Diabetes Wellness Winter 2019 by Diabetes New Zealand

wellness

WINTER 2019

DIABETES

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

CELEBRATING MATARIKI • IS YOUR INSURANCE FAIR? • DELICIOUS KALE • DIY ARTIFICIAL PANCREAS NIGHTSCOUT ARRIVES • BUSTING EXERCISE MYTHS • “ADDED SUGARS” EXPLAINED

THE MORE THE MERRIER

Traditional Māori games and exercise

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Ask your healthcare professional how a FreeStyle glucose meter may assist you. Always read the label and use only as directed. *Scanning the sensor does not require lancets. ‡A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or if hypoglycaemia or impending hypoglycaemia is reported by the System or when symptoms do not match the System readings. ††For a complete glycemic picture, scan once every 8 hours. The FreeStyle Libre software, designed to be used in conjunction with FreeStyle Libre reader and sensor, provides a snapshot of glucose patterns and variability; for more information, see the Software page. §The reader can capture data from the sensor when it is within 1 cm to 4 cm of the sensor. †The indication for children (age 4 - 17) is limited to those who are supervised by a caregiver who is at least 18 years of age. The caregiver is responsible for managing or assisting the child to manage the FreeStyle Libre Flash Glucose Monitoring System and also for interpreting or assisting the child to interpret FreeStyle Libre readings. For more information call Customer Service on 0800 106 100. FreeStyle 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. Medi’Ray New Zealand, 53-55 Paul Mathews Road, Albany, Auckland 0632 www.mediray.co.nz NZBN 9429041039915 ADC-07478 TAPS No: NA 9883

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Contents WINTER 2019 VOLUME 31 | NO 2

COVER: HARKO BROWN WITH A PAKAUKAU, A GLIDER WOVEN FROM NĪKAU FRONDS. PHOTO © JESS CHARLTON, 2018

4 EDITORIAL

5 UPFRONT: Diabetes Otago opens foot clinic

22 TECHNOLOGY: Diabetes tech advocates, Nightscout 23 EAT: Vegan Parmesan

6 UPFRONT: Anytime Fitness supports annual fundraiser

24 CARE: Insulin injection management in New Zealand

8 COVER: Harko Brown helps traditional Māori games and sports make a comeback

26 GROW: The case for kale

10 YOUR DIABETES NZ: Part two of our story on Diabetes NZ’s helpline

31 COMMUNITY: “About a diabetic” world film project

12 EAT: Pūhā & Pākehā – healthy kai and waiata 16 KNOW YOUR RIGHTS: Are you getting a fair deal on your health and life insurance? 18 LIFE WITH T1: Motherhood, mindfulness and the mysteries of diabetes 20 COMMUNITY: Andrew Good – from camper to leader

28 EAT: Navigating the world of “added sugars”

32 MOVE: Craig Wise busts six common exercise myths 34 LIFE WITH T2: Alan Murray’s T2 adventure 36 LIFE WITH T1: Samantha Williams on challenge and strength 38 COMMUNITY: Sewing enterprise and support forum for Northland

21 TECHNOLOGY: Andrew’s DIY artificial pancreas

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DIABETES WELLNESS | Winter 2019

Editorial

Welcome to our winter edition, under the stewardship of our new editor Johanna Knox, who has replaced Caroline Wood. We welcome Johanna who has a strong background in editorial work and lifestyle writing, particularly around food and sustainable living, and is mother to a teen with type 1 diabetes. We would also like to thank Caroline for the many years she has dedicated to Diabetes Wellness. Caroline’s innate understanding of our membership’s interests has taken the magazine from strength to strength and seen it widely acknowledged for its professional content and image. Johanna has joined us at a significant time. We are in a transitional phase and will become a charitable trust on 1 July 2019 – a move overwhelmingly endorsed by membership at the AGM in November. This is another stage on the journey which began in 2012 when the majority of existing societies joined together. In 2017, a Review sought members’ and branches’ experiences of the unification, and identified a degree of frustration, along with a general consensus that Unification was not complete. Branches wanted a truly national organisation. The DNZ Board reviewed governance options, and after lengthy consultation with Committees and membership, it was clear that forming a charitable trust would better assist with achieving Diabetes NZ objectives. The Board and Advisory Council are confident that this new structure will build on the strengths of local support networks and activities, yet allow the organisation to respond to the needs of all people with diabetes throughout the country. This is an exciting time as we explore different ways of delivering an effective and up-to-date service to ensure that all people affected by, or at risk of, diabetes have access to the information and support needed to manage their health and well-being. Society is changing, and how people exchange information and ideas is changing. However, we believe there is still a demand for our magazine, as evidenced by a significant subscription uptake in recent months. As part of our move to the Trust model, financial membership of Diabetes NZ will cease, and current members will be transitioned to free Support Membership with the option to subscribe to the magazine. We are confident that most existing members will take up the subscription option, and continue to be kept well informed on the many aspects of living with diabetes. Our feedback tells us that Diabetes Wellness is often read from cover to cover. We hope this issue, with all the usual advice, investigation, personal stories, recipes and news, will be no exception. HEATHER VERRY

Chief Executive, Diabetes New Zealand

DIABETES WELLNESS | Winter 2019

Diabetes New Zealand is a national charity that provides trusted leadership, information, advocacy and support to people with diabetes, their families, and those at risk. Our mission is to provide support for all New Zealanders with diabetes, or at high risk of developing type 2 diabetes, to live full and active lives. We have a network of branches across the country that offer diabetes information and support in their local communities. Join today at www.diabetes.org.nz

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

DIABETES WELLNESS MAGAZINE Editor 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

DIABETES OTAGO OPENS FOOT CLINIC A bequest from a member, Vic Crimp, has enabled Diabetes Otago to open a long-hoped-for clinic to help people with foot care.

iabetes Otago’s foot clinic opened in November 2018, at their branch office in Frederick Street, Dunedin. It operates on the first Tuesday and Wednesday of each month, between 10am and 2pm, offering 30-minute appointments at $40. It’s open to those living with diabetes, plus others who need it. Podiatrist Georgia Dacres works with Diabetes Otago to run the clinic, and says the vision is “maintenance podiatry for people whose condition makes their feet vulnerable, and aged care for those who cannot see or bend to care for their own feet.”

NZ_Diabetes Wellness.pdf

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The hope, say Noeline Wedlock and Paula Fryer from Diabetes Otago, is to make a difference in people’s lives by offering podiatry that’s affordable. Paula says, “The patients are rebooking after each appointment, so it’s great knowing they’re happy with the service we provide.” Diabetes Otago has worked with medical centres to get the word out, and also liaises closely with the NZ Red Cross, which provides transport for patients who are unable to drive to and from appointments. “It’s been good to build upon this relationship with our local medical practitioners and the DHB, as it gets exposure for Diabetes Otago and we can all work together as a team.” With word of mouth spreading, appointments fill fast. Diabetes Otago hopes to keep growing the numbers of people they see, and eventually to increase the clinic’s

For Georgia Dacres, “providing a safety net for patients who’d otherwise not be able to care for their feet, and educating about good foot health, brings real satisfaction and joy.”

hours. Paula says, “So many people overlook caring for their feet, and this can lead to lifelong complications or even amputations, so it’s important that we continue to raise awareness and be there for people when they need it.” For more info, phone (03) 474 0240 or email noeline@diabetes.org.nz

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DIABETES WELLNESS | Winter 2019

Upfront

ANYTIME FITNESS NZ CONTINUES SUPPORT OF DIABETES NZ WITH ANNUAL FUNDRAISER

fter coming on board in late 2017 as a Champion Sponsor, Anytime Fitness New Zealand is excited to continue its support of Diabetes NZ for 2019. Anytime Fitness NZ CEO Richard Ball says he’s delighted to partner with Diabetes NZ and the invaluable work they do to support people with, or at risk of, diabetes, and to raise awareness about the illness. “We know regular movement and exercise is a key part of managing diabetes, but that sometimes exercise can seem daunting, especially if you don’t know where to start,” he says. “As an inclusive gym fitness provider that welcomes people of all ages and fitness stages, we’re proud to continue our support of Diabetes NZ and to work in partnership to help our communities reach a healthier place.” Last year, Anytime Fitness raised thousands of dollars for Diabetes NZ through the Cardio KMs for Diabetes Fundraising Challenge.

The challenge saw clubs across the country donate money for every kilometre staff and members completed inside and outside the gym throughout the month of July. In July this year, clubs will take part in another health and fitnessinspired challenge to raise funds for Diabetes NZ and promote the benefits of regular exercise. “This year’s fundraising challenge will have the same theme of bringing people together to work towards a common goal, not just to raise some muchneeded funds but also to heighten awareness of the importance of acting now to live well,” says Ball. “We know that significant changes in health and exercise are a long-lasting commitment, but it can be hard to take that first step. That’s why we’re passionate about supporting Diabetes NZ, their members, and the community to take action now, no matter how small, towards a healthy life.”

This time last year, Richard Ball – CEO of Anytime Fitness – shared his own prediabetes story with Diabetes Wellness. He talked about his personal journey to increased health, as well as his adult daughter who has a diabetic condition. This combination of factors made him determined to do something to help, and the partnership between Anytime Fitness and Diabetes NZ was born.

GET INVOLVED Keep an eye on Anytime Fitness and Diabetes NZ’s websites, and on Facebook and Instagram, for upcoming details on July’s challenge and how you can take part: www.anytimefitness.co.nz www.diabetes.org.nz

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

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

DIABETES WELLNESS | Winter 2019

International study seeks participants Would you use remote digital monitoring to manage your type 1 or type 2 diabetes? More than 700 people living with diabetes have already participated in an international study launched by the Centre for Research in Epidemiology and Statistics (National Institute for Health Research INSERM, France) in collaboration with the Knowledge and Evaluation Research Unit (Mayo Clinic, USA). Digital innovation (wearable sensors, artificial intelligence) is revolutionising diabetes management and could facilitate daily life for the 422 million adults living with diabetes. However, wearing a digital device in public and logging personal information could represent a burdensome intrusion of privacy.

This international survey aims to identify what people with diabetes think about using remote digital monitoring as part of their care. Participants are asked to rate different possible forms of using digital tools to monitor and manage their diabetes, and to share their views and expectations of how digital transformation would affect their lives.

If you are 18 years old or over, have type 1 or 2 diabetes, and wish to get involved in the ongoing study, you can take the 15-minute survey online, in English or French, at clinicalepidemio.fr/diabete/en At the end of the study, the researchers will share a summary of the findings with Diabetes Wellness magazine.

STUDY RESULTS: CONSUMER EXPERIENCES WITH PHARMACIES Last year Diabetes NZ supported a University of Auckland study that explored the views of health consumers who live with at least one long-term condition â&#x20AC;&#x201C; focusing strongly on diabetes. Now the results are in. As conditions such as diabetes and heart disease become more common in New Zealand, the demand for healthcare services is growing. Community pharmacies are seen as well placed to provide more of these services effectively and efficiently. But first, researchers need to understand the views of healthcare consumers. This study collected data between July and September 2018 using an anonymous survey. Participants had to be at least 16, and to have lived in New Zealand for over six months.

KEY FINDINGS

Responses from 178 health consumers were analysed. Eighty one (46%) of the respondents reported having diabetes and 114 (64%) identified as NZ European. Trust findings 46% would not find it difficult to discuss private things with the pharmacist. 64% were more interested in the quality of care than the providersâ&#x20AC;&#x2122; professions. 13% preferred to discuss medication issues with the pharmacist rather than the doctor. Satisfaction findings 83% were totally satisfied with their most recent visit to their pharmacist. 20% wanted more time with the pharmacist.

25% thought their interaction with the pharmacist could have gone better. Satisfaction with self-management support 72% were satisfied that the pharmacist had told them everything about their medicines and treatment. However: 25% were told what signs and symptoms would indicate that their condition was worsening. 40% were told what to do if their condition worsened. 33% were given lifestyle advice. Further research is needed to find out more about consumersâ&#x20AC;&#x2122; views on the potential role of the pharmacist in helping those with diabetes and other long-term conditions to manage their health.

DIABETES WELLNESS | Winter 2019

Cover

MĀORI GAMES FOR EVERYONE Tākaro Māori – traditional sports and games – are making a comeback. PE teacher Harko Brown, whose philosophy is “the more the merrier”, explains.

ur daughter Billie has now had type 1 diabetes for 10 years, and her exercise and sport have overwhelmingly contributed to her positive outlook and sociability, as well as moderating her blood sugar levels. Billie’s diabetes has also been a motivating factor in my own professional life. It’s been a calling for me personally to try to be a facilitator for a wide variety of physical activities – collaborating with others to revive and sustain our traditional Māori pastimes. We all know that youth need to be enthralled and excited by the recreations they choose, and I believe that out of the hundreds of our own cultural games legacies, at least one will be a good fit for anyone with any form of diabetes, and for youth in general. NATURE’S APPARATUS

Billie collects resources to make aro-tākaro (games implements).

DIABETES WELLNESS | Winter 2019

Traditional Māori games – tākaro – are a great resource for physical activity, because their aro-tākaro (implements of play) are readily available from our environment. You merely need to walk into a native bush, show your respect for the domain of Tāne-mahuta, offer your appropriate thanks, and be introduced to a plethora of plants and trees for making games artefacts. Such explorations are in themselves exercise, and with the ambience of forest trees and birds, perhaps a cooling breeze, and the sparkling of dappled sunlight through ferns and branches, it can be a deeply meditative experience.

THE WORLD OF HUPARA

People have shown a lot of interest lately in ancient Māori games artefacts known as hupara. Hupara are designated logs or wood-based apparatus (often decorated) which are used for exercise and socialising. At our home in the Bay of Islands, we’ve installed several hupara for Billie, her sister Yves and their friends to use in their training regimes. Hupara were once integral to daily tribal life, and their range of uses is awe inspiring. As well as exercise apparatus, they’re educational tools and psychological enablers for individuals and entire tribes. Each hupara has its own stories and legends. The book I was privileged to author in collaboration with Physical Education NZ (PENZ), Ngā Tāonga Tākaro II, has an entire chapter on these remarkable cultural icons. AUCKLAND’S HUPARA GARDEN

The Auckland Council have installed 10 hupara together in a giant ‘mara hupara’ (hupara garden) as part of their massive, two-kilometre-long Te Auaunga Awa wetlands project in Mt Roskill. It was officially opened in April this year by Auckland Mayor Phil Goff. Tangata Whenua, local boards, construction companies, and architects – along with several schools – all worked passionately together to realise this, the first ever council-founded mara hupara in Aotearoa. Several more mara hupara are planned for other parks and reserves in the near future.

Harko speaks at the opening of the new mara hupara in Mt Roskill.

WIN A BOOK To show their support for Diabetes New Zealand, PENZ is generously giving away six copies of this beautiful, informative book by Harko Brown.

Students from Ōwairaka School stand on decorated ‘hīkeikei’ hupara.

MOARI AND MORE

In the Far North where we live, there is a rich history of hupara. One of the once-common hupara was a giant stride swing called a moari. It consisted of a tall, massive tree trunk with several ropes dangling from the top. The moari would be slanted at an angle over a river or a breathtaking drop, and exhilarated users would swing freely around, singing chants as they flew. Moari were so revered in the north that there was an entire region, centred on Kaeo, called Te Moari. Te Moari Road leads to its ancient location on the banks of the Kaeo River. In nearby Pakaraka, there is a Hupara Road. It follows a range of hills which were once dotted with moari, as well as hupara such as kōkiri, hīkeike, puri, and tūpekepeke – which you can walk, run, jump and hop along. Many of the 60 hupara we’ve

researched are once again seeing the light of day, and being utilised for the hauora and social benefits of communities around Aotearoa New Zealand. HOW TO GET INVOLVED

If you live in Auckland, check out the amazing Mt Roskill mara hupara along O’Donnell Avenue. If you’re in another region, maybe it’s time your council got on board and created their own cultural hupara icons. You could let them know. These creative, fun-filled natural playgrounds are pleasingly bereft of steel, rubber and plastics. They also have enormous educational possibilities, and we’re currently putting efforts into showing our Ministry of Education what can be gained emotionally, physically, mentally, and spiritually for our youth by having them integrated into school precincts.

Ngā Taonga Tākaro II – The Matrix by Harko Brown published by Physical Education New Zealand (PENZ) RRP: $77.00 Info: penz.org.nz Take an enthralling educational journey into the whakapapa and contemporary uses for over 50 traditional Māori games and activities. Comprehensive insights into their spiritual, environmental and musical aspects, combined with their practical applications, guarantee a rich resource for classrooms, gymnasiums, playgrounds, marae, sports fields, backyards and living rooms in Aotearoa and worldwide. To go in the draw, put BOOK in the subject line, and email your name, phone number and postal address to: draw@diabetes.co.nz Or post to: Freepost Diabetes NZ PO Box 12-441 Wellington 6144 Competition closes 31 July 2019.

DIABETES WELLNESS | Winter 2019

Your Diabetes NZ

HERE TO HELP (PART TWO) More than 200 people a month phone Diabetes NZ’s helpline to ask for support and advice. In autumn, we ran an article sharing some of their questions, and it was so popular with readers that we decided to do another. Diabetes NZ operates a helpline (0800 DIABETES or 0800 342 238) weekdays from 9am to 3pm, providing free diabetes support and advice to people around the country. After hours, you can leave a message on the answerphone. In a diabetes emergency, call 111.

icky Steel is the friendly voice at the other end of Diabetes NZ’s free helpline. Here are some of the latest questions she’s fielded. All names and locations have been changed.

CALLER 1

Aroha, office manager for a Canterbury primary school, phones to ask if Diabetes NZ has any resource material to help staff prepare for the arrival of two new pupils with type 1 diabetes. Diabetes NZ has a flip chart available for schools that explains how to support a student with type 1. The Diabetes NZ website also includes links to diabetes action and management plans. These documents have been produced by the New Zealand Child & Youth Clinical Networks in partnership with the Paediatric Society of New Zealand. They provide a guide for the consistent care and management of children and young people with diabetes in schools and early childcare organisations. Nicky gives Carol a link to the plans: www.diabetes.org.nz/diabetesaction-and-management-plans

Some of the team at the DNZ office: (from left) Marsha Mackie, Heather Verry with Jerry the Bear, Stephen Jarvis, Nicky Steel and Liz Dutton.

DIABETES WELLNESS | Winter 2019

CALLER 2

John is an inmate in a North Island prison and has type 2 diabetes. He says his blood glucose levels are bouncing around, and he wants to know how to manage his diabetes for lower and more consistent readings. He says he knows he needs to lose some weight. Nicky advises John to look at what he’s eating and how much, and suggests he asks the prison if he can be put onto a special low-fat diet or vegetarian menu (less meat, lower in fat and calories). He also needs to try and ensure he takes regular exercise – at least 30 minutes daily which can be broken into smaller bursts over the day. CALLER 3

Graeme phones from Nelson asking where to get a new diabetes logbook, as the one he’s using is full. Logbooks are typically supplied by diabetes medication companies and should have information printed on them about how to reorder. Diabetes NZ has a small stock of Pharmaco’s My Diabetes logbooks available. CALLER 4

Tina, a truck driver from New Plymouth, has been diagnosed with type 2 diabetes and wants to know what she needs to do to manage it. She drives long distances each day, with a stop for lunch at a roadside takeaway. She tries to take walks after work as often as she can. Anyone living with diabetes who has to spend long periods of time in a sedentary role should eat healthy food in sensible portion sizes, and also try to take regular breaks for some physical activity. Nicky discusses with Tina whether she could also take a quick walk whenever she stops for a truck stop break, even if it’s just around her vehicle, and challenge herself to increase the number of laps over a period of time.

CALLER 5

Roger from Te Awamutu has type 2 diabetes and has been feeling dizzy. He was prescribed Metformin a few weeks ago, but stopped taking it because it made him nauseous. People starting a new diabetes medication such as Metformin may feel unwell in the initial stages as their body adjusts. Usually these feelings subside. However, if you’re feeling nauseous or unwell for more than a week, talk to your GP. This is what Nicky advises Roger to do. Your pharmacist is also a good source of information about diabetes medications and managing any side-effects. CALLER 6

Gillian is pregnant and has been diagnosed with gestational diabetes. She calls from Hawke’s Bay wanting to know if this means she’ll get type 2 diabetes in the future. Nicky explains that women with gestational diabetes have a higher risk of developing type 2 diabetes, but not all will. Doctors advise women with gestational diabetes to get regular diabetes checks for the rest of their life. Research also shows that making lifestyle changes straight away, for example losing weight if appropriate and switching to a healthier diet, can reduce the risk of going on to develop type 2.

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on. No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 257,000 New Zealanders with diabetes to live full and active lives.

CALLER 7

Barry from Whanganui has booked an air ticket to the UK. He’s taking insulin and wants to know how to keep it cool during the flight. Nicky advises Barry to buy a cooling bag for the flight. These are available from Diabetes NZ Auckland’s online shop: diabetesauckland.org.nz/shop

For a confidential discussion, please contact Nicky Steel admin@diabetes.org.nz or 04 499 7150

DIABETES WELLNESS | Winter 2019

Eat

Jarrad and Belinda McKay are the couple behind Pūhā and Pākehā, a Māori fusion cuisine business. Here they talk food, wellness, and what Matariki – the Māori New Year – means to them.

DIABETES WELLNESS | Winter 2019

MATARIKI WITH PŪHĀ & PĀKEHĀ

s winter settles over the country, preparations for Matariki, or in some places Puanga, begin. Traditionally marking the end of harvest, this is a time for reflection, planning and renewal – one which has again become celebrated widely in this country. For Jarrad (Tainui and Ngāti Kahungunu) and Belinda (Pākehā), Matariki is “a time for celebration and feasting; sharing kai with guests and those close to you.” They’re both passionate about food and its importance to health and wellbeing. The duo started their business five years ago, motivated by seeing a huge lack of Māori and native New Zealand kai in the market. A Massey University study, showing that it’s vital to Māori health to acknowledge the importance of traditional kai, became “another reason we felt it was important to bring aspects of Māori kai to the forefront of cuisine offerings available to the public”. “The purpose of kai is to sustain your body,” says Belinda. “What you put into your body can have a positive or negative effect on your health.” Jarrad says, “Culturally, Māori see themselves as an integral part of their surroundings, connected to the land, the sea, and the bush through whakapapa. From a Māori perspective, people are land and

land is people. We all come from Papatūānuku, the earth mother. Papatūānuku sustains us while we are alive, and we return to the land when we die.” This fundamentally respectful approach to the local land and sea, and the food provided by both, informs everything that Pūhā & Pākehā do. They’ve developed a strong kaupapa around “engaging the people of Aotearoa with the kai of Aotearoa.” They say their brand is also about inclusiveness, bringing two cultures together, and “adding one thing to another to create something new.” MOBILE BEGINNINGS

Pūhā & Pākehā started out with a caravan in 2014, taking their food to markets and other events. They rapidly added catering to their activities, then last year they opened the doors to their own eatery in Auckland’s Grey Lynn. They say it’s good to finally have a permanent home, where customers can find their Pūhā & Pākehā favourites anytime. “Our aim is to bring people together over food,” says Belinda. “It’s a great leveller and a great way to connect.” Music is also integral to their eatery. They note that music and waiata have always been important to manaakitanga (hospitality). And for Māori, “hosting guests enhances the mana of the people hosting, so it’s very important that your guests

have a good time. You’ll often find a relaxed, jovial environment at the marae of people sharing kai and singing waiata. And guests use waiata as a way to thank their hosts for their hospitality. “We have a guitar on hand at the eatery for anyone to pick up and play if the mood strikes, and we play only New Zealand music. It’s a way of creating a relaxing, proudly Kiwi environment.” This year, Belinda and Jarrad will take part in a number of Matariki events. “We often cater to companies wanting native New Zealand kai to go with their celebrations.” If you don’t have a chance to experience their food at one of their events or at their eatery, you can still enjoy one of their most popular winter recipes, Smoked Kahawai and Kūmara Chowder, which they generously share with Diabetes Wellness readers on the next page. “It’s great to promote a sustainable fish that’s often underrated, the combination of smoked kahawai and sweet kūmara is quite unique.” Recipe on page 14 FIND JARRAD AND BELINDA AT www.puhaandpakeha.co.nz www.facebook.com/puhapakeha www.instagram.com/ puhaandpakeha

Whiria te tangata | Weave the people together. WHAKATAUKĪ/PROVERB

DIABETES WELLNESS | Winter 2019

Eat PŪHĀ & PĀKEHĀ’S SMOKED KAHAWAI AND KŪMARA CHOWDER MAKES ABOUT 3 LITRES | SERVES 6

This recipe is a winter favourite at Pūhā & Pākehā, and Jarrad and Belinda have generously offered a special version to Diabetes Wellness readers. 1 medium carrot, finely chopped 1 stick of celery, finely chopped 1 brown onion 1 clove garlic 1 tbsp smoked paprika 1 tsp pepper 250g potato, peeled and roughly chopped 500g kūmara, peeled and roughly chopped 4 cups (1 litre) Campbells Real Stock – Fish 300ml low-fat milk 200ml water 500g smoked kahawai – pulled 200g sweet corn 2 tbsp chopped fresh chives 2 tbsp chopped fresh flat leaf parsley Place carrot, celery, onion, garlic, smoked paprika, salt, pepper, potato, kūmara and stock in a large pot. Cover and bring to the boil. Reduce heat and simmer for about 20 minutes or until vegetables are tender. Add milk and water, then blend until smooth. Add sweet corn, chives, parsley and smoked kahawai, and heat through. Serve with a dollop of yoghurt, a garnish of chives and some crusty bread. Dietitian’s note: Smoked kahawai contains salt. If you want to reduce the salt in the recipe, use a reduced salt vegetable stock in place of the fish stock. PER SERVE | CALORIES: 1300kJ (311kcal) | PROTEIN 24.8g | FAT 5g (SAT FAT 1.5g) | CARBS 34.5g (SUGAR 16.6g) | SODIUM 626mg

TAKAKAU (SODA BREAD) This simple, traditional bread is fantastic when still warm, and especially good with winter soups. SERVES 8

1 cup plain flour 1 cup wholemeal flour 2 teaspoons baking powder 1 cup low-fat yoghurt Olive oil spray Preheat oven to 230°C. Put the plain flour, the wholemeal flour, and the baking soda in a bowl, and whisk together with a fork. Make a well in the middle of the flour, and pour in the yoghurt. Mix gently then knead for a minute or two, just until the dough comes together in a ball. Spray a baking sheet with oil, place the takakau dough on the sheet, and press it into a thick disc. Score a deep cross or eight-pointed star into the dough. Bake for 10 minutes, then spray oil across the top of the bread. Turn the oven down to 200°C. Bake for another 10, or until a knife inserted comes out clean. Remove the takakau and let it cool for at least 10 minutes. TIPS

You can flavour your takakau with citrus zest, and/ or herbs such as finely chopped chives or kawakawa. Mix them into the dry ingredients before adding the yoghurt. Buttermilk makes a good alternative to low-fat yoghurt. A citrus-infused olive or avocado oil used to grease the tray and brushed on as a glaze is a delicious alternative to olive oil spray. Dietitian’s note: Sliced into 12 pieces this would be 100kcal per slice. ENERGY PER SERVING (SERVES 8): | CALORIES: 623kj (150kcal) | PROTEIN 6.3g | FAT 1.3g (SAT FAT 0.3g) | CARBS 24.9g (SUGAR 2.3g) | SODIUM 162g

DIABETES WELLNESS | Winter 2019

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www.zilch.co.nz To the Consumer: This Voucher is non-assignable and is only valid on the following products: Zilch Chocolate, Zilch Vanilla Bean & Zilch Summer Berries. Only one Voucher can be used per product purchased. This Voucher cannot be used or exchanged for any other products, nor redeemed for cash. Copies are not valid, originals only will be accepted and can only be used once. This Voucher must be redeemed by 31/05/2020. This Voucher may not be used in conjunction with any other discount or special offer. This Voucher is issued by Emerald Foods Ltd, please present at your nearest supermarket ranging Zilch™ Ice Cream within New Zealand. To the Retailer: Provided this Voucher is redeemed in accordance with the customer offer above, it will be credited in full, plus the normal handling fee by sending to; The Coupon Company Ltd, PO Box 47-319, Ponsonby, Auckland 1144.

TCC 19959

Know your rights

Is your insurance fair? New Zealanders who live with diabetes often pay exorbitant insurance premiums, no matter how well their condition is managed. Until recently, one of these people was Rae Ah Chee, and his story points to a possible solution.

ae Ah Chee – caterer and former chair of Diabetes Auckland – was shocked when he went to take out business life cover 25 years ago. “Because I had been diagnosed with type 2 diabetes, the insurer had a set ‘loading’ which they would not budge on.” “Loading” is an extra cost built into an insurance policy. It’s intended to cover losses to the insurance company that could come from insuring someone who they consider carries an especially high risk. In Rae’s case, the initial loading was 400% over and above the normal premium. Rae has been insulin dependent for nearly 20 years, but has always managed his condition and his general health carefully, and his HbA1c levels remain within his target range. When he was first told how much he would have to pay for insurance, he asked what he needed to do to get the loading reduced: “I asked for medical yardsticks against which I could be tested to support my control of key indicators – weight, blood sugar control, HbA1c, blood pressure, etcetera. But they wouldn’t budge on the loading, nor answer anything to

DIABETES WELLNESS | Winter 2019

indicate what I had to do to get the loading looked at.” However, Rae was persistent. Every year he contacted his insurance company, presented his test results to them, and asked again to get his loading looked at. “By showing consistent HbA1c readings, good blood pressure, good cholesterol readings, static weight, along with overall good health and no diabetic-related medical issues I was able to get the loading slowly reduced over a period of eight years. Eventually, I was rated ‘normal’, with no loading!” He says his diabetes specialist has told him his management is “exemplary”. WHAT ABOUT OTHERS?

Rae had several factors in his favour. As well as his own dogged determination, he had an insurance broker who was behind him all the way, and he’d by now found an insurance company that was willing to listen. He knows that many other people with diabetes are still struggling with excessive loading on their life and health insurance policies, and he has a keen sense of how unfair it can be. “When I chaired Diabetes Auckland, we had an annual lunch for people with diabetes who’ve

been on insulin for 50 years. The attendees at these functions were obviously senior, but all looked to be in good health, indicating to me that diligent care of your health can very likely lead to normal life expectancy.” Rae wanted to take further action to help other people. “About five years ago I started to canvass whether insurers would consider giving people with diabetes standard rates as long as they met certain criteria. HbA1c readings are a gold standard and a proven yardstick. So with those, along with weight, blood pressure, and cholesterol readings, a person should be able to be rated ‘normal’ or subject to a small loading which can become normal if they show consistent ongoing readings within the tight range that is agreed.” He found that many insurers were not interested. “Insurers are very, very slow to change. They are ultra conservative.” However, “with 240,000 diabetics in New Zealand, this is a huge number who may well be unfairly paying too much for insurance protection, or even be considered ‘uninsurable’. To put people in a position of being uninsurable is grossly unfair, especially for those who diligently

look after their health. “I would like insurers to treat people with diabetes fairly, with agreed criteria, so that premiums can be normal or loaded according to how the person measures alongside the criteria. And if annual checks are necessary, the premiums can be assessed accordingly – static, upwards or downwards.” Rae believes that hard questions around diabetes and insurance need to be asked – and answered. Diabetes NZ is interested in taking up this cause. While work around this is in the very early stages, the organisation is currently looking at supporting a proposed new system that would take advantage of recent advances in data management to develop a world-leading suite of insurance products for people with diabetes. Insurance companies have traditionally operated in a way that means they don’t have the time or resources to manage each and every client’s case in the complex and ongoing way that people with diabetes really require. A company will do one assessment, and then that’s it. But new technology has begun to be used overseas that allows insurers to manage much higher caseloads with more complexity and ongoing responsiveness. Diabetes NZ says: watch this space.

MINIMED™ 640G SYSTEM WITH SMARTGUARD™ TECHNOLOGY Guardian™ Sensor 3 Our most accurate sensor drives our exclusive SmartGuard TM technology to help reduce hypoglycaemia1.

CONTOUR® NEXT 2.4 blood glucose meter The only meter to link wirelessly to the MiniMed TM 640G insulin pump for highly accurate sensor calibrations .

MiniMed ™ Quick-set infusion set Medtronic oﬀers a wide range of infusion sets so that you can choose the right one for your comfort and safety.

CareLink ™ software Upload to CareLink™ software to conveniently track your glucose control and remotely share this information with your healthcare professional.

WHAT CAN YOU DO ABOUT YOUR INSURANCE NOW? If you have cover that has additional premium loadings or exclusions ask your broker, or the insurance company directly, to review your situation. However, be aware that this needs to go hand in hand with your selfmanagement. Are your HbA1c results steady or improving? Is your diet appropriate, and do you control your sugar intake? What does your exercise routine look like, and are you able to monitor this and provide evidence to the insurer? Do you consistently take your medical prescriptions? Are you exposed to other health complications as a result of poor or difficult management? If you’re applying for insurance for the first time find an adviser or broker who you trust, and ask that they work for you to obtain the best terms possible. Again, this needs to go hand in hand with close management of the condition you live with.

MiniMed 640G Insulin Pump Fully Funded for eligible patients Talk to your healthcare professional today for more information For detailed information regarding instructions for use, indications, contraindications, warnings, precautions, and potential adverse events, please consult the device manual. For further information, contact your local InterMed representative on 0800 333 444.

References: 1. Abraham MB. et al. Diabetes Care 2018 Feb;41(2):303-310 2. Bailey T, et al. Clin Chim Acta 2015;448:139-145 UC201906873EE © 2018 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. Ascensia, the Ascensia Diabetes Care logo, and CONTOUR are trademarks of Ascensia Diabetes Care.

InterMed Medical Limited Free Phone: 0800 333 444 www.intermed.co.nz 71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740 The MiniMed 640G Insulin Pump is fully funded in NZ for eligible patients by Special Authority. TAPS PP3861

Life with T1

Motherhood, mindfulness and the mysteries of diabetes

W Aimee Young’s diagnosis of gestational diabetes came as a shock – so did discovering she had type 1 eight years later. A busy mother and legal practice manager, Aimee has found her condition doesn’t follow textbook patterns, making it tough sometimes to get adequate treatment.

DIABETES WELLNESS | Winter 2019

hen Aimee Young was 28 weeks pregnant with her first child, she went into early labour. ‘They stopped it, but I’d been quite unwell, and when they did the gestational diabetes test it came back high.” The frontline treatment for gestational diabetes, metformin, didn’t control her blood sugars, so she was put on insulin. After her daughter was born, her blood sugars returned to normal. “With my second daughter, I was 12 weeks pregnant and they said we should do another HbA1c to keep an eye on my blood sugars – and they were already off the charts. I went straight back on insulin. “Both babies were fine and my blood sugars were normal afterwards.” As gestational diabetes sometimes indicates you’re prone to type 2 diabetes, Aimee’s GP and others gave her lifestyle advice, but her diabetes midwife from Auckland Hospital felt “something didn’t add up”. After the birth, “she said, just to rule it out, get this blood test done. It takes a couple of weeks, then we’ll find out if you’ve got the antibodies that indicate type 1. “I had the test and didn’t give it another thought until the phone call. She said, ‘I hate to tell you

this but your antibody levels are high’. I was in shock. My HbA1c was still normal, but they said, ‘It’s just a matter of time. You need to continue to do your HbA1c and check your blood sugars regularly.’” It wasn’t until about two years later, when Aimee got sick with a virus, that her blood sugars rose, and she had to start taking basal insulin regularly. “So I had the longest honeymoon phase. And they say I’m still in honeymoon. If I eat high carbs, I need short-acting insulin. But a lot of the time I get away with just basal. But I also have terrible lows. They think my pancreas must surge insulin now and again. I can be eating and doing everything like normal, but then what my pancreas creates, along with the Lantus in the background, is too much.” Aimee took part in a fitness and low-carb diet challenge last year, and during that time didn’t need insulin at all. “I don’t know if it would still be the same now. And no one can give me any real answers about what to expect.” Her pancreas is following its own idiosyncratic time line. “The hardest thing is that I fall in and out of the system. My levels will be good, so they discharge me to my doctor. Then my levels get bad, and they take me back on at

hospital. Then they discharge me again. At present, I’ve only just managed to get another hospital appointment because I dropped off the system altogether, and my levels at the moment are not good. It’s frustrating. Can’t they just keep me in the hospital system? It’s not like it’s going to go away. But they said that’s just how it works.” COPING MENTALLY

Aimee says the strict way she had to control her diabetes during pregnancy still impacts on her approach. “Take the regular management of type 1 and turn it up by ten. The way I was taught to deal with it during pregnancy, it’s different to how you deal with it outside of pregnancy. During gestational I kept my blood sugars strictly between five and seven – which is such a tight line – and tested every two hours. Now I find I beat myself up a lot. I shouldn’t have eaten that, I should have known what the dose for that was, my levels are terrible ...” She says a mindful self-compassion course helped her in early 2015. Health psychologist Anna Friis ran it. She was researching the ways stress increases blood sugar levels, and how stress reduction through self-compassion could help people with diabetes. “It was for eight weeks – one night a week – mindfulness and self-compassion for people with diabetes. You had your HbA1c done regularly throughout. The effect it had on people’s blood sugar levels was very positive overall, and her study’s now been published around the world.” Aimee thinks a refresher course could be useful for her, but she’s recently found joy and relaxation in indoor and outdoor gardening. “That’s a mindfulness thing. When I’m tending to my plants I don’t think about anything else. And you see the results of your care. It’s like daily therapy. For other people it’s having a pet or a hobby.” WORKING WITH MY IDENTITY

Also vital to Aimee has been seeking out others with type 1 for support and inspiration. “Mostly on Instagram – you find these people and stories, and sometimes that story is a lot like yours, and you reach out. Next thing, you’re networking with people all over the world.” It was through Instagram that Aimee met Hayley McDonald from My Identity. Aimee jumped at the chance to work with Hayley to design the medical bracelet on this page. She says, “I knew I should wear my medical bracelet, but it was too big. I’d take it off all the time. This I can wear: my birthstone is turquoise, and I wear beads all the time with my Fitbit, it’s perfect.” Aimee’s Instagram www.instagram.com/justcallmeplantlady

Community

In April this year, when Andrew Good received an ASB Good as Gold Award for his work with Diabetes Youth, he was surprised and overwhelmed. For him, volunteering has always been about giving back to a community that he says gave him so much as he was growing up.

Andrew and wife Hayley

ndrew Good, Chair of Diabetes Youth Auckland, was diagnosed with type 1 when he was five. He says, “a natural choice soon became apparent. Either be defeated by diabetes, allow it to control my life, and forever see it as an obstacle to success, or take control; learn to recreate the boundaries of what a lot of people consider a defining or restricting condition. “My parents played a huge part in developing the mindset I live with today. After struggling for months, holding me down to do my injections, they helped me build my own confidence and independence to self-manage. They encouraged me to try things and push the perceived limits.” Andrew was a regular at Diabetes Youth camps as a child. “I was always excited to attend, albeit homesick, and I have fond memories of the activities and learning.” It was thanks to camp that he discovered how much he enjoyed rock climbing, which is still a huge part of his life today. “It led me to climb

DIABETES WELLNESS | Winter 2019

FROM CAMPER TO LEADER socially throughout my teens and adult life – around New Zealand, Australia and the USA.” There have been difficult times too: “Diabetes burnout is always there, even today. And especially through my teenage years, I had a horrific HbA1c. There were too many other things to focus on. But keeping active in sports and outdoor adventure kept things in perspective for me.” THE DECISION TO GIVE BACK

In 2012, Andrew decided to volunteer at the annual children's diabetes summer camp. “Initially, I returned simply to be a helping hand, but I quickly realised there was something much bigger happening. It needed passionate people to build confidence and independence, and to inspire youth and their families. As a community, we all know how difficult type 1 diabetes can be to manage, so I wanted to help others see around what could be considered as a barrier to achievement.” Before long, he’d joined both the Auckland and national

Diabetes Youth committees. He wanted “to bring in a youth voice and speak for those who relied on the services we provide the most. Youth are the future of our organisation so to support them makes absolute sense to me.” Most of all, he loves seeing “those moments where children realise they are no different from anyone else – when they achieve things both in diabetes and in the activities that have pushed them outside of their comfort zones. And then when someone asks how they can get involved to make a difference, just like I have, this gives meaning to everything we do.” And what about the people supporting the supporter? “My wife Hayley; past and current endocrinologists Cheri Hotu and Steven Miller; and Carla Canty – friend & fellow DYA volunteer/committee member – have all supported, encouraged, guided and motivated me to take on new challenges, and to lead and inspire others living with type 1.”

Technology

Andrew is a leader in more ways than one. He’s among a small but growing number of New Zealanders with type 1 who are constructing artificial pancreas systems for themselves.

ANDREW’S ARTIFICIAL PANCREAS

ost people with type 1 have a method of monitoring their glucose, and a method of administering insulin, and the two operate completely separately from each other. But would it be better if you could link these processes so that your real-time blood glucose levels automatically controlled exactly how much insulin you received? Connecting a glucose monitor to an insulin pump like this requires some sophisticated technology, but, as many already know, this technology does exist. The end result is called “closed loop insulin delivery” or an artificial pancreas system (APS). While the technology is out there, getting access to it through the conventional medical system can be difficult or impossible. However, the global #WeAreNotWaiting movement, led by people with type 1, is on a mission to change this. In this country, an organisation called Nightscout NZ is leading the charge, and Andrew is one of Nightscout NZ’s founding members. Andrew first came across the international #WeAreNotWaiting movement in early 2018. When he realised it was possible for someone to make their own APS, he seized the opportunity. “After ordering the various items needed, I successfully ‘closed the loop’ in

July 2018 with a FreeStyle Libre; MiaoMiao (a device that converts the Libre into a continuous glucose meter, or CGM); a Medtronic 554 pump; and an 'OpenAPS' rig – a small computer device used to process all the data. “The artificial pancreas system automatically adjusts basal rates and delivers bolus doses based on the CGM result (and recent history), insulin on board, and carbs eaten. “While it's not a set-and-forget system, it’s helped to improve my control and taken a significant amount of manual calculations out of day-to-day life. I spend less time managing my diabetes and I get better results. I now wake up right on target every morning. I can trigger different bloodglucose targets based on what's happening in my Google Calendar – like automatically increasing my target blood glucose before going to the gym. And I enjoy more freedom and less stress, both in everyday life and when I’m active. “It’s reassuring that my system’s actively working to prevent hypoglycaemia by shutting off the delivery of insulin if it predicts I’ll go low, as well as bringing my glucose levels down to avoid sustained high blood sugars.” It does take some time to set up and learn how to use it, says Andrew, “but plenty of people who aren’t techy have done so successfully. The growing community worldwide as well as the presence of Nightscout NZ,

means you don't have to do-italone.” He believes that “between community support and easy-tofollow online guides, anyone can get an artificial pancreas up and running in a short timeframe.” You do currently need the financial resources to do it, though. “I self-fund the FreeStyle Libre sensors and also the FreeStyle Optium blood glucose test strips to allow for a higher accuracy blood glucose result. That gives me confidence that when calibrating my APS I’m able to achieve the desired control. These costs add up quickly.” For Andrew, “it’s a small price to pay given the additional flexibility and control gained and reduction of long term health risks.” However, Nightscout NZ is well aware that many people with type 1 diabetes don’t have the financial resources to take advantage of recent technology. One of their aims is to advocate for funded access for all people with type 1. Andrew adds that, “While DIYAPS is an unapproved and unregulated system, safety is the number one priority. Overall, I’ve experienced it as a much safer way to managing my diabetes compared to MDI (multiple daily injections) or a pump on its own.” For more on Nightscout and the #WeAreNotWaiting movement, see page 22.

DIABETES WELLNESS | Winter 2019

Technology

Nightscout New Zealand A new, local organisation is part of a global movement of people with type 1 diabetes, who are creating technological innovations for themselves and others under the #WeAreNotWaiting banner. Tim Gunn, Chair of Nightscout NZ, explains.

ive years ago, a group of parents of children with type 1 got together and released the first version of the software we call “Nightscout CGM In the Cloud”. This enabled their children’s CGM (continuous glucose monitoring) data to be viewed “live” from anywhere with internet or cellphone coverage, and allowed parents and children with type 1 to sleep more comfortably knowing they were being “scouted” for while they slept. Since then, Nightscout has grown into a comprehensive piece of software to manage and view anything to do with diabetes. It has also kickstarted the international #WeAreNotWaiting movement. Nightscout NZ is a non-profit organisation that we launched on the 23rd of January, 2019. Its mission is to act as an advocacy and education organisation to support New Zealanders with type 1 diabetes to access and implement new technologies, so that they can improve glycaemic control and quality of life. We’re independent from our US Nightscout counterpart, but we have the same core principles at our heart – just adapted to the New Zealand context. We have a wide scope and we’re focused on patient-centred solutions. All our founding committee members are people

DIABETES WELLNESS | Winter 2019

living with type 1, who have personally benefited from being early adopters of diabetes technologies. Too few New Zealanders with type 1 currently have access to these technologies, and we’re concerned that the New Zealand healthcare system will continue to be slow to fund new diabetes technologies. We believe that people with type 1 diabetes deserve access to transformative technologies, that these should be funded by the healthcare system, and that the costs of funding them will be offset by reductions in hospital admissions and diabetes-related complications. Since we launched, we’ve given talks in Christchurch, Rotorua, Auckland, Cambridge, Hamilton and the broader Bay of Plenty to a very warm reception, which is great to see. Our advocacy work includes talking to diabetes health professionals as well as to people with diabetes. WHAT WE ADVOCATE FOR

1. Funded access to continuous glucose monitors (CGMs) and flash glucose monitors (FGMs) for every person with T1D. 2. Data from funded diabetes devices being readily accessible to patients, so they can share this with whānau, supporters and healthcare professionals. 3. Funding of an accurate blood glucose meter (such as the Bayer Contour Next One) to ensure CGM and SMBG (self monitoring of blood glucose) readings are as accurate as possible. 4. Funding of modern and innovative insulin for every person with type 1 diabetes. 5. Funding of approved commercial Artificial Pancreas Systems, particularly interoperable systems.

6. Recognition for the value of peer-to-peer learning and support as part of the model of diabetes care in New Zealand. Given that funding changes may take time to achieve, we do not believe that people with diabetes should wait for these developments to occur. Thus, we also advocate for – and support people with T1D in their use of – open-source Do-ItYourself (DIY) diabetes technologies, specifically: 1. DIY CGM technologies such as Nightscout, Spike, Xdrip+ and bluetooth converters for FGM. 2. DIY artificial pancreas technologies such as OpenAPS, AndroidAPS and Loop. Although DIY technologies do not currently have regulatory approval, multiple observational studies of OpenAPS and AndroidAPS, demonstrate that DIY technologies are more effective and safer than existing standards of care. Internationally, DIY diabetes technologies are increasingly recognised as having a positive, disruptive and transformational influence on diabetes care and are now a regular feature at international diabetes conferences. Tim Gunn is the Chair of Nightscout NZ and an AndroidAPS developer (one of the DIY artificial pancreas systems). For more information: www.nightscout.org.nz www.facebook.com/nightscoutnz

Eat

Dietitian Helen Gibbs tries out a homemade Parmesan substitute, and gives her verdict.

VEGAN PARMESAN Parmesan cheese is often used in small amounts to enhance foods such as pasta, pesto or pizza, but it’s high in saturated fat and salt. With increasing numbers of vegans in the community, we’re starting to get some really interesting plantbased alternatives to things like Parmesan. Here’s a vegan substitute that’s worth trying. It has a similar amount of energy to regular Parmesan but 1.5g less saturated fat and 109mg less sodium per 10g serving. It’s actually really, really nice!

INGREDIENTS 60g raw cashew nuts (unroasted, non-salted) 20g yeast flakes (sometimes called brewer’s yeast or nutritional yeast) 5g onion flakes 5g garlic granules Put all ingredients into a food processor and blitz until the cashews are coarsely ground. Store in the fridge in an airtight container. Eat within 10 days. NUTRITION PER 10g SERVING: ENERGY 204kJ (49kcal) | PROTEIN 2.4g | FAT 3.3g (SAT FAT 0.6g) | CARBOHYDRATE 2.1g (SUGAR: 0.7g) | SODIUM 41mg

EAT WELL LIVE WELL

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

DIABETES WELLNESS | Winter 2019

Care

INSULIN INJECTION MANAGEMENT IN NEW ZEALAND A new study has looked into how New Zealanders with diabetes manage their injection regimens and the support with this that they receive from their healthcare professionals. It’s come up with important findings.

n 2018, medical technology company BD supported a survey into insulin users’ injection practices in New Zealand, and found that many are struggling. Participants were a mix of those with type 1 diabetes, and those with type 2 who inject their medication, sourced from Diabetes NZ’s electronic direct mail and Facebook page. Here’s what the survey found. INJECTION TECHNIQUE

53% of participants stated they didn’t recall receiving practical demonstration of injection technique. However, those injecting for less than 5 years were more likely to recall having a practical demonstration (64%) than those injecting for 5 or more years (39%). 48% of those injecting for less than five years had never had a review of their injection technique, and 63% of all participants said they had not had review of their technique in the last 18 months. This feedback highlights the need for patients to check-in regularly with their healthcare professional to make sure they are injecting their medication correctly.

DIABETES WELLNESS | Winter 2019

INJECTION SITE CHECKS

36.% said they don’t recall having their injection sites checked, and only 37% remembered having their sites checked in the last 12 months. Breaking this down, never checking was higher for those with type 2 (47%) than those with type 1 (22%). NEEDLE LENGTH

Only 63% of participants were using the recommended 4mm and 5mm pen needles. Others were using longer needles, which in the vast majority of cases, there shouldn’t be a need for. 66% reported they had not been given information about shorter needle lengths by their healthcare providers. MISSING INJECTIONS

75% of participants reported missing injections, and this number rose to 84% among those under 50. Reasons included inconvenience, forgetting, feeling sick of injecting, feeling embarrassment in public, and falling asleep. Only one-quarter (25%) said they never missed an injection. There was little difference in the numbers between those with type 1 and type 2 diabetes.

NEEDLE RE-USE

86% of participants re-use pen needles, and more than one third (34%) “frequently” re-use their pen needles. The researchers say needle re-use appears more common among people who inject their medication multiple times a day, and may be associated with the number of pen needles available per prescription in New Zealand. SOME OTHER FINDINGS

• 63% do not leave pen needles in for the recommended time. • 64% were not following best practice on changing injection sites. • 19% of those under 50 said diabetes had an “extreme impact” on daily life. • 44% of those under 50 felt judged by others for having diabetes. 1

These are just a few of the findings. Diabetes Wellness magazine will be following up with future articles. See opposite for a refresher in injection technique.

2 3

Simple steps for injecting diabetes medication

Step 1:

Step 2:

Attach a new pen needle to your medication pen.

It’s important to prime your medication pen.^ Dial 2 units on your medication pen and hold it upright so the needle is at the top. Press the plunger until you see at least a drop of insulin at the tip of the needle.

Step 3:

If you don’t see a drop of insulin at the tip of the needle, repeat the priming process using a new pen needle.

If using a 4mm or 5mm pen needle, insert needle straight into your skin at 90 degrees.* Press the plunger on your medication pen until all your medication is delivered.

Next, dial your required medication dose.

Step 4: After you have injected your medication dose, retain pressure on the plunger and hold the needle in place for a count of 10 seconds to allow the medication to absorb, before removing the needle from your skin.

Step 5: Remove the needle from your pen device and dispose of it in a sharps collector. Do not store your medication pen with a needle attached to it.

Always use a new needle to avoid developing lumps and bumps that can affect how your medication is absorbed. Using a new needle every time you inject can also help minimise pain.

Remember ... Inject at least one finger-width away from your last injection. A single injection site should not be used more than once every 4 weeks.

BD Pen Needles are compatible with all leading diabetes medication pen devices.† ^Always follow the instructions from your medication pen manufacturer. *Children or lean adults may require a skin lift. †At March 2019.

BD Pen Needles are used to inject diabetes medication. Always read the label and consult your healthcare professional regarding treatment of your diabetes. Becton Dickinson Limited, 14b George Bourke Drive, Mt Wellington Auckland 1060, New Zealand Toll Free: 0800 572 468.

Grow Life

THE CASE FOR KALE Rachel Knight explores the numerous ways to grow and cook this versatile vegetable.

rown throughout the world, kale – in all its glorious, colourful forms – is an ancient, robust and nutritious green. Farmers’ market tables in the colder months are often groaning with a wide array of kale, but growing our own is straightforward and rewarding. Related to cabbage and broccoli, kale is part of the “cruciferous” vegetable family. It’s rich in vitamins and minerals, and is a great source of fibre. It doesn’t form a heart like a cabbage, so you can pick a leaf or two at a time. A few plants can keep you in greens for many months. Even if you don’t have a garden, you can enjoy the taste and health benefits of kale grown inside as sprouts or microgreens.

OUTDOOR CULTIVATION

INSTANT KALE

COOKING KALE

To grow kale as a microgreen, plant seeds in a shallow tray of potting mix and place them on a good sunny windowsill. They’ll be ready in a fortnight. You can buy the seeds online from suppliers like naturesnutrition. co.nz or kingsseeds.co.nz You can also sprout kale in a Mason jar on a kitchen bench. It takes about a week. If you’ve never sprouted seeds before, a kit is a great place to start as they come with everything, including instructions. Try the above suppliers or wrightsprouts.co.nz You can grow kale sprouts or microgreens indoors all year round, although I favour winter when everything outside is growing slowly.

DIABETES WELLNESS | Winter 2019

Outside, kale seedlings need to get growing before the weather turns cooler, so you’ll need to wait till next year for that now. March is an ideal month to plant out seedlings as the summer crops come out of the garden. I sow seed in February so I can grow a range of different varieties, but there’s often a good range of healthy seedlings available at garden centres. Cabbage white butterflies can be a problem. I cover seedlings with insect mesh or spray regularly with organic “bT” caterpillar control. Cold-hardy kale grown outside can be harvested all winter and frost will enhance its flavour. The easiest way to use kale is to remove any tough stems, tear it into pieces and cook in a little boiling water for about 10 minutes, until tender. Drain well and serve with a splash of soy sauce. I love it raw in a salad, but shred it finely and choose immature leaves, sprouts or microgreens for this. It also makes a delicious extra layer in a lasagne, or you can add chopped kale to stews and soups just before serving and allow it to cook in the heat of the liquid. It’s so delicious you won’t even notice the good it’s doing you.

Cavolo nero, or Tuscan black kale, has slim, dark, deeply savoyed leaves with a strong flavour.

Curly kale has deeply crinkled green or blue-green leaves.

Red Russian kale has attractive frilly leaves with purple stems.

This “mesclun” kale blend contains a mixture of kale seed varieties to grow as sprouts, microgreens or baby-leaf. These sprouts are one week old.

ZERO-SALT KALE CHIPS If you’ve never made kale chips before, make this the winter you do. They’re easy, healthy and addictive. A large bunch of kale A tablespoon of olive oil Two tablespoons of yeast flakes (natural salt substitute extraordinaire) Preheat oven to 175°C. Wash kale and dry well. Chop or tear kale into pieces 3–4 centimetres long, removing the thickest stems. Place the pieces in a bowl, then add the oil and yeast flakes and rub them into the kale till it’s fully coated. Place oiled pieces on a baking sheet in a single layer, and bake for around 10 minutes. They’re ready when they’re crisp and just starting to brown round the edges. (Cooking times will depend on the thickness and density of the kale. Check them after the first five minutes to make sure they’re not cooking faster than you expect.)

TIPS

Curly kale, red Russian kale, and thicker-leaved bunches make the best chips. Avocado or olive are especially healthy oil choices, but rice bran and canola are good too. If you have only a small bunch of kale, reduce the amount of oil accordingly. Try rubbing in different flavourings, such as cumin, citrus zest, chilli powder, garlic powder, chopped chives or smoked paprika. Mix and match and find your favourites.

DIABETES WELLNESS | Winter 2019

Eat

SWEET! Our consultant dietitian Helen Gibbs explains how to navigate the world of “added sugars”.

WHAT ARE “ADDED SUGARS”?

The World Health Organisation (WHO) calls added sugars “free sugars”. I think that term is confusing, so I change “free” to “added”. WHO says: [Added] sugars are those added to foods and beverages by the cook, consumer, or manufacturer, and sugars naturally present in honey, syrups, fruit juices, and fruit concentrates. Added sugars are different from the naturally occurring sugars in whole fruit, vegetables and milk, which form part of a balanced diet.

rom my previous articles, you’ll know I write a lot about vegetables, fibre, whole grains, and the right fats – but sugar rarely comes up. I figured it was time to revisit this. The current advice is that less than 10% of a person’s total energy should come from “added sugars”. For even better health, aim for less than 5%. Daily energy intake

Added sugar in most NZ diets (20%)

10% added sugar goal

5% added sugar goal

The table below shows how much added sugar a person should aim for, depending on their total daily energy intake. So someone consuming 8,400 kJ (2,000 kcal) per day – a fairly normal amount for an adult woman – will likely be having about 26 teaspoons of added sugar a day. We’re suggesting that, long term, they go to 13, or even 7 teaspoons of added sugar a day. Unfortunately, food labels don’t show added sugar, only total sugar, so we have to estimate how much is “added”. It’s safe to say that in many processed foods, quite a lot is, and in soft drinks, all of it is! WHY IS JUICE A PROBLEM?

(kcal)

tsp

6300

(1500)

7500

(1800)

8400

(2000)

105

9200

(2200)

116

10500

(2500)

132

12500

(3000)

159

DIABETES WELLNESS | Winter 2019

HOW MUCH ADDED SUGAR IS 5–10%?

People are often surprised to see juice in the list of added sugars. Making juice involves processing fruit and breaking open its cell walls. Once the cell walls break apart, the sugar is freed up. This means the human body will be able to absorb the sugar fast. Dietitians advise everyone to limit fruit juice to less than 200 ml per day.

“BUT HONEY IS NATURAL!”

I hear a lot of arguments about honey and various plant-based syrups (including maple, agave and others). People defend these as “natural and containing extra nutrients”. But they still raise blood glucose quickly, and the actual amount of additional nutrients is so small that it’s not really going to improve your diet. MAKING CHANGES

Cutting back from a typical diet to one that gets only 10% of its energy from added sugars is fairly easy. You need to: • Choose or prepare foods and drinks with little or no added sugars. • Choose or prepare foods and drinks that are mostly “whole” and less processed. • Make plain water your first choice over other drinks. Getting down to 5% is quite a lot harder. You’ll need to: • Limit the treat foods you eat socially, like ice-cream at the movies or cake offered at work. • Choose the lowest-sugar option out of any processed food (e.g. baked beans or tomato sauce). People wanting to do this may find Food Switch a useful tool: www.foodswitch.co.nz

We need your help to help them A diabetes diagnosis can be scary, overwhelming and confusing. It’s a steep learning curve whatever kind of diabetes you have. We want Kiwis to know they are not alone, we are here to help them live well with diabetes and support their journey every step of the way. Your generous gift will improve the day-to-day

“ISN’T SUGAR JUST BAD?” One of the most common queries we get at Diabetes NZ is, “Why aren’t we saying no sugar to everyone?”

lives of people living with diabetes and help us to spread the prevention message far and wide.

There are two reasons:

As a charity, every dollar we raise is crucial

1. There’s no research evidence that cutting all sources of sugar from the diet has health benefits. Naturally occurring sugars in whole foods form part of a balanced diet.

2. Health psychology shows that saying, “Don’t do this,” doesn’t work. People may decide that they can’t cut out all sugar, so they may as well give up on making any dietary change. Or they may feel more guilty when they have sugar, and this negative thinking often leads to further lapses. It’s better that we chart a course for moderation, and if people want to go hard, then that’s their choice. Continues on page 30

– please support our work today: Give securely at www.diabetes.org.nz or call 0800 342 238. Donate via Westpac 03 0584 0197985 09 – use your full name as reference.

Send a cheque to Freepost Diabetes NZ, PO Box 12441, Wellington 6144.

Eat WHAT ABOUT ARTIFICIAL SWEETENERS?

One of the first bits of fake news on the internet was the “aspartame causes cancer, lupus and MS” email. It started circulating in 1995, and has been making the rounds ever since. Neither the author nor the event she attended ever existed. But because of this email, and other claims about artificial sweeteners, most people are concerned about them.

• Toxicity studies involve feeding large amounts of these sweeteners to animals. Human exposure at similar levels would mean drinking 40 litres of diet soft drink per day. • Even with regular use, most adults consume less than the Acceptable Daily Intake (ADI) of artificial sweetener. And the ADI is 1% of the amount at which there were any side effects for animals in toxicity studies.

ARTIFICIAL SWEETENER FACTS

ARTIFICIAL SWEETENERS AS A PATH TO CHANGE

• Many sweeteners are hundreds of times sweeter than sugar. Only tiny amounts are used to make the food sweet.

day, stopping cold turkey might not be possible. I suggest they move onto diet versions, then reduce by one can per week or month. The goal is to come off them entirely and drink water by choice. Some people may not make it to “no energy drinks”, but reducing the amount still reduces risks. The “transitional product” approach seems to be a sensible middle ground right now. This may change as we gain more knowledge. For example, there’s some concern that these food chemicals might affect the diversity of gut bacteria, but we need further research evidence to prove this. Watch for future updates – this is an ongoing story.

As a clinician, I refer to artificial sweeteners as “transitional products”. If someone drinks several cans of energy drinks each

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SLOW-COOKED THAI GREEN CHICKEN CURRY SERVES 6 • COST PER SERVE $6.80 • HANDS-ON TIME 30 MINS • COOKING TIME 6 HOURS • DIABETES FRIENDLY • NO DAIRY Ingredients CURRY PASTE 3 shallots, halved 3 cloves garlic 6cm piece fresh ginger, peeled and chopped 2 teaspoons ground cumin 2 teaspoons ground coriander 2 teaspoons ground turmeric 2 red chillies, chopped 4 teaspoons sugar 1 tablespoon oil 1 tablespoon fish sauce 4 tablespoons lemon or lime juice CHICKEN AND VEGETABLES 1 tablespoon oil 2 onions, sliced 6 chicken breasts (900g), halved 4 kaffir lime leaves, sliced ¹⁄ cup fresh coriander leaves ³

DIABETES WELLNESS | Winter 2019

3 courgettes, sliced 400g green beans 1 cup salt-reduced chicken stock ½ cup reduced-fat coconut milk (we used Trident)

Method

GLASS NOODLE SALAD 200g glass noodles (cooked and chilled) juice of 1 lime 2 teaspoons sugar 1 red chilli, finely chopped 2 cloves garlic, finely chopped ¹⁄ cup fresh coriander ³ 2 tomatoes, cut into wedges 2 carrots, cut into ribbons with a peeler or julienne cutter

2 Heat a large non-stick frying pan and add oil. Add onions and cook until softened. Stir in curry paste and cook for 3-4 minutes. Add chicken and cook for a few minutes, tossing in the paste.

GARNISH 1 small cucumber, sliced ¹⁄ cup peanuts or cashews ³

1 Preheat slow cooker to low. Place curry paste ingredients into a blender with ¼ cup water and process until smooth.

3 Place all ingredients in slow cooker, adding liquids last. Cover and cook for 6 hours. 4 Prepare noodle salad by mixing the ingredients together. Serve curry with noodles. Sprinkle with coriander and sliced chillies.

Community

A film project that seeks to unite people with diabetes from around the globe is the brainchild of Alexander Edenwind from Stockholm, Sweden. Alexander, who lives with type 1, explains his vision and his plans.

SMALL WORLD M

y project is called about a diabetic. Since October last year, I’ve travelled around Europe to film and interview people with diabetes in different countries. I want to highlight the differences that exist globally, and investigate what unites and separates us, depending on where you are born. I hope it can help to level the playing field for people with diabetes around the world. In May, I’ll visit Ukraine to meet two organisations that – with limited means – are seeking information and supplies for adults and children with diabetes. By contrast, the interviewee who I met in France, Lola, is well provided for with all the healthcare and premiums needed. These differences between economic background are

examples of what I’m trying to describe and illustrate. I believe that we can build bridges and support each other by emphasising issues that otherwise go up in smoke where national borders are drawn. The diabetes community is strong, and I believe that together we can give each other support, in terms of information as well as equipment and medication. HOW I WORK

I visit each participant for a couple of days, then I interview them and their relatives later to create the videos that you can find on YouTube and Instagram. Each person brings something new to the table through what they show and tell. There are no dos and don’ts. The participants

Alexander has been filming across Europe, and will travel more widely later in the year – including to New Zealand, where he hopes to interview people who live with both type 1 and type 2 diabetes.

figure out what we’ll do and what they’ll show me beforehand, while I create and shape the end result. They are of various ages and they come from diverse backgrounds and geographic locations. Although we are hundreds of millions of people with diabetes worldwide, it sometimes feels lonely. I hope that the fragments depicted in about a diabetic will reflect a bigger picture, as well as support, entertain and create awareness, making diabetes easier to handle – no matter who you are or where you’re from. To find out more and watch Alexander’s films go to: aboutadiabetic.com/stories www.instagram.com/aboutadiabetic www.facebook.com/aboutadiabetic

DIABETES WELLNESS | Winter 2019

Move

BUSTING

EXERCISE MYTHS When you live with Type 1 or Type 2 diabetes, it can feel like everyone and their dog has exercise advice for you – often conflicting. Fitness consultant Craig Wise busts some of the most common myths you might hear.

MYTH

If you do the right exercise you’ll get rid of type 1 Diabetes.

People with diabetes can’t exercise or play sport.

Exercise can make it harder to manage your diabetes.

TRUTH Type 1 diabetes is an auto-immune condition. There is no exercise that will change the autoimmune functioning of the human body.

TRUTH People with both type 1 and type 2 diabetes are participating in every sport or activity you can think of. Exercise can play a vital role in managing both types of diabetes, as it helps increase your sensitivity to insulin. It also reduces the risks of developing some of the chronic complications that can come with each type of diabetes. You can participate in any sporting activity you wish.

TRUTH The increased insulin sensitivity that you get from exercise will, long-term, make management easier. However, for those on insulin, it can take some work to find the balance between food, exercise and medication. You may find that at first you experience more blood-sugar lows than normal. Over time, you can learn how to adjust food and medication to prevent this. Build up the amount of exercise you get gradually, and if you’re struggling to manage your blood-sugar levels while exercising, it’s important to talk to a medical professional about it. Everyone reacts differently to exercise but there are some common trends that most people with type 1 and type 2 diabetes see. Most see a decline in their blood sugar levels during steady-state cardio exercise (a workout that involves a continuous, steady effort). On the other hand, blood sugar may increase during more intense workouts such as high-intensity interval training or lifting heavy weights. Grab yourself a notebook and pen, and keep track of patterns. It can be annoying and may take some time, but it will be worth it in the long term.

DIABETES WELLNESS | Winter 2019

MYTH

Aerobic activities like biking, swimming or walking are all you need to do to control diabetes and HbA1c levels.

You need to join a gym to get a proper workout that will help control your diabetes.

If your blood sugar levels are well controlled and you know your body well, you shouldn’t need to plan too much when you exercise.

TRUTH The best way to manage your health is with a well-rounded activity plan that includes both aerobic and resistance (weights) activities. According to the HART-D study,* combining both aerobic and resistance training can have a greater impact and be more successful in reducing HbA1c levels. * The Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes (HART-D) study was presented to the American Medical Association and published in 2010.

TRUTH Advice from a fitness professional at your local gym can make your activity time more effective, but it’s not the be all and end all. Many activities are available without gym memberships. Some hand weights (even a couple of heavy books) and resistance bands can give you a good workout in your own lounge. You can do aerobic exercise at the park, beach, or river. A local swimming pool is another great option, especially for anyone with orthopaedic problems, neuropathy or arthritis. Try to do 30 minutes of aerobic exercise five times a week. If you skip two or more days of exercise, the previously gained benefits can be reduced.

TRUTH Preparation before exercise is important for everyone, whether they live with diabetes or not: • Be sure to eat before exercise, then wait between 30 and 60 minutes after the meal, depending on its size. Alternatively consider a small snack prior to your activity if you don’t have time to eat a full meal. • If you inject insulin, be mindful of your injection site. For example, you don’t want to inject into your arm and then go lifting heavy weights; this will increase your risk of low blood sugar. • Remember that exercise will affect your blood sugar levels, no matter how well controlled they are, so be prepared for the possible lows. • Wear comfortable clothing and well-fitting, closed-toe shoes (with insoles if needed) and socks which are not too worn. You may want to put some powder between your toes to lower the risk of fungal infections from perspiration, as people with diabetes are often more prone to this. • If you have a medical bracelet, wear it at all times. (Sometimes people remove them at the gym.) • If your activity takes you away from home or your gym, then make sure that you carry your phone with you in case of an emergency, and always make sure you have plenty of fluids to keep you hydrated. • If you’re sick, or your body is stressed in some way, then adjust your activity level accordingly. Consult your doctor or healthcare professional to make sure that your special health needs are looked after when you are exercising.

DIABETES WELLNESS | Winter 2019

Life with T2

A diagnosis of type 2 diabetes took software engineer Alan Murray by surprise, but he was determined to see it as a positive.

MY TYPE 2 DIABETES ADVENTURE

y type 2 diabetes adventure started in April 2018, when my doctor sent me for a blood test and it came back with an HbA1c reading of 85. A double-check a few weeks later showed it had increased to 87. I really didn’t have any symptoms as such, but I’d noticed I’d put on weight from 70kg to 75kg. The first thing I did was write down everything that I ate and research what I could eat and what I shouldn’t eat as a type 2 diabetic. This turned out to be a very useful exercise. In the past, I hadn’t paid too much attention to food. I’d just eaten what I wanted. I learned how to read food labels and was amazed how much sugar was in everything. I didn’t think I’d been eating particularly badly, but when I added it all up it came to 1kg of sugar per week! I couldn’t believe it. Breakfast cereals, a can of coke with lunch, one or two chocolate bars per day, dilutable fruit syrups, and several chocolate biscuits on an evening quickly adds up – as I found. I stopped eating virtually all processed food and stopped eating in the café at work. I started making more healthy breakfasts – low-sugar cereals and unsweetened yoghurt with berries.

DIABETES WELLNESS | Winter 2019

I was lucky as evening meals have always been mainly cooked from scratch. However, I paid more attention to portion sizes and significantly reduced the amount of carbs. I read the Diabetes and Healthy Food Choices booklet and followed the ¼ protein, ¼ carbs and ½ vegetables guidelines. Making extra was easy, and the healthy leftovers went straight into the freezer, which I have for lunch most days. I replaced chocolate bars and biscuits with fruit and nuts as snacks during the day and evening. Plus I added a regular 20- to 30-minute brisk walk four or five times per week over lunch. My weight quickly dropped to my target of 70kg, and after the first three months, my HbA1c had dropped to 61. After six months, it had dropped to 48, and at the latest test it had come down to 45. I think the hardest challenge for me was the thought of giving up all the things which I really liked, but which were not a good fit for a person with type 2 diabetes – beer, chocolate, desserts and fruit juice. I overcame this challenge by thinking of these items as treats

“People who have been diagnosed with type 2 are certainly not alone.” to be had in small amounts and only now and again. I found this works for me, and I now look forward to these treats. The important thing for me was that I had to enjoy the changes I was making, as I knew this was a permanent lifestyle change. Eating with type 2 diabetes is just eating a healthy diet with a lot less processed food, significantly less sugar, less carbs, more vegetables, and correct portion sizes. After changing my lifestyle nearly 12 months ago I would not go back, as it now makes a lot of sense to me. People who have been diagnosed with type 2 are certainly not alone, and there are a lot of resources out there: cooking books, a good New Zealand Facebook group, and lots of information on Pinterest. Everybody has been supportive, and a lot of people were actually very interested in the more healthy eating habits I was implementing.

measures spoon-for-spoon like sugar Chocolate Chip Cookies Preparation 15 mins | Cooking 10 mins | Serves 24 Ingredients

Method

cup butter, softened 1 egg 1 tsp vanilla bean paste cup EQUAL Spoonful cup firmly packed light brown sugar ¾ cup all-purpose flour ½ tsp baking soda ¼ tsp salt ½ cup semi-sweet chocolate chips or mini chocolate chips

1. Beat butter with electric mixer until fluffy. Beat in egg and vanilla until blended. Mix in Equal and brown sugar until combined. 2. Mix combined flour, baking soda and salt. Stir into butter mixture until well blended. Stir in chocolate chips. 3. Drop dough by rounded teaspoons onto ungreased baking sheet. Bake in preheated 175°C oven 8-10 minutes or until light golden colour. Remove from baking sheet and cool completely on wire rack. Store in airtight containers at room temperature.

*Please note: this recipe does contain a small amount of sugar. Equal substitutes half of the sugar of the original recipe in order to provide a lower calorie option.

Nutritional Information Average Quantity Per Serve: • Energy 285kJ (68 Cal) • Protein 1g • Fat Total 9.4g • Fat 4g • Carbohydrates Total 16mg • Sodium 55mg

The Essential Ingredient EQUAL Spoonful is low calorie and measures spoon-for-spoon like sugar. Perfect for baking, cereal and drinks. Find more delicious recipes at club

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Life with T1

“SOMETHING I’VE BECOME PROUD OF” “Some days I just want to give up, and those are the hardest.”

“E

very day I realise how much I don’t know about this disease. Every day I seem to stumble on a new surprise. Even after 12 years I can’t get it right because it’s constantly changing. Everything can affect your sugar levels – exercise, stress, a period, food ... You have to think about a lot: calculating insulin doses, working out how much to eat, when to test and how often, learning and understanding the signs from your body. A good day for most people is where they hang out with friends or complete a task. For me it’s keeping my levels in the target area and not feeling sick or dizzy. Some days I just want to give up, and those are the hardest. Usually they strike when you’ve got a million other things going on in your life and you really don’t want diabetes as well. But there’s no holiday from it. Some days, I’d give anything to be normal again, even for a day. I think the mental health side of living with a disease like type 1 diabetes is more significant than most realise. You’re constantly trying to control something that has a million factors affecting it, and trying to guess what impact

DIABETES WELLNESS | Winter 2019

In the autumn issue, 18-year-old Samantha Williams talked about the stigma around type 1 diabetes. Now she discusses the dayto-day grind of managing the condition – and celebrates what keeps her going. each factor will have. You’re in a fight with your own body, and it’s not easy to process. It’s easy to feel alone and isolated, and that’s the scariest part. There’s no cure for type 1 diabetes at the moment – only medication, as well as technology being developed to help with control and management. One is the Abbot FreeStyle Libre, which I’m incredibly lucky to have been using for just on a year. It’s a small patch that goes onto the arm, with a tiny wire that goes into the skin and reads glucose levels. I can scan it with my phone, and it tells me my blood sugar and shows a graph of my levels over the last eight hours. This technology has helped me take much more control of my type 1. But it’s currently not funded by the NZ Government and costs $100 per sensor (which lasts two weeks). I’m lucky to be in a position where this is a cost we can afford, but many people with type 1 diabetes cannot. When people ask about my sensor, I love it. It gives me the opportunity to talk about type 1 diabetes which raises more awareness – something I’m passionate about.

There are so many people that are supportive. My family always have my back, and I’m forever grateful because it hasn’t been easy. My friends are an incredible bunch of girls who I’m lucky to be blessed with. Although they may not understand the full extent or get the whole thing, they do their absolute best and they sure as hell do care, and that’s all I can ever ask for. My colleagues – the ones that are aware of my type 1 – are incredibly supportive and always checking up on me, which means so much. And the online type 1 diabetes Facebook community is always there when I need advice, or just somewhere to blab to people who’ll understand. It still is hard to believe it’s been 12 years. That’s 4,383 days of living with this disease. I don’t remember a life without type 1. It’s something I’ve become proud of. It’s not going to stop me from achieving my dreams, but instead, encourage me to push harder to reach them. This disease may come with hurdles that are hard to jump over, but every day it makes me stronger and gives me the strength and power to push on.

”

Community

STITCHING TOGETHER COMMUNITY We love hearing stories about new connections and creative collaborations between those who live with diabetes and those who don’t. This is one of them.

tratford mother of four Tammy Blair runs a small sewing enterprise as a hobby – Bizy Lizy. She specialises in thoughtful, customised items that are useful and user-friendly as well as attractive. Waterproof-lined book bags, car-key pouches, reusable sandwich bags, and super-soft slippers are among her designs. In February this year, another mum at her children’s school, whose eight-year-old daughter lives with type 1 diabetes, approached Tammy: Would she design a belt pouch for her daughter’s insulin pump? Tammy says, “Hers from Australia were around $35 to $50, so I thought I can make these cheaper to help her family out. I also wanted it to be comfortable to wear all day, as she had ones with elastic that were hurting.”

Tammy and her Bizy Lizy belt pouches.

Tammy designed a pattern and made three pouches. She was thrilled with the response. “The look on my friend’s daughter’s face when she could wear something soft and comfortable ... I want other Kiwis to share that.” Tammy has begun offering to make these pouches more widely. As a busy mum, she’s not looking to start an empire, but if she can break even and cover a little of her labour at the same time as making day-to-day life easier and more comfortable for insulin-pump users, she’ll be happy. To find out more, visit Bizy Lizy at www.facebook.com/bizylizynz

CALLING PEOPLE FROM NORTHLAND/TE TAI TOKERAU A new online forum is offering support and connection to people in the north who live with any form of diabetes.

aihia teacher Mark Munday, who set it up, has lived with type 1 diabetes for 41 years. He says, “There are a lot of people in Northland with diabetes and they get little if any peer support. It seemed a specific diabetes communication platform would be useful.” The plan was cemented when he talked to diabetes nurse Sarah

DIABETES WELLNESS | Winter 2019

Willacy earlier this year. He’d just moved back to New Zealand after working overseas, and was referred to the diabetes clinic at the Bay of Islands Hospital. “I’m transitioning from a pump back onto MDI so I discussed it with Sarah Willacy. She liked the idea of a forum and felt we should try to keep it local. “The forum is for all people with diabetes – type 1, LADA, type 2, and gestational. While there are important differences, we all have a lot in common in terms of daily challenges.” The forum is “a non-threatening and safe place to exchange ideas.” Members can “make an observation, raise an

issue or ask a question and see what other members think.” Mark says, “The big advantage of a forum compared with a Facebook group is the ability to organise threads into topic areas. A knowledge base that’s easy to navigate and search develops. This is useful for people with diabetes who are grappling with daily challenges. Ideally this forum should become a store of knowledge based on member experience and insight.” For more info and join, go to http://northlanddiabetes.boards.net

HELPING TO MANAGE YOUR DIABETES

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NEW 2

FIT FOR EVERYBODY

Fitbit was built on the idea that there is no one-size-fits-all approach to fitness. That’s why Fitbit has introduced a new line of products that’s more accessible, approachable and affordable than ever. From a sleek watch for cost-conscious shoppers to trackers that encourage first-timers to start their fitness journeys – there’s a fit for everybody. 1. Fitbit Inspire – $13995 If you’re new to the world of wearables and want a lower-cost, easy-to-use tracker, Fitbit Inspire is the perfect choice. It has the essential health and fitness features to help you stay motivated, including automatic activity, exercise and sleep tracking, goal celebrations, Reminders to Move, and timer & stopwatch features to stay on track. Both Fitbit Inspire and Fitbit Inspire HR have a comfortable and swim-proof design* with a touchscreen

display, smartphone notifications (when your phone is nearby), and up to 5 days of battery life for day** to night wear.

2. Fitbit Inspire HR – $18995 Looking for a super affordable and stylish 24/7 heart rate tracker? The Fitbit Inspire HR is for you. It packs all-day automatic activity, exercise, and sleep stages tracking, with 15+ goal-based exercise modes, connected GPS, and relax guided breathing in a chic, slim design.

*Up to 50m. **Battery life varies with use and other factors.

3. Fitbit Versa Lite Edition – $26995 You already love the Fitbit Versa, and this super versatile, everyday version of the watch tracks your heart rate, activity, and sleep and offers personal guidance to help you reach your goals. The Fitbit Versa Lite Edition opens a world of possibilities with key fitness and smart features, vibrant colours, and an easy one-button design to inspire you to live boldly and make your goals a reality.

Find out more at fitbit.com