGY 1580kJ (380kcal) | PROTEIN 36.7g | FAT 15.6g (SAT FAT3g) | CARBS 18g (SUGAR 2.8g) | FIBRE 8.5g | SODIUM 232mg

Life with T1

NICOLE SILVER DEXCOM WARRIOR 34

DIABETES WELLNESS | Summer 2023

Four years ago, having already struggled with chronic fatigue for years, Nicole Silver suffered a dramatic change in the quality of her life before she and her family realised what was causing it.

t wasn’t until Nicole Silver came across social media posts by people with diabetes that she began to understand what her new symptoms meant – the oversleeping yet always feeling exhausted, the losing weight, the feeling constantly thirsty, and the frequent bathroom visits. ‘One time, I had just started a new job and I had to go to a conference where I fell asleep. I would also go to lectures and fall asleep.’ As a result of the symptoms, Nicole was forced to move from her flat back into the family home. And it was here where she twigged that something in her body had changed. She went to her GP. ‘She ran tests and, sure enough, it was type 1!’ Nicole began with the normal finger pricking and multiple injections, but, being newly diagnosed, she didn't know much about insulin stacking or the importance of timing doses. She would forget to factor in exercise or whether she was going to be sitting down for the next three hours. She remembers going low with no warning at the most inconvenient times, like when talking to a customer at work or in the middle of a gym class. ‘I would stumble out of the room with everyone looking at me, or I would

be sweating profusely and slurring my words like I was drunk.’ Keen not to repeat this, Nicole became fearful and anxious and would let herself run with a slightly high blood sugar to avoid the embarrassment. Running high all the time meant she was increasing her HbA1c, causing her to feel like a zombie. ‘I felt like the walking dead every day and I knew it would increase my risk for other complications later in life, like kidney damage.’ Nicole says she felt scared all the time as well, especially when going to sleep at night. How would she know if she went low while she was sleeping? Naturally, she worried whether she would wake up the next morning. Or if she ate before bed, would she then go high and stay high during the night and cause ketones? After a year of fear and anxiety, Nicole was approved to get an insulin pump. Not long after that, she made the decision to get a Dexcom Continuous Glucose Monitor (CGM). She had since moved out of home but had to move back in again as rising living costs and the cost of a Dexcom CGM made it hard to stretch her finances. She says she would be over the moon if the Dexcom CGM was funded in New Zealand. ‘It would change everything. I could be a normal 28 year old and move out of home. It feels like a no-brainer given the Dexcom CGM integrates with the pump that is already funded.’

Nicole has roller skated since she was eight years old and competed throughout her teens and into her twenties before retiring and becoming a coach. She now teaches public and private classes in artistic roller-skating. Each class hosts up to 50 people, and she coaches six girls in a private class. ‘It’s like ice skating. You wear costumes and compete with a choreographed routine to music.’ What she enjoys about the community is meeting people of different ages. Some women begin skating in their thirties and

SKATER GIRL

Nicole says she now has more energy and that her mood is a lot better, giving her more confidence to go out and do things. This includes being a roller-skating coach.

DIABETES WELLNESS | Summer 2023

My Identity

is proud to create

start competing. ‘I am passionate about bringing older people into the sport – you don’t have to start young to have a skating career.’ She credits her CGM for allowing her to live such an active and social life. A keen hiker, she enjoys the freedom of going out alone and being connected to loved ones via her blood sugar data, which is shared onto their phones. ‘With my insulin pump, I have Control-IQ, so if I’m about to hit

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the gym, then I can set my activity, which reduces the risk of going low. I also get warned when I’m dropping too quickly or before I have a severe low, so I can treat it in time before anything embarrassing happens. ‘This device is literally a life saver. Long term, it’s putting years back on my life, and short term it’s saving me from life-threatening hypos.’

Your DNZ

2023 DNZ AWARD WINNERS Every year, we grant a number of awards to recognise determined and hardworking people in our diabetes community. JOHN MCLAREN YOUTH AWARDS

These awards offer a scholarship to young people living with diabetes who are aiming high in their chosen fields. The calibre of applicants was very high this year. Our academic awards go to Auckland University engineering student, Adi Bhattacharya. Our sports award goes to nineyear-old Kartsport champ, Toby Thompson. Our cultural award goes to Massey University design student, Danica Waters.

SIR CHARLES BURNS MEMORIAL AWARD

Diabetes NZ presents this award to anyone with diabetes who can demonstrate that they have managed their diabetes through insulin therapy for a continuous period of at least 50 years. The 2021 award recipients are: Angelica von Reitzenstein, Myfanwy Long-Taylor, Malvina Dick, Joanne Hazlitt, Bernadette Barry, Peter Hogg, and Yvonne Dobbie. DIABETES NZ AWARDS

Each year, these awards honour some of the inspiring members of our community. This year, we acknowledge Joy Smith. She

started with the Otago Branch in 2009 and spent many years assisting with the finances for the Branch. Deborah Connor, also from Otago, has served an impressive 19 years as an integral part of the organisation, having held many leadership positions and volunteered her time for countless events over the years. SILVER MEDAL AWARD

This award is for anyone who can demonstrate that they have managed their diabetes through insulin therapy for a continuous period of at least 25 years. This year our recipients are Maryanne Rogers, Sue Pearson, Dawn Forest, and Antony Watson.

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DIABETES

Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

Research

RESEARCH ROUNDUP

We present some of the latest diabetes research news from round the world. GLYCAEMIC CONTROL AND DEMENTIA RISK IN PATIENTS WITH TYPE 2 DIABETES

In April of this year, a study was undertaken to examine the associations between cumulative exposure to various ranges of HbA1c concentrations and dementia risk. The trials were across sex, and racial and ethnic groups, studying the associations of current therapeutic glycaemic targets with dementia risk. A total of 253,211 participants with type 2 diabetes were aged 50 years or older during the study period of 1 January 1996 to 30 September 2015. The data was then analysed from February 2020 to January 2023. Participants with more than 50% of HbA1c measurements (at 9% or more) had greater risk of dementia compared with those who had 50% or less of measurements in those categories. By contrast, participants with more than 50% of HbA1c concentrations (less than 8%) had a lower risk of dementia. Persisting hyperglycaemia, as measured by HbA1, increases the risk of dementia. This study shows that keeping HbA1c levels below 9% (75 mmol/mol) reduces the dementia risk. https://jamanetwork.com/journals/ jamaneurology/article-abstract/2803244

RESEARCH CONTINUES TO SUPPORT THE ROLE OF EGGS IN A HEALTHY DIET FOR DIABETES

A recently published research on 70,468 Chinese adults has observed an association between higher long-term egg intake and the risk of developing type 2 diabetes. These findings have stimulated interest in whether caution in egg intake is needed. In 2020, a systematic review and

DIABETES WELLNESS | Summer 2023

meta-analysis by Harvard University researchers explored the existing body of evidence and found no association between moderate egg intake and the development of type 2 diabetes. Furthermore, egg intake of one or more eggs per day was not associated with the development of type 2 diabetes in Asian populations. Well-designed intervention trials have indicated that individuals with, or at risk of, type 2 diabetes can include six to 12 eggs per week as part of an overall healthy diet. In 2018, researchers at Sydney University undertook a 12-month randomised controlled trial exploring egg intake in individuals with, or at risk of, type 2 diabetes. Known as the DIABEGG study, participants consumed at least 12 eggs per week for 12 months, with no detrimental outcomes on heart disease risk factors or blood glucose levels. These findings are in line with advice from the Australian Dietary Guidelines that eggs can be included as a core part of the everyday diet. https://www.australianeggs.org.au/news/ new-research-continues-to-support-the-roleof-eggs-in-a-healthy-diet-for-diabetes

REMOTE PATIENT MONITORING PILOT GIVES WHĀNAU IN RURAL AREAS MORE CONTROL OVER THEIR HEALTH

Te Aka Whai Ora has invested $2.3 million into four whānau-led pilots. These pilots are for isolated rural areas to test the effectiveness of remote patient monitoring (RPM) in achieving improved hauora outcomes, reduced rates of hospitalisation, and reduced visits to emergency departments for whānau living with long-term conditions. Te Aka Whai Ora is working alongside Te Whatu Ora to support hauora Māori partners based in Te Tai Tokerau, Te Tairāwhiti,

and Wharekauri to deliver these whānau-led pilots. Te Aka Whai Ora is funding the service delivery costs, and Te Whatu Ora is providing remote patient monitoring devices and supporting technology. Jade Sewell, who is the Maiaka Tau Piringa, Deputy Chief Executive – Service Development for Te Aka Whai Ora, says the improved access to healthcare will support whānau to manage their own health and wellbeing, and to be more involved in decisions about their own care. ‘Te Aka Whai Ora is investing in te ao Māori approaches focused on prevention, screening, early diagnosis, and self-management for whānau with long-term conditions such as diabetes, stroke, heart conditions, and gout. ‘Whānau-led remote patient monitoring provides a technological solution for improved access to healthcare where whānau manage and monitor their condition with a device and kaiāwhina support. This allows whānau to co-create and plan a response pathway with their health provider when they require clinical support. ‘This is in line with the goals of Te Pae Tata Interim New Zealand Health Plan and the Rural Health Strategy, which are focused on improving health outcomes and improving equity in health,’ Jade says. Te Aka Whai Ora and Te Whatu Ora are co-leading workshops with hauora Māori partners and whānau to develop the remote patient monitoring model and provide training on how the devices work. Te Aka Whai Ora is committed to ensuring all parts of the pilots are designed with whānau. https://www.teakawhaiora.nz/news/remotepatient-monitoring-pilot-gives-whanau-inrural-areas-more-control-over-their-health/

HELPING TO MANAGE YOUR DIABETES

FreeStyle Libre 2 Glucose Monitoring System NOW WITH OPTIONAL ALARMS! The FreeStyle Libre Flash Glucose Monitoring System is a glucose monitoring device indicated for detecting trends and tracking pattern in persons aged 4 and older with insulin dependent diabetes mellitus, without the use of lancets. Diabetes Care

FreeStyle Optium Blood Glucose and Blood Ketones Testing

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

• Waterproof adhesive patches for your FreeStyle Libre sensor • Designed to suit activity, sport or fashion choice • Assorted colours available • Pack of 20

ESENTA™ Sting-Free Adhesive Remover Sprays and Wipes

Skin Glu™ Barrier Wipes • Barrier wipe used pre-CGM application • Gives the skin extra protection and helps your CGM stick better • Pack of 40

The new ESENTA Sting-Free Adhesive Remover is a fast, painless way to remove adhesive residue that is frequently left behind while changing an ostomy pouch.

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

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

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

A selection of convenient carry cases for medical supplies. • Easy Bag Single • Easy Bag Classic • iCool Weekender • iCool Prestige transforming lives • iCool MediCube

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

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

Powerful, simple, 1 accurate . Introducing Dexcom G7. The real-time continuous glucose monitoring system is now more powerful and easier to use with a small, all-in-one wearable and redesigned mobile app. Building on the trusted performance of Dexcom CGM, Dexcom G7 enables greater diabetes control and improved health outcomes so you can move with conﬁdence, knowing diabetes doesn’t have to hold you back.

For more information on Dexcom G7, please contact NZMS Diabetes on 0800 500 226 or at dexcom@nzms.co.nz nzmsdiabetes.co.nz Always read the label and use only as directed. Read the warnings available on nzmsdiabetes.co.nz/resources before purchasing. Consult your healthcare professional to see which products are right for you. † If your glucose alerts and readings from Dexcom G7 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. ‡ Smart device and Receiver not included with Dexcom G7 CGM system. For a list of compatible devices, please visit dexcom.com/compatibility. § Results obtained with a prior generation Dexcom CGM System. || Separate Dexcom Follow app and internet connection required. Internet connectivity required for data sharing. Users should always confirm readings on the Dexcom G7 app or receiver before making treatment decisions. Compared to a prior generation Dexcom CGM System. # Healthcare providers can register for Dexcom Clarity at clarity.dexcom.com/professional/registration. ** An internet connection is required to send glucose data to Dexcom Clarity via a compatible smart device: dexcom.com/compatibility. Healthcare providers will only be able to view user’s glucose data if the user elects to share it with them through Dexcom Clarity. 1 Welsh JB, et al. Diabetes Technol Ther. 2019;21(3):128-132. 2 See Dexcom G7 user guide for more information. 3 Beck RW, et al. JAMA. 2017;317(4):371-378. Distrubuted in New Zealand by NZMS, Auckland. NZMS is subsidiary of Dexcom. LBL-1001151 REV001 October 2022

Diabetes Wellness Summer 2023

Articles inside

Research roundup

2023 DNZ award winners

Nicole Silver, Dexcom Warrior

Major parties promise shelter from diabetes tsunami

LEAPS

HELPING HER HAPŪ

Fast and furious 37

Coming out with diabetes

Healthy Plates

Samoan Twist

THE SAMOAN SCIENTIST

BIKE IT, YOU'LL LIKE IT!

BIKING THE OLD GHOST ROAD

Saving your life, saving your vision

Diabetes Action Month 2023

Summer 2023 Editorial