Diabetes Matters Autumn 2019 - WHAT'S YOUR STORY?

Autumn 2019 $6.95

A Diabetes WA Member Magazine

If you’ve got it, we get it

From the Editor

the ir radar, For som e peo ple dia betes is jus t a blip on and wh ile for oth ers it is com pletely life-ch anging ove rwh elm ing.

noses different, but also Not only are people’s bodies and diag one is right or wrong. no and their mental state and attitude, t it is. wha of ss rdle Your experience is real, rega on of the magazine, that We discussed in the Summer 18/19 editi it, we get it”, (it’s also the got ve Diabetes WA’s new mantra is “If you’ also wanted to hear from we but theme of this issue of the magazine), own condition and your in ” erts you. We know that you are the “exp day. We wanted you to have are finding new ways to manage it each and to have the chance to hear the opportunity to share your stories ptoms and challenges. from others experiencing similar sym – through our Diabetes WA So, we asked the diabetes community – what you find to be the Facebook page and our e-newsletters We share these responses in . etes biggest challenge living with diab across the spectrum of diabetes our feature on page 16. People from stories and experiences diagnoses also share with you their (page 11). be easier when you have access Remember, coping with diabetes can hand what it takes to manage to a network of people who know first often the first line of diabetes the condition. Family and friends are t support network in itself, support. And while this is an importan that it’s more helpful to talk many people with diabetes often find condition. with others personally dealing with the regular exercise, and Enthusiasm for eating healthily, getting be difficult to maintain over can ls leve monitoring your blood glucose a support group can keep the long term. Finding and sticking with it be online or face-to-face, you engaged and motivated. Whether support group can be a valuable depending on what best suits you, a provide a list of support part of your diabetes management. We your area or online. groups in WA on page 27. Find one in etes Matters for 2019.

So welcome to your first edition of Diab we hope you find them useful.

You will see a few small changes and Enjoy!

If you’ve got it, we get it

Contents

From the Chair ........................................................................... 3 Perspective ................................................................................. 4 Who’s in the Driver’s Seat? .................................................... 5

Diabetes News

CGM Support ..............................................................................

Funding News ............................................................................

Diabetes Global Threat ............................................................

Where Have We Been This Summer? ................................

HBF Run For A Reason ............................................................

6 6 6­ 7 8

If You’ve Got It, We Get It

Your Stories .............................................................................. 10 Opportunity to Vent ................................................................ 16 Common Complications of Diabetes ................................. 18 Back to School ........................................................................ 20 Group Therapy Helps Older People .................................. 21

Workshop Calendar

Natash a

Plan Your Sessions ................................................................ 22

Research News AUTUMN 2019 Editor Natasha Simmons Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA, 6904 Phone 1300 001 880 Email media@diabeteswa.com.au Editorial submissions should be sent to Diabetes WA, care of the above address.

All care will be taken with contributions however no liability for loss or damage to unsolicited materials will be accepted.

Disclaimer The opinions expressed in articles and the claims made in advertising materials presented in Diabetes Matters are those of the authors and the advertisers respectively, and do not necessarily reflect the view of Diabetes WA, unless stated.

The information provided is for the purposes of general information and is not meant to substitute the independent medical judgment of a health professional regarding specific and individualised treatment options for a specific medical condition.

No responsibility is accepted by Diabetes WA or their agents for the accuracy of information contained in the text or advertisements and readers should rely on their own enquiries prior to making any decisions regarding their own health.

Photography DWA staff, magazine contributors, Shutterstock, Pacific Magazines Design Brigitte James Print Quality Press Diabetes WA Diabetes WA – Subiaco Office diabeteswa.com.au Level 3, 322 Hay Street, Subiaco WA 6008 Postal Address: Diabetes Helpline: 1300 001 880 PO Box 1699, Subiaco WA 6904 Email: info@diabeteswa.com.au Diabetes WA – Belmont Office 172 Campbell Street, Belmont WA 6104 Postal Address: PO Box 726, Belmont WA 6984

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Research Round-up ............................................................... 24 Diabetes Research WA Update ........................................... 25

Living Well

Connecting with Others ........................................................ 26

Moving Well

Single Workout ....................................................................... 29

Diabetic Living

Recipes ...................................................................................... 30

In the Community

Stepping Up for Diabetes ..................................................... 32 Burning Questions ................................................................. 32

Shared Pathways

Smarts in the Regions .......................................................... 33

Eating Well

Substituting Sugar ................................................................. 34 Recipes ...................................................................................... 36

Members’ Area

Members’ Puzzle and Competition .................................... 37 Member Partners .................................................................. 38

What’s On

Dates for your Diary .............................................................. 39

Watson Dr Moira

With this edition of Diabetes Matters we start the year the way we finished it, and the way we intend to continue moving forward – focused on the person living with diabetes.

From the Chair While we recognise the importance of having comprehensive organisational structures and policy to support our activities, we see it as paramount to keep people front of mind and remember what it is all about – those for whom we are doing this important work.

Diabetes WA provides education and services that are evidence-based and person-centred. Person-centred care is about treating a person receiving health care and information with dignity and respect and involving them in all decisions about their health.

Professor Barry J. Marshall

We understand that tailoring our programs and services to suit your needs and what you want to achieve, supporting you to understand and learn about your diabetes, and helping you to find ways to better manage your condition, while remaining as independent as possible, will result in better outcomes and happier, more confident people.

There’s a power in that sense of shared experience, that you are not alone; that someone understands how you are feeling and feels the same way.

So, in this edition we present to you stories from people across the spectrum of diabetes, who share their perspective on their own experience of the condition. We hear from those that are living with it and those that are supporting people living with it.

Diabetes WA Corporate Lunch In exciting news, we have just secured Professor Barry J. Marshall as keynote speaker for this year’s Diabetes WA Corporate Lunch, to be held on Friday 13 September. Barry Marshall is Director of the Marshall Centre for Infectious Diseases Research and Training and is a Clinical Professor at the University of Western Australia.

A medical pioneer whose work transcends all boundaries Barry Marshall, alongside Dr J Robin Warren, was awarded the Nobel Prize for Physiology or Medicine in 2005 in recognition of their 1982 discovery that a bacterium, Helicobacter pylori, causes one of the most common and important diseases of mankind, peptic ulcers.

Ensure you put the Corporate Lunch date in your calendar and bring together a table of colleagues to share in Professor Marshall’s insight.

Until next time …

Dr Moira Watson Diabetes WA Board Chair

Finding a support network that understands what you are going through and provides an opportunity for you to share personal experiences and feelings, coping strategies and firsthand information about diabetes is also an invaluable health asset.

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perspective

Parenting a child living with type 1 diabetes Caroline Mudd’s daughter was diagnosed with type 1 diabetes at the age of 12. This is her account of the diagnosis and her perspective on supporting someone living with diabetes.

Oh, we’re going straight through… we’re in the first bed…. WOW there’s lots of medical staff around us… she’s not even on the bed and they’re putting the IV in… ahh… this is SERIOUS… don’t cry…, don’t cry, hold it together, it’s alright we are where we need to be… look calm, we are going to be fine, we’ve got this, it will be okay, we can do this.

I remember that moment with clarity, I am there right now.

My daughter had woken still not feeling well from the day before, all week I had been trying to work out what it was, she was just not right. It was the beginning of high school, those first couple of days had been seriously hot and she had been doing lots of exercise and had even attempted to run 4km the day before at school. By chance I was going to the doctor for her brother, a minor issue but she came with us. The doctor took one look at her, did our first BGL and ketones test and sent us straight to the Princess Margaret Hospital emergency department.

The week in hospital is a blur, as I remember it was overwhelming. I felt like I was on a travellator, moving along and having all this stuff given to me – session with the diabetes educator, forms, pens, needles, BGLs, lots of stuff. All this so we could go home and be on our own. I’m not a good nurse, in fact I am really bad…like really bad!

Will I be able to cope and how will I remember everything?

Four years on and the blur continues as we are always trying to find OUR way to live with diabetes. This is hard as every day is different, even when we try to do the same thing. Watching the trends, eating, exercising, school, friends – there are lots of things to consider and they all affect the way we live with diabetes.

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For me, the challenge has been learning to be versatile, adaptable, super-organised, impulsive and prepared for any situation. I try not to focus on the glucose levels and wanting to know what they are. I ask myself now ‘is this the way I know she is alright?’

These days when I see her, sure I still ask her what her levels might be, but when she talks to me and is telling me about her day and the things that are happening around her, I realise as I listen that she does know what she is doing, and I need to give her control. I am working on understanding that her diabetes is not for me to manage. They’re not my choices and to expect perfection is simply not fair.

I’m her mum and I am here to support her, tell her she’s got this and that it will be okay; she can do this.

Caroline grew up in Zimbabwe, moving to Australia when she was 11 years old.

After flexing her creative arm, dabbling in graphic design and throwing pots, she spent 15 years looking after her family, eventually settling into a career as a clinical support administrator. She lives with her husband, James, 16-year old daughter and her 12 and 14-year old sons. Playing hockey and participating in Adventure Races are some of her favourite past times, though she feels that “parenting teenagers is an adventure in itself.” Caroline, along with her daughter and youngest son, lives with coeliac disease (despite her husband growing up on a wheat farm) and says there is no history of diabetes in her family.

WHO’S IN

the drivers seat

Empowerment What does it mean and why is it important?

‘Empowerment’ refers to the process by which people gain control over the factors and decisions that shape their lives. In fact, it is the very definition of “Who’s in the Driver’s Seat?” – Who’s managing the situation? Who is in ‘charge’?

When it comes to health and diabetes management, enabling people to make informed decisions and play an active role in planning and decision-making in health-related activities will generally mean better health outcomes.

It is important that a self-management plan, developed in collaboration with a GP, diabetes educator or health professional, is designed to not only fit with a person’s diabetes-related priorities but also acknowledges their

noun: 1. authority or power given to someone to do something.

2.

t he process of becoming stronger and more confident, especially in controlling one’s life and claiming one’s rights.

feelings, goals, resources, culture, and lifestyle and provides meaningful self-management choices. This type of health professional support recognises that diabetes and its management belongs to the person.

To manage diabetes successfully, the person living with the condition must be able to set goals and make frequent daily decisions that are both effective and fit their values and lifestyles, while taking into account multiple physical and personal factors. Education and self-management plans that enable people to make decisions about goals, therapeutic options, and self-care behaviours and to assume responsibility for daily diabetes care are effective in helping people care for themselves.

For a person to feel empowered to manage their diabetes as best they can, they need to be informed about the treatment and management options that are available to them and feel that they are capable of making decisions that will work for them. Building self-esteem and self-confidence allows people to choose personally meaningful, realistic goals.

For people living with type 2 diabetes, feeling empowered can have a big impact on health outcomes, as it helps to address deeply embedded aspects of a person’s daily life.

To maximise the chance for reaching health goals, people must be internally motivated, particularly with goals related to weight loss, nutrition, and physical activity. (e.g., “Losing weight is really important to me.”) rather than externally motivated (e.g. “My doctor thinks I should lose weight.”)

For people living with type 1 diabetes, empowerment is also about self-care but can make a real difference in assisting to develop effective coping strategies to deal with their lifelong chronic condition.

Diabetes WA uses the Diabetes Empowerment Scale to assess whether a person’s belief in their ability to selfmanage their diabetes has been enhanced through attending one of our education programs. The scale measures the psycho-social self-efficacy of people with diabetes, meaning, it measures how confident they feel in their own ability to manage their condition effectively.

Empowerment begins when health care professionals, such as doctors and educators, acknowledge that people are in charge of their daily diabetes care.

For people living with diabetes it means becoming informed about their condition, gaining support from those around them and ensuring they feel confident and capable of making autonomous, informed decisions about their diabetes self-management.

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DIABETES

news

Reminder: Don’t forget more CGM support for type 1 from 1st March The Federal Government has now rolled out the $100 million package to extend the CGM Subsidy Initiative. From March 1, eligibility for fully subsidised continuous glucose monitoring device was expanded under the National Diabetes Services Scheme to include:

• women with type 1 diabetes who are pregnant, breastfeeding or actively planning pregnancy

• people with type 1 diabetes aged 21 years or older who have concessional status, and who have a high clinical need such as experiencing recurrent severe hypoglycaemic events

• children and young people with conditions similar to type 1 diabetes who

require insulin. This includes a range of conditions such as cystic fibrosis related diabetes or neonatal diabetes

If this applies to you, you can find out more at NDSS.com.au

Diabetes second biggest global health threat according to WHO The World Health Organisation (WHO) has released a list of the top threats to global health in , and non-communicable diseases, like diabetes, was included at number two. First on the list? – air pollution and climate change.

The WHO website states: Noncommunicable diseases, such as diabetes, cancer and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people. This includes 15 million people dying prematurely, aged between 30 and 69.

Over 85% of these premature deaths are in low- and middle-income countries.

The rise of these diseases has been driven by five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution.

Funding News $10 million for research into precision medicines The Federal Government is investing $10 million into research that will analyse a person’s DNA and their environment to help create personalised medicine for a multitude of medical conditions including obesity, autism and type 2 diabetes.

Using cutting-edge technology, researchers receiving the funding at the Perth-based Australian National Phenome Centre at Murdoch University plan to map the phenomes of large sections of the population, giving them a window into environmental and social factors influencing health trends and providing generations with a “crystal ball” to look into their future health risks.

A person’s phenome is a snapshot of their unique biology that results from complex interactions between their DNA and their environment, which includes factors relating to diet, lifestyle and exposure to pollutants. Studying these little biological fingerprints, allows researchers to better understand the underlying causes of disease and ultimately to develop personalised therapies and treatments.

Researchers will have a particular focus on the detection, treatment and prevention of obesity, autism, and type 2 diabetes among children and the Australian Indigenous population.

Among many things, this year WHO says they will work with governments to help them meet the global target of reducing physical inactivity by 15% by 2030 – through such actions as implementing the a policy toolkit to help people to become more active every day.

The WHO plans to address these threats via its newly released 13th General Programme of Work, a five-year strategic plan designed to ensure “1 billion more people enjoy better health and well-being.”

Hybrid closed loop system now available in Australia Medtronic have just launched their new 670G insulin pump and CGM system. It is the first commercially available hybrid closed loop system in Australia. Dubbed an “artificial pancreas”, it monitors blood glucose levels and automatically adjusts basal background insulin every 5 minutes, based on CGM readings to prevent high and low glucose levels. It is an investment with a price tag of RRP $9025.

Medtronic’s (real-time) CGM products are indicated for use by people living with type one diabetes. Guardian™ Sensor 3 may also be used as part of the MiniMed® 670G system^ for people living with type 1 diabetes age 7 and up.

For more information visit the Medtronic site. https://medtronic-diabetes.com.au/products Image Copyright © Medtronic. All rights reserved.

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Image credit: Newscorp

Labor party pledges $50m for diabetes research Opposition Leader Bill Shorten has pledged a $50 million funding boost for type 1 diabetes research if Labor wins the next election. The funding, which currently ends in June and will be extended to 2024 with the funding promise, would allow the Juvenile Diabetes Research Foundation’s Clinical Research Network to seamlessly continue their work as well as boost the number of clinical trials, translate research into new treatments and help find a cure.

Where Have We Been This Summer

DIABETES

Let’s Prevent – Bunbury

Eleven more local health professionals in the South West are now qualified to conduct our Let’s Prevent program, after they attended a facilitator training day run by Diabetes WA educators, Kylie and Sue.

news

Type 1 Tech Night We held our first Type One Technology Night for in February. One of our credentialled diabetes educators, Nyaree Lawler, chatted to people living with type one diabetes, and their loved ones, about the pros and cons of using insulin pumps and continuous blood glucose monitors.

Making the decision to use diabetes technology is a significant financial investment and the free evening workshop allowed attendees to ask specific questions of representatives from Medtronic, Roche, Abbott, My Life Diabetes Care and Cell Novo and to try out their products.

Feedback from the attendees was overwhelmingly positive. “Simple, but different format that is backed by evidence – this has revolutionised my practice in delivering programs in chronic disease,” Hayley said. “Provides training that is comprehensive and with excellent, easy to understand resources,” another attendee wrote.

Visit to Warburton and Warakurna Measuring In November 2018, the Aboriginal Health team from Diabetes WA flew to regional Health Outcomes and remote Australia to deliver the Indigenous DESMOND program. Funded by Ngaanyatjarra Health Service, the team spent the week delivering the two-day Conference adapted program in both Warburton and Warakurna, which educators say was an amazing experience.

Participants and educators in Warakurna

Community response to the program was overwhelmingly positive with participants saying that “everyone with diabetes in our communities should come to one of these workshops” as they said they were learning things about diabetes they didn’t understand before.

Staff also had positive feedback about the program. “The hands-on activities and the way the information was presented encouraged interaction, participation and encouraged people to think more about their diabetes and to ask questions without shame about things they weren’t sure about,” said Cezanne Ezard, ICDC Care Coordinator for Ngaanyatjarra Health Service (pictured standing).

If funding can be sourced, the Aboriginal Health team are hoping to head back to these communities in to deliver additional programs.

In recognition of their achievement in developing and implementing the NDSS National Evaluation Framework and commitment to high quality evaluation, Diabetes WA’s Research and Evaluation team were invited to present to delegates at the Measuring Health Outcomes Conference in Melbourne on ‘Identifying which health outcomes to measure’.

In contrast to an abstract submission being accepted by a conference committee, the invitation to present at the conference in December was an acknowledgement that Diabetes WA is an organisation committed to quality, both in the services we provide and in the way we are evaluated.

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DIABETES

news

HBF RUN FOR A REASON Take on the HBF Run Challenge and support Diabetes WA! The 10th Anniversary HBF Run for a Reason will take place on Sunday, 19 May. But training time starts now!

Join us as HBF Run for a Reason celebrates 10 years, 10 million reasons. Don’t miss out on early bird pricing.

You are the change-makers, the earth‑shakers, the ground‑breakers.

You come from far, and wide.

You move at your own pace, and in your own way.

You celebrate the little things, and find joy in every step.

You’re there for each other, and inspire others to follow.

Together, you’ve made a decade of difference.

Registrations are now open so register and start fundraising to show your support for Diabetes WA. How to Take Part 1 – Visit Us: Go to the Diabetes WA website and click on the banner to register.

2 – How Far Can You Go?: Choose your event course and sign up, then follow the prompts and emails to set up your fundraising page.

3 – Gather Your Crew: Invite your family and friends to join you!

4 – Get Busy Sharing: Talk to everyone you know and ask them to support you. Share your page on social media. Hold a fundraising BBQ or morning tea. Introduce a free-dress day at work for a gold coin donation.

Choose your course: Commonwealth Bank 4km Blackmores 12km Snap Fitness Half Marathon If you can’t run in the event, you can help in other ways.

Become one of the volunteers that Diabetes WA provide to run the DWA water station located along the course on the day.

To find out more email volunteering@diabeteswa.com.au

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SUNDAY 19 MAY

To join Ryan and Nina, whilst supporting Western Australians living with diabetes, register for the HBF Run for a Reason and create a Diabetes WA fundraising page.

Visit our website diabeteswa.com.au and look for the banner on our home page or go to the news section.

OUR AMBASSADORS Ryan Shand In 2017, Ryan, 32 years old and a father of two, was diagnosed with pre-diabetes and warned he only had three years to live. Since then, he has committed to losing weight through diet and exercise and has lost 61kg.

He started by making small changes, like walking to his closest roundabout. He is now running marathons. He recently placed second in the Australia Day Ultra 50km race.

“I’m excited about being an ambassador because I want to make a difference. I am inspired by the work of Diabetes WA and want to support them by raising money as part of my participation in HBF Run for a Reason . The more people that know about Diabetes WA, the greater their impact.” Read more about Ryan’s story on page 11.

Help Ryan fundraise for Diabetes WA: hbfrun. everydayhero.com/au/ryan-shand

Nina Gelbke Nina is a Swiss-Australian living with type 1 diabetes. She is a qualified clinical nutritionist with a Bachelor’s degree in Health Science (Nutritional and Dietetic Medicine). She is passionate about helping people live their healthiest lives. Her Instagram page @naturally_nina inspires her 161 000 followers with recipes and meal ideas, evidence-based nutrition education and promotes a balanced and positive relationship with food and our body and mind. Her website, naturally-nina.com, provides real-life accounts of managing diabetes and healthy living, while sharing her creativity and passion for creating delicious wholesome food.

“I’m really excited to be an advocate for type 1 diabetes and bring more education and awareness about the condition and what it really is and how it affects the lives of individuals on a day to day basis. I want to bust some myths surrounding the condition, as well as inspire and empower other type 1s in pursuing their dreams and passions, seeing diabetes as a small hurdle and learning curve, not a barrier!”

Help Nina fundraise for Diabetes WA: hbfrun. everydayhero.com/au/naturally-nina

If you’ve got it, we get it

Life is filled with challenges. There’s the daily kind (traffic!), and there are also more serious issues such as work pressure, divorce or money problems.

Add in the challenges of managing diabetes, and all these tasks can sometimes feel overwhelming.

Being diagnosed with diabetes is often a shock that turns your life upside down.

Whether you were diagnosed as a young person, or only recently, it takes constant work to accept and psychologically adjust to the diagnosis. You are directly responsible for the complicated, demanding and chronic treatment of your diabetes, which can require major changes to your daily habits.

On one hand, you have the power to change the course of your condition; on the other, you are burdened with this enormous responsibility.

But we aren’t telling you anything you don’t already know, are we?

If you’ve got diabetes, then we get it. Whether it’s type 1, type 2, pre-diabetes or gestational diabetes, we understand the challenges, the triumphs, the frustrations, the confusion as well as the mundane normality of everyday life.

And so do other people living with, or supporting someone who is living with, diabetes. So, reach out – get some support. Share your experiences. Arm yourself with knowledge and information about your condition to help you to better manage it.

Hear what other people have to say who are experiencing something similar to you. You don’t have to do exactly as they do, but there might be one little tip, amongst the hundreds you hear, that also works for you. And if you don’t learn any revolutionary new information that you didn’t already know – just talking about it and sharing your own experience might make a difference.

Everyone has good days and bad days. It’s normal to feel discouraged from time to time. The most important thing is to realise that help is available. Your diabetes educator, Diabetes WA, your doctor, and your support system such as your family and friends are there for you and can help you cope.

This feature is all about you and your experiences.

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Reminders for the tough times:

• Seek support: It’s really important

to have a network of people you can turn to. Build healthy relationships with your spouse, loved ones or friends. Talk to them when you are upset so they can help you. Seek opportunities to meet other people with diabetes so you can remind yourself that you aren’t alone.

• Move your body: When you are

sad or worried about something, go for a walk or bike ride. Research shows when you are active, your brain releases chemicals that make you feel better.

• Think positive: It may sound

too simple, but having a positive attitude really helps. Think about and celebrate the successes you’ve had managing diabetes (even small ones). Think about the people and activities in your life that make it enjoyable. Recalling the good stuff will help you get through the tough times.

• Be good to yourself: It’s important

to feel good about your successes.

But it’s also important not to beat yourself up if you fall short of a goal. Maybe you’re expecting too much. Maybe you’re trying to change things that really are beyond your control. Do the best you can, look at what worked and what didn’t and then move on. Do something that you enjoy every day.

IFYOU’VE GOT IT

we get it

Battling with pre-diabetes In 2017 Ryan Shand, 32 years old and a father of two, was diagnosed with pre-diabetes and warned he only had three years to live.

I have had difficulties with my weight for most of my life, with a family history of type 2 diabetes. Starting as a teenager (I was a chubby boy) but being in the football team essentially “normalised” my size as it was considered an

I got sick with the flu one year which persisted for 16 weeks.

When I finally got to a doctor, I was warned that my very volatile weight fluctuations, poor eating habits and binge eating/drinking would not allow me to live much longer.

A quick blood glucose test showed I had elevated blood glucose levels many hours after my last meal – a sign of potential pre-diabetes.

People often ask me whether that was the “scare” that shocked me into action. The answer is a fairly unremarkable “no” – being a stubborn person I chose to ignore it as long as possible.

The turning point for me came in multiple smaller phases.

When travelling I was so big, I barely fit into the aeroplane seats and had to ask for seatbelt extensions. I was no longer able to play with my kids at home, getting wiped out and puffing within a couple of minutes of chasing them around the house.

I knew it was time to make a change, not only for myself but to be around for my family.

I started with small changes like walking to the roundabout and back and choosing salad instead of chips with my meals.

I researched a lot about health and nutrition, learning as much as I could and adopting an overall lifestyle change rather than a diet – something sustainable in the long term.

“asset” to the team. I was never a fast runner or athletic but could take a good mark and kick a decent goal.

When I left school, stopped playing sports and went to uni, I adopted the typical 20-something party lifestyle. Before I knew it, I was 130+kg with no idea of how I got here or how to change it – nor was I motivated to do so.

I met my now-wife Lisa in my mid 20s and when we decided to get married, both of us worked hard to look our best. I was 157kg in 2010 and we worked out, doing boot camp fitness and aerobics classes five days per week and went on a “health kick” of weight watcher frozen dinners and protein shakes.

From here I looked up the Diabetes WA website for some further reading and I found some healthy recipes and meal ideas which helped, and I developed more of an understanding about insulin, insulin resistance and its role in my hormone development and weight problems.

May will mark two years since I was 143kg and living on “easy” and “cheap” foods, had mood swings, no energy or exercise at all, and wearing 7XL clothes.

I now weigh 82kg, have no signs of diabetes or pre-diabetes and challenge myself by running marathons when I can.

I recently came second in the Australia Day Ultra 50km race.

After one year, I shed 60kg in time for the wedding, and was the lightest I had been since I was 17 years old. I was “happy” with myself and had taken up recreational running.

I love running and getting involved in the running community has changed my life for the better – the people I have surrounded myself with are immensely supportive and I would not have been able to sustain my momentum without the support of my family and my running friends.

Old habits crept back in, and my weight fluctuated a lot.

Over the years following the wedding, I gained almost all of the weight I had worked so hard to lose – getting back to 143kg in 2017.

Ryan will be leading the Diabetes WA team on Sunday 19 May at the HBF Run for a Reason, as our Community Ambassador. Read more about it and how you can help him fundraise on page 9.

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IFYOU’VE GOT IT

we get it

Living with type 1 diabetes Dianne Schoch was diagnosed with type 1 diabetes as a five-year-old. In 2013, she received a Kellion Victory Award for living with type 1 diabetes for 50 years.

My first memories of diabetes started when I was five years old. I started to vomit and felt very unwell for about two weeks. My parents took me to our GP and he suggested I go to Princess Margaret Hospital where I was diagnosed with type 1 diabetes.

In those days it was down to my parents to look after me.

My Dad would inject the insulin into my thighs or arms and my Mum would sterilise the glass syringes. My parents did a wonderful job looking after me. They watched what I ate but I had four brothers and a sister so my parents made sure I fitted in. My brothers and sister would have Easter eggs, but I would have a small toy. I was brought up just the same as the other family members but sometimes I would need some extra attention. I am so grateful to my parents to have raised me this way.

a few diabetes-related complications along the way but if you can manage your blood glucose, lots of these illnesses can then be more easily managed. Only you can help yourself. There are other people to guide you and be there for you, but it really is up to you. I am not saying it is easy ... there are times when it is very hard.

Throughout my school days I had quite a few hypos and hypers but my parents kept a very tight rein and my results were very good. In those days there were no daily blood tests. We urinated on a strip which gave a BGL reading.

After finishing school I found a job and married a wonderful man and had children. Throughout my pregnancies my blood sugars were quite high. Hence, I had a 9lb 8oz baby girl for my first child and a 8lb 6oz girl for my second child.

The second pregnancy was easier as I was more familiar with how to manage my diabetes better.

I am a very small person so to produce large babies was a challenge, but you get through it. Trying to breastfeed my children was also a challenge as my blood sugars would be very low on many occasions.

I had a normal life while the children were growing as they also needed quite tight routines. While my routine stayed in place my diabetes was very good.

I then went through a divorce and found stress a huge strain on my diabetes. My blood glucose levels went so high. The stress can cause other parts of your body to start reacting and you find you have to pull yourself together so the diabetes doesn’t take control of your life.

Three years later and with a new partner, I decided to go onto an insulin pump to help me manage my fluctuating levels. After 10 months, I went overseas and my Dad passed away so I feel I didn’t give the pump a chance. Eventually, after returning from my holiday and dealing with the stress of losing a loved one, I decided to go off the pump and back on daily injections. The pump was very involved and really didn’t fit into my life at that stage.

I am now 62 years old and working on lowering my blood glucose levels and becoming a bit healthier. I have had quite 12

Dianne with her mother at the Kellion Awards ceremony

I just recently went to a DAFNE course run by Diabetes WA which I found was so beneficial (see our website for more about DAFNE). At this course you get a better understanding of the insulin you are taking, plus carb counting and understanding about the impact of ketones when you’re sick. I had a pretty good idea of all of this but the course was reassuring for me. I also learned how long the insulin takes to work and dividing my night time, long-acting insulin has benefited me so much. I had thought of going back on an insulin pump, but after doing this course I feel my understanding of diabetes has improved and so have my blood glucose results.

All in all I have had a fantastic life. There are times when I wish I didn’t have diabetes, but I then think of other people who are much worse off than I am, and it brings me back again. I believe it has made me a stronger person because of all the daily routine and hiccups that happen along the way.

I am very grateful to my parents for managing my diabetes so well throughout my childhood. They have given me a good grounding as I have learned how to look after myself.

My biggest challenges would be to protect my eye sight and to keep my legs, feet and other organs in the best condition, as when you have diabetes for so long, these are the longterm effects.

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Managing type 2 diabetes Zara Secker says being diagnosed with type 2 diabetes two years ago was a huge wake-up call that made her realise how quickly life can change.

I had been suffering from thrush that wouldn’t go away.

It became so painful that I decided to see a doctor. I found that when I ate anything high in sugar the thrush would flare up, and when I told my doctor this, he asked if anyone in my family had diabetes. I confirmed that they did.

I was overdue for my regular diabetes check, which is usually clear, so I didn’t think anything of it when she ran the blood tests. I was certain I wasn’t going to develop diabetes, but this time my results came back positive for type 2. I felt like someone had punched me in the stomach and winded me.

It was a huge wake up call.

My diagnosis has made me more aware of the importance of looking after myself

– eating healthily, exercising and having regular medical checks. I’ve lost a lot of weight which has helped to bring my glucose levels down to a healthy range and my eating habits have improved.

I also feel like my moods are much more level and I’m happier than I was before my diagnosis.

to realise that I’m not alone. There are many other people out there that not only have the condition, but are probably experiencing the same, or similar, highs and lows that I am. I try to get my hands on as many books and resources as possible. Knowledge is power with this condition.

I think the biggest challenge with living with diabetes, for me, is trying to stay positive and overcoming the frustration of having to watch what I’m eating all the time. I also find it hard to come up with healthy meals on a low income and having to take emergency food supplies with me when I head out and about.

Sticking to my medication schedule and drinking enough fluid each day is also really challenging sometimes.

My advice to people is that if you have a loved one, or know someone, who has diabetes, read up on what it is and speak with that person about how you can best support them. Knowing that they have the support of family and friends is absolutely critical to them managing the condition effectively.

I attended a DESMOND course in 2017 at Diabetes WA which I found really informative and useful. It helped me

I’m excited as I’m starting up a diabetes support group this month.

Our inaugural meeting will be held at the Armadale library at 1pm on March 22nd. Contact me if you are interested in joining us: zarasecker@gmail.com.

Navigating adolescence with type 1 diabetes Jake Langrick was eight-years-old when he was diagnosed with type 1 diabetes but has found support from his friends to help him manage his condition.

Five years ago, I was always drinking lots of water, feeling really tired all the time and going to the toilet a lot. I lost lots of weight in a really short amount of time and then the doctor diagnosed me with type 1 diabetes.

After a little while I started using an insulin pump and a CGM and I find it makes managing my diabetes easier.

I still have to be careful about what and when I eat meals and Mum says she is constantly worrying about my

levels, especially when I am not with her, like at school or with my friends.

The CGM helps with stopping her worrying as much now though.

I find it hard having to test my blood levels all the time, but my friends are very supportive, and school has been really helpful with managing my condition while I am there.

The hardest thing I find about having diabetes is going to parties.

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Pregnant with type 2 diabetes Clare Hayman was diagnosed with type 2 diabetes 18 months before conceiving her first child eight years ago. She now has two gorgeous healthy boys aged seven and two.

I wasn’t particularly surprised when I was diagnosed, as I have a family history of type 2 diabetes. Prevalent in my mother’s female line, my mother, sister, aunts and a number of female cousins all have type 2 diabetes.

It was however disappointing given I have a low BMI, eat well and exercise regularly.

To me it just shows that the prejudice that can sometimes surround type 2 is not warranted. I am an example that there is no “typical” person with type 2 diabetes and it is not always the fault of the person due to a bad diet or lack of exercise.

I had already been diagnosed a number of years earlier with polycystic ovarian syndrome (a risk factor for type 2 diabetes) and when I came off the pill to start trying for our first child, my GP sent me off for a number of routine tests and my diabetes was diagnosed.

difficult, particularly in the evening and I experienced a number of hypos in the early hours of the morning and after strenuous exercise.

It was frustrating, as there is enough to worry about during pregnancy without having to throw diabetes into the mix, but again at 38 weeks Ari, a healthy baby boy, was delivered by planned caesarean section.

My obstetrician, diabetic obstetrics specialist and diabetic midwife all took great care of me and my baby throughout my pregnancy and the birth.

Having the constant, accessible contact with the specialist midwife throughout my pregnancy was

invaluable to me. If I didn’t have her care I think my anxiety, in respect to the impact my diabetes was having on my unborn child, would have doubled and I would have felt quite isolated.

Now, I don’t feel like my type 2 diabetes restricts my life in anyway.

I’m still a capable mum, wife, friend and employee, doing all the things that I have always enjoyed.

I find the constant having to snack draining and frustrating as I’m someone who would normally only eat when they were hungry, not because they “have to”. I also find having to over think food, i.e. how much protein or carbohydrates in each serve, taxing.

I had a really lovely first pregnancy with no complications and, surprisingly, my blood glucose levels actually improved during my first pregnancy. My medication dosage, metformin, was reduced from 1,500mg to 500mg. I was however induced at 38 weeks as my obstetrician didn’t want my son to be larger than four kilograms, as I am quite a small person.

Ultimately Isaac was born by emergency caesarean after a long labour. He was 4.2 kilos at 38 weeks and despite his size, he was a beautiful healthy baby, no post birth complications.

My second pregnancy was a different story. Despite always previously having good management of my diabetes through diet and exercise, I ended up on insulin injections four times a day. Managing my levels was 14

Clare with sons Ari and Isaac

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Supporting someone living with diabetes Valerie has a brother-in-law living with type 2 diabetes and a son-in-law with type 1 diabetes. She provides support to both men in different ways.

My brother-in-law has type 2 diabetes. He checks his blood sugar multiple times throughout the day and administers insulin. The thing that I found most disturbing is that in discussing diet and the changes we could make, he informed me that his doctor told him he did not have to modify his diet and that they would just change his medication as needed.

I was appalled with this and set out to create food that can be safely eaten by someone with diabetes who still wants something sweet.

My son-in-law, Colin has type 1 diabetes.

He was originally diagnosed with type 2 diabetes, but now as a type 1.

Transitioning from type 2 diabetes to type 1 diabetes is not something I even knew was possible. I had always believed that you were born with type 1 and that type 2 was due to diet and lifestyle. I was about to be educated.

He checks his blood glucose multiple times a day and administers insulin.

The support I can provide for my brother-in-law is limited as he lives in NSW and I am in QLD. He spends holidays with us and I always provide ‘safe’ foods for him during his visits and we talk about his condition and things he could do. As an older man, he is less likely to change his habits and it is a bit frustrating sometimes.

With my son-in-law, it is very different.

He was working away as a chef and the demanding schedule was getting too much and did not allow for regular meals, which is a big problem for someone with diabetes. So, shortly after the diagnosis and starting on metformin,

he quit his job and came to work with me in my business, Green Living Australia. Here he can have a more manageable schedule, can have regular meals and take time out for testing his blood and administering his medication.

Everyone knows that he is a diabetic and it has become a team effort to change the way we all look at food and sugar. For example, if there is a birthday, we always got a cake for that staff member. Now we offer the person a choice between a cake and some other food. We have done chicken birthday lunch, shouted everyone to Subway, and other sugar-free options.

We have a Melbourne Cup lunch and run a sweep. The prize was always a big box of chocolate. Now it is a fist full of scratchies.

What is the biggest challenge you find both men face living with the condition?

Finding food that they can eat. Our society creates food full of sugar and carbs. Finding suitable food is difficult and more expensive.

If you want to just go to the store and get something easy to prepare, those foods are usually not suitable for a diabetic. Preparing good food from scratch is what they need to do. This is not a problem for my son-in-law as he is a fully qualified chef. Not so easy for people who do not have that background and who are used to being able to buy whatever they wanted to in the past and did not have to read the label and see what is really in the package.

I do think we are facing the challenge of a food industry that is not focusing on health foods but more on making money.

Do you have any ‘tips’ on managing diabetes and diet that you have found?

I have found that telling people to give up sugary foods that taste great does not work. You must come up with something that replaces those comfort foods. I give jars of my sugar-free jam to people and they love them. They get that sweet treat with no added sugar and use it to fill that sugar craving they could not resist. I use honey, which is low GI, stevia and xylitol to make jams and then started using them in other cooking as well. I can make anything at all now without sugar, so people who need to reduce their sugar intake do not have to feel like they are missing out on anything at all.

It’s not just sugar Colin reminds me that it is not just sugar, of course, it is all those highly processed carbs, white bread, white pasta, white rice, etc. He also said that learning portion control is a big challenge.

Read more about Valerie’s experiences, not only supporting family members living with diabetes, but also caring for her daughter who was born with an extreme chemical sensitivity. She has created a recipe book about home preserving and we feature a few of her recipes in Eating Well on page 36. We also have a copy of her book to give away in our Members’ Competition.

See page 37 for competition details.

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We gave you the

We put a call out on our social media channels and through some of our e-newsletters asking you to “Tell us the biggest challenge you face living with diabetes.”

We were inundated with stories over the six weeks – some that made us cry, some that made us laugh and some that taught us something new. But all the stories we received were relatable, real stories of the frustrations of living with a chronic condition.

They are stories of people facing the daily challenges of managing their type 1, type 2, pre- and gestational diabetes. We wish we could include them all but here is just a snippet of what you had to say …

Most common complaints: 1. Mental health and wellbeing 2. Managing BGLs 3. Cost of diabetes management 4. Attitudes of others 5. Nutrition challenges 6. Medication 7. Health care professionals 8. The confusion between type 1 v type 2 diabetes

The biggest challenge for me is the emotional impact of having life-changing technology out of reach because I can’t afford it.

My Challenges: 1. Keeping BGL readings between 4 & 8.

2. People being aware of the difference between type 1 & type 2.

3. The price of anything diabetes-related.

The fact there are great devices out there, but general population can’t afford them.

4. Finding a snack that has exactly 15g carbs in it

Type 1: Having to pay for medication to stay alive.

Calculating carbs.

I’m a newly diagnosed type 1LADA. I always seem to misjudge the carbs. I use the Calorie King app and it’s certainly a great help. But still not the perfect way to add up what carbs are in your next meal. I’m sure I’ll improve as time goes by. Keeping my BGL under 10 is a challenge.

Schools! So frustrating! They don’t get the complexities of type 1 diabetes, won’t get training and expect our kids to carry on like nothing has changed after a diagnosis. Just wish that they would support us better.

My 16 yo type 1 says the biggest challenge for him is to be able to switch off and pretend as if he didn’t have type 1.

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Just injecting insulin everyday ...

I know I have to do it to survive, but sometimes it’s just all too much ... My life has changed so much – weight loss, mood swings, I wish things could be different.

Having to continually explain the different types of diabetes to people.

My sympathy to those with type 1 diabetes ... it’s hard enough being type 2.

Hope they find a cure for you guys with type 1.

My biggest challenge is working hard to get my BGL to the correct level they should be. It is a huge emotional rollercoaster for me especially having depression, anxiety and stress in my life.

I suffered from gestational diabetes when I was pregnant with twins and had no further support from health professionals. I think the lack of support and education on diabetes needs to be more supported for people that need assistance.

I wish everyone living with type 1 and/or type 2 to obtain the help and support that they need.

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opportunity to vent.

I’m an athlete and hate so much having to take focus away from my game and training to make sure my BGLs are running well to allow me to compete at my best. Sometimes other athletes don’t realise how lucky they are to not have these worries. #jealous

For me the biggest challenge is, since becoming a mum, remembering to look after myself.

Some days I need to remember to put my health first, taking the time to remember to test and bolus with a meal instead of worrying about cleaning off my toddler or cleaning the meals area straight away. Also juggling work and life stresses with levels, feeling guilty for having to constantly be on top of my levels when at work working with children, and how much stress can affect me. Also feeling I’m not able to The attitude give 100% as I am too busy/consumed by trying to get of others.

My son in my BGL under control and feeling less than fantastic law (who’s eating habits are very from rollercoasting levels. And of course, there’s unhealthy) sat at the other end of the some days when you just need a damn table during Christmas dinner and looked Having a break from it, but of course that’s at the juice pop top that had been given to his toddler with type never going to happen. nearly 3-year-old daughter.

He passed it back to 1, the biggest challenge her and said “here have some diabetes.”

Aside is having to bribe him to from him being so hypocritical in his ways, since finish his meals which we have he was drinking coke, it just drives me nuts already prepared, calculated and Being told to “stop when people have no clue (I have talked administered his insulin for as using needles” or “get off to the whole family) and smart a*se he doesn’t understand he the meth” ... due to my size, smallattitudes don’t help either. I have will have a hypo if he minded people assume to know me learnt to count to 10 in my doesn’t eat. when they have no idea. If I could gain head a lot. weight I would be happy as, but at 48kg, with my PTSD an added bonus, I find it hard to find somewhere to give myself insulin I personally think without being judged as a junkie. more education training My biggest challenge #SmallMindedPeopleAreMean on diabetes needs to be given to is chocolate, real chocolate. #IAmAliveThanksToTheDrugs doctors, nurses and schools. Yes they I’ve tried the alternatives, but they #TypeOneDiabadass all have been taught but how long ago. just don’t cut it. I try and avoid the #HopeForAT1DCure I can say this because I worked in one of aisle with the chocolate, but it’s as if it’s those positions before I became a diabetic. calling me, luring me like a Siren lured 6-mthly or yearly training would be more the sea men on ships of old. appropriate. DESMOND was a BIG I know that sounds dramatic, but help when my husband became a it’s a real challenge, for me The biggest diabetic and they give regular anyway. challenge for me is courses. being on a roller coaster that I can’t get off. Highs and lows, carbs or no carbs, change set now or later what’s in that food – sugar My biggest struggle We’ve only been on or none? And not being able to be being a type 1 diabetic insulin for 4 months but spontaneous anymore there’s a is trying to rise above the watching my beautiful 14-yearbarrage of things that need mental game of knowing I don’t old girl inject insulin 4 times a day. to be thought of first ... have a choice but to keep going, She doesn’t complain but it hurts my so I just try to be grateful heart. Especially when she’s excited to that I have the life-saving have dinner and everyone is already medication at all. starting, and she says “wait for me” as she’s scrambling to get her insulin done.

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The most common complications of diabetes … and how to reduce your risk of developing them

There are a number of long and short-term complications of diabetes that can occur because of damage to the body’s organs, blood vessels and nerves. If your diabetes is well-managed and you do your best to take care of your general health, you can reduce the risk of diabetes-related complications.

Diabetes complications can be divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). High blood glucose levels from diabetes means that the glucose can stick to the sides of the blood vessels, causing them to ‘fur-up’ or become blocked, and harden.

Despite this bad news, it is important to remember there are ways of preventing or reducing the risk of these problems occurring. For those people who might already have some of these issues, you can do things to prevent them getting worse and, in some cases where the damage is early, reverse it.

Microvascular complications include damage to eyes (retinopathy), to kidneys (nephropathy) and to nerves (neuropathy), particularly in the feet. Smaller blood vessels become weaker and narrower, meaning they are more likely to become clogged.

By recognising your risk factors for complications, you can work with your health care team to decide what you need to do to prevent these problems developing. Some you can do on your own, and others you might want to discuss with your health care team first.

Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and problems with circulation in the lower limbs. The main cause of large blood vessel damage in people with diabetes is atherosclerosis.

This occurs when plaque – made up of cholesterol and other fats – builds up inside the walls of blood vessels, causing narrowing and reducing blood flow to the organs and other parts of the body.

Self-monitoring blood glucose levels and keeping them in your recommended target range as best you can is an important step in avoiding complications. Reducing your blood pressure and cholesterol, making healthy food choices and keeping physically active while maintaining a healthy weight will all go a long way to making a positive difference.

Aim to have regular appointments with your doctor and diabetes health professionals and complete all of your annual cycle of care health checks.

High blood glucose levels can also damage nerves, particularly in feet. For men, all these things can combine to cause problems with getting erections, and new evidence suggested diabetes can affect women’s sexual health too.

In addition to high blood glucose levels, high blood pressure, high cholesterol, weight around your middle and smoking all increase the risk of damage to the blood vessels.

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Early diagnosis, optimal treatment and effective ongoing support and management reduce the risk of diabetes-related complications.

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Neuropathy (nerve disease)

Reducing your risk

Diabetes causes nerve damage through different mechanisms, including direct damage from high blood glucose levels and decreased blood flow to nerves by damaging small blood vessels. Peripheral nerve damage occurs in the legs, arms and hands. Autonomic neuropathy is damage to the nerves affecting the stomach, intestines, bladder or genitals. This nerve damage can lead to sensory loss, damage to limbs, and impotence in men with diabetes.

Early detection provides the best outcome so 12-monthly checks are advised. If diagnosed at an early stage, several measures can delay the progression to kidney failure. These include management of high blood glucose, reduction of high blood pressure, intervention with medication in the early stage of kidney damage, and restriction of dietary protein.

Cardiovascular disease

Neuropathy is the most common complication of diabetes.

High blood glucose levels damage blood vessels through atherosclerosis, or clogging of the arteries, as previously explained. This narrowing of arteries can lead to decreased blood flow to the heart muscle (causing a heart attack), or to the brain (leading to stroke), or to the extremities (leading to pain and decreased healing of infections).

Symptoms & diagnosis Damage to nerves can cause pain, tingling or numbness in the affected area. Decreased sensation to feet can lead to people not recognising cuts and developing foot infections.

Early diagnosis is made by early recognition of symptoms by the affected person or their health team and by careful examination at regular intervals.

Reducing your risk If detected early, and blood glucose levels become more balanced, these complications can be prevented or delayed.

Diabetic Retinopathy (eye disease) Diabetic retinopathy is a leading cause of blindness and visual impairment. It is caused by small blood vessel damage to the back layer of the eye, the retina, leading to progressive loss of vision.

Symptoms & diagnosis Blurred vision is often the first sign there is a problem, although other visual symptoms may also be present.

Diagnosis of early changes in the blood vessels of the retina can be made through regular eye examinations.

Symptoms & diagnosis The symptoms of these different conditions are varied: ranging from chest pain to leg pain, to confusion and weakness or numbness down one side of the body. Some people with diabetes may not have any symptoms of a heart attack due to nerve damage. While early detection of these complications can delay progression, early detection and management of other risk factors such as smoking, high blood pressure, high serum cholesterol and obesity are even more important.

Reducing your risk As with all diabetes complications, early detection is key. Recognising and addressing the other risk factors, and maintaining a healthy lifestyle, along with managing blood glucose levels, can prevent or delay cardiovascular complications.

Reducing your risk Managing blood glucose levels can delay the onset and progression of diabetic retinopathy. Early detection and treatment of vision-threatening retinopathy can also prevent or delay blindness. This involves regular eye examinations and timely intervention.

Nephropathy (kidney disease) Diabetic kidney disease is also caused by damage to small blood vessels in the kidneys through high blood pressure and high blood glucose levels. The tiny blood vessels that filter the blood become leaky, which can cause kidney failure.

In developed countries, this is a leading cause of dialysis and kidney transplant.

Symptoms & diagnosis Symptoms are often not evident early on, but as the disease progresses, it is common to feel tired, become anaemic, not think clearly, or develop dangerous electrolyte imbalances.

Early diagnosis can be made by a simple urine test for protein, as well as a blood test for kidney function.

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Back to School

Diabetes WA recognises the important role that schools play in assisting young people to manage their diabetes. And so, it seems, do teachers at WA schools.

In early 2019, our diabetes educators were kept busy, visiting schools across the state to educate teachers, school nurses and education assistants on how to best support kids living with diabetes within their school community.

their allocated professional development days to understand their circumstances.

Our Diabetes Awareness in Schools program, developed with input from Perth Children’s Hospital and suitable for early years, primary and secondary school kids, is designed to increase levels of understanding and knowledge of diabetes management among school employees.

The session covers topics such as:

• What diabetes is and the difference between type 1 and 2 • The signs, symptoms and management of low and high blood glucose levels families each day

• How exercise and different foods can impact the blood glucose levels of a child living with type 1

• How to work with parents to create and use school management and action plans

• How insulin pens and pumps can be used to manage type 1 diabetes

• How to use language to create a supportive environment for the student

Diabetes WA educators visited 35 schools to conduct the education sessions, which were attended by more than 600 staff across WA. “We have a couple of kids of different ages at our school with type 1,” John Simmons, PE teacher and Head of Year at St Marks Anglican Community School said. “You want those kids to feel confident to come to school knowing that the staff have their backs and that managing their condition can be a normal part of their day.

“You also want their parents to trust that you are taking the best possible care of their child while they are with us and that if anything does go wrong that we are capable of handling it.”

Community education coordinator Jarnia Davies is still fielding multiple requests each day from schools to book an educator to run a session.

“It’s great to see school staff keen to broaden their knowledge and to be prepared for the upcoming year,” Jarnia said. “Some schools have new students with diabetes joining their school community and staff are keen to use part of 20

Teachers at Belridge Senior High School with Diabetes WA educators Tara Stevens and Carly Luff.

“Feedback has been that schools not only want to be prepared in the case of a medical emergency, but also to ensure they can best support these kids living with diabetes to feel comfortable with their teachers and amongst their peers,” continued Jarnia.

John Simmons agrees, “We find that all these kids want to do is fit in and be a regular kid,” he said. “Knowing how to best make them feel comfortable, by creating a supportive and understanding environment, helps with that I think.”

For more information on the Diabetes Awareness in Schools program visit the Professionals tab on our website diabeteswa.com.au Tara shows a teacher how to measure his blood glucose levels.

• The impact of type 1 diabetes on the student and their

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Group therapy shown to help older people with diabetes A study by researchers in the US recently examined whether older adults with diabetes (aged 60-75 years) could benefit from group therapy self-management interventions as much as younger adults with diabetes who underwent the same group interventions.

To conduct the study, researchers divided 71 communitydwelling older adults and 151 younger adults living with either type 1 or type 2 diabetes into three groups: those receiving one-to-one education, those in an attention control group, and those in a structured behavioural group.

Researchers examined each person’s HbA1c level as well as a variety of self-care and psychosocial factors, and recorded the results at baseline, three months, six months, and 12 months post-intervention.

The psychosocial factors assessed included:

• coping styles • depression • self-efficacy • diabetes distress • self-care frustration • quality of life

The self-care factors assessed included:

• frequency of self-care • blood glucose level checks • pedometer readings (every 3 days)

The results of the study, which were published online in Diabetes Care, showed that, when comparing the two age groups, both sets of people with diabetes had improved HbA1c over time, including those receiving one-on-one education.

However, those patients in the group settings showed more improvement and maintained those improvements 12 months post-intervention. (For those in the know, the results showed: older structured behavioural group change in HbA1c -0.72 ± 1.4%, older control group -0.65 ± 0.9%, younger behavioural group -0.55 ± 0.1.2%, younger control group -0.43 ± 0.1.7%).

In addition to improved HbA1c levels, those participants (both younger and older adults) who were in the group environments also demonstrated improved emotional coping, quality of life, depressive symptoms, frequency of self-care, diabetes distress, frustration with self-care, frequency of glucose checks, and self-efficacy.

The research results demonstrate that older people living with diabetes within a community-setting, (to be distinguished from those living in residential facilities whom this study did not include) can have a positive impact on improvements in managing their blood glucose levels through participating in group diabetes behavioural interventions.

The findings are pertinent not only for individuals looking for better ways to self-manage their diabetes, but also for health professionals, who should be encouraged to consider group self-management interventions as treatment for their older patients with diabetes.

See our Workshop Calendar on page 22 for Diabetes WA group education workshops in your area.

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Workshop We have a range of workshops and services that can help you on your health journey.

Self-management Workshops Diabetes WA runs a number of education programs, held as two-to three-hour workshops, to help you manage your diabetes and improve your health.

ShopSmart – this supermarket tour or classroom session helps you decode food labels.

FootSmart – everything you need to know about caring for your feet.

MeterSmart – master the art of blood glucose monitoring.

CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass.

MedSmart – understand what your medications are, what they do and how to address any concerns you have.

Living with Insulin – everything you need to know about using insulin; including equipment, hypos and blood glucose levels.

Ready Set Go, Let’s Move – make exercise part of managing diabetes each day, with your own step by step plan.

Note: This is not a fitness program.

Insulin Pump Workshop – learn about the features of your pump and how to get the most out of it with this hands-on session.

Type 1 Technology Night Explore pumps, CGMs and flash monitoring and meet with device company representatives to find out the pros and cons.

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9 April 9 April 30 April & 1 May (two half days) DESMOND 12 June DESMOND 5 April FootSmart 14 March DESMOND (FULL) 21 March DESMOND (FULL) 29 April DESMOND 16 May DESMOND 8 June DESMOND 27 June DESMOND 9 May DESMOND 15 April DESMOND 10 April DESMOND 12 April DESMOND 25 March DESMOND 20 & 21 May (two half days) DESMOND 26 June DESMOND 29 April DESMOND 17 May DESMOND 14 June DESMOND 24 May FootSmart 16 May Classroom ShopSmart 16 May DESMOND 20 March DESMOND 15 May DESMOND 15 May CarbSmart 28 May FootSmart 28 May DESMOND 12 April DESMOND 6 May DESMOND 10 April DESMOND 22 May

Free to Diabetes WA members an d NDSS registr ants

Connect with Diabetes A 2.5 hour free presentation for people with type 2 diabetes, carers, families and those at risk of diabetes.

Connect with Diabetes enables you to understand and manage your diabetes and learn about food choices.

DESMOND DESMOND – Diabetes Education and SelfManagement for Ongoing and Newly Diagnosed is a one day workshop designed to equip those living with type 2 diabetes with the knowledge and skills to better manage their condition.

DESMOND can help you achieve lower HbA1c, weight reduction, greater physical activity, reduced diabetes distress and better overall health outcomes.

Telehealth The Diabetes Telehealth Service for Country WA is available to those living out of the metropolitan area. One-on-one appointments via video-conferencing can be arranged through your doctor, or contact Diabetes WA on 1300 001 880.

Upskilling for health professionals in country WA The Diabetes Telehealth Service upskilling sessions are typically 1–2 hours in duration and are easily accessed via a desktop computer. The sessions cover a wide range of diabetes-related topics such as chronic kidney disease, diabetes retinopathy and gestational diabetes. To find out more or to register for any upcoming sessions call 1300 001 880 or go to our website.

For more information or to book into any of these workshops, visit diabeteswa.com.au, call 1300 001 880 or email bookings@diabeteswa.com.au 23

RESEARCH

news

Research Round-Up It’s great news for people with obesity Scientists in Wales are trialling a process where carefully filtered gut bacteria from faeces is turned into a liquid and injected into the nose. They believe this could lead to weight loss and potentially coming off medications prescribed for type 2 diabetes.

It’s good news for people who get migraines A study of more than 74,000 French women has found that there is a silver lining for people who suffer from migraines, as they have a significantly lower risk of developing type 2 diabetes.

It’s bad news for people that don’t like oranges A new study from Deakin University has found that taking 500mg of vitamin C twice daily can help those with type 2 diabetes by lowering elevated blood glucose levels across the day and minimising spikes in blood glucose after meals.

7 4 3 2 8 1 6 9 5

1 6 8 5 9 7 4 3 2

5 2 9 6 3 4 8 7 1

9 1 7 8 2 5 3 6 4

3 5 4 7 6 9 1 2 8

6 8 2 1 4 3 9 5 7

8 9 6 4 7 2 5 1 3

2 3 5 9 1 8 7 4 6

4 7 1 3 5 6 2 8 9

Sudoku – Solution (from page 37) 24

The vaccine that may help prevent type 1 diabetes New research has found that the rotavirus vaccine that’s saving young lives around the world may also help prevent type 1 diabetes.

The vaccine that protects infants from the nasty stomach virus, which causes severe gastroenteritis, became a routine immunisation for Australian babies in 2007, and unlike some other countries, it’s had widespread uptake.

Given to babies aged two and four months to protect them against rotavirus, the vaccine has already saved millions of lives in more than 90 countries and slashed Australian gastroenteritis hospital admissions from 10,000 each year to less than 2,000.

While investigating the number of Australian children diagnosed with type 1 diabetes from 2000 to 2015, researchers from Melbourne’s Murdoch Children’s Research Institute and Walter and Eliza Hall Institute found that diagnoses in children aged between birth and four years declined from 2007, the same year the rotavirus vaccine was introduced as a routine infant vaccination. This was the first time the type 1 diabetes rate had fallen in young Australian children since the 1980s.

While this single study does not conclusively tie the vaccine with protection

against the condition, the discovery builds on earlier research suggesting natural rotavirus infection may be a risk factor for type 1 diabetes.

The study’s lead Dr Kirsten Perrett says the decreased rate was only found in very young children born after 2007. “The significant decrease ... wasn’t seen in older children aged 5-14. This suggests the young children could have been exposed to a protective factor that didn’t impact older children,” she said.

Earlier research has also suggested that rotavirus infection of pancreatic cells can trigger an immune attack against the insulin-producing cells – similar to what occurs in type 1 diabetes.

Further research, expected to be completed by the end of , will continue to look more closely at the correlation by comparing the health and immunisation records of young children with or without type 1 diabetes. It will also aim to confirm whether this reduction is a permanent effect and if it is only relevant to Australian children.

Article source: University of Melbourne

Insulin-producing cells grown in lab Researchers in San Francisco have transformed human stem cells into mature insulin-producing cells that act as healthy pancreatic beta cells, forming a critical step towards the goal of creating cells that could be transplanted into people with diabetes.

In previous similar studies, the cells being produced were getting stuck at an immature stage where they weren’t able to respond adequately to blood glucose and secrete insulin properly. But in this new study, published in Nature Cell Biology Feb19, researchers realised that the key to getting lab-grown beta cells to fully mature lay in an overlooked facet of beta cell development – the physical process by which the cells separate from the rest of the pancreas and form the so-called ‘islets of Langerhans’.

When the researchers replicated that process in lab dishes by artificially separating partially differentiated pancreatic stem cells and reforming them into islet-like clusters, the cells’ development suddenly progressed. Not only did the beta cells begin responding to blood glucose like mature insulinproducing cells, but other less-understood alpha and delta cells also seemed to develop in ways that had never been seen in a laboratory setting.

The researchers then transplanted these lab-grown “islets” into healthy mice and found that they were functional in a matter of days – producing insulin in response to blood glucose much like the animals’ own islets.

The discovery brings us one step closer to finding a cure.

Extract from article on www.ucsf.edu Feb 19

Please note: The information on this page is a snapshot of the latest advances in diabetes research. Please keep in mind that research findings will not necessarily apply to your individual situation and this information should not be used to make decisions about treatment and management without the input of a health professional.

RESEARCH

news

Aveni Haynes & Sherl Westlund

Research into CGMs for children at high-risk of type 1 diabetes

by Diabetes Research WA executive director Sherl Westlund

We hope you’ve all had a great summer – it’s been wonderful for us to meet with one of our newest research teams about a project that could ultimately help prevent type 1 diabetes developing in very young children who are at high-risk of the condition.

Our $60,000 grant to research fellow Dr Aveni Haynes from the Children’s Diabetes Centre at Telethon Kids Institute and her team will be used to investigate continuous glucose monitoring (CGM) for measuring blood glucose levels in children at high-risk of developing type 1 diabetes but who are not yet showing clinical signs of the condition.

symptoms. Previously these children have been monitored using blood tests which only reflect a snapshot in time,” explained Dr Haynes.

The project will involve children enrolled in the Australia-wide Environmental Determinants of Islet Autoimmunity (ENDIA) study who have either a parent or sibling with type 1 diabetes and who have developed type 1 diabetes specific autoantibodies that indicate they are on the path towards developing the autoimmune condition.

Dr Haynes said given these children had a much higher risk of being diagnosed with clinical type 1 diabetes, their parents may experience anxiety related to this. This project could help alleviate some of that anxiety by giving parents more information about whether or not there were any signs of changes in their child’s day-to-day blood glucose levels.

“There’s evidence that blood glucose levels in these high-risk children could be abnormal some months to years before they develop type 1 diabetes

“Our work is looking to find early changes in the pattern of blood glucose levels in very young children in more detail and the CGM will show us what’s happening to those levels 24 hours a day.”

“The information could also be used in future research aimed to reverse, delay or slow the progression of these

children developing symptomatic or clinical type 1 diabetes; perhaps by helping to preserve insulin-producing cells that are lost in type 1 diabetes, or using other possible treatments earlier than is standard practice now,” she said.

“We want to reduce the chances these at-risk children will first present to hospital with diabetic ketoacidosis which can be life-threatening and is caused by blood glucose levels being too high for too long.”

This project holds enormous potential to impact future treatment and prevention of type 1 diabetes and we are incredibly excited to watch its progress.

To hear Dr Haynes talk about this research, head to the Diabetes Research WA YouTube channel.

And, as always, we thank everyone who has made the awarding of these annual grants possible. diabetesresearchwa.com.au (08) 9224 1006

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LIVING

well

Connecting with Others Diabetes can be an isolating condition. You might sometimes feel like you are the only one who is confused, frustrated and struggling with your diabetes management. In truth, you are far from alone.

Finding a support group; a community of people with diabetes, either online or face-to-face, can provide you with a rich source of encouragement and information. Members can help you solve problems, suggest questions for your next doctor’s visit, and get you through tough times.

The benefits of diabetes support groups have also been demonstrated by scientific research. According to some studies, members of diabetes support groups have experienced a greater reduction in HbA1c levels, better blood glucose level management and were better able to adopt healthy lifestyle behaviours and stick with them.

According to the National Standards for Diabetes Self-Management Education and Support published in Diabetes Care in January 2013, on average, those initial health improvements people often make begin to diminish within six months if a person doesn’t have ongoing self-management support. But people with type 2 diabetes who attend support group meetings are better able to sustain or even build on their health improvements, according to a study published in the January 2012 issue of Diabetes Research and Clinical Practice.

While support from family and friends is essential to help you manage your condition, a diabetes support group can provide a place to go to discuss issues that others with the condition may be experiencing too. It can help you realise that you are not alone.

For many people, a health-related support group may fill a gap between medical treatment and the need for emotional support. A person’s relationship with a doctor or other health professional may not provide adequate emotional support, and a person’s 26

family and friends may not understand the impact of a condition or treatment.

A support group among people with shared experiences may function as a bridge between medical and emotional needs (Mayo Clinic June 18).

There are several factors to consider when looking for a support group:

• Do you want a group that

provides speakers or a traditional group with a facilitator who leads the discussion?

• Accessibility is also key – if you

choose a face-to-face group, is it close to home? Is there parking and does the time and frequency of meetings suit you?

• You might want a support group

geared toward a certain aspect of diabetes management, such as eating healthy or losing weight.

• Feeling at ease is important — you’ll get the most from a support group you’re comfortable participating in and if you find it hard to share with people, an online group might be right for you.

Offline, Online: Finding a support group that’s right for you A key point to consider is whether to attend an in-person or online support group. Each has its advantages.

Younger people may prefer an online support group. For some, the anonymity of online support makes it easy to ask questions they might be too embarrassed to ask at an in-person session.

Having said that, a face-to-face group may also provide a level of support an online group can’t for young people. It really does come down to the individual and where they feel most comfortable.

Online support groups are also beneficial for people who do not have a local in-person support group they can attend or are isolated by location or disability. And online support groups have the advantage of being available 24/7, which eliminates the need to be at a set location at a specific time.

Group support is particularly important if you live in a regional area where diabetes health professionals are few and far between.

But for others with diabetes, an inperson support group might be better.

In-person support groups offer the benefit of face-to-face, one-on-one conversation. Sometimes the tone of a conversation can be lost when people are typing messages back and forth on a keyboard.

Another advantage to attending a support group in your area is the ability to find out more about local resources. Also, you just may make friends you look forward to seeing on a regular basis, making it more likely that you’ll continue attending and receiving the support you need for effective diabetes management.

Read our list of diabetes support groups in WA to find a support group that fits your needs and location.

Alternatively, ask your doctor or diabetes educator for recommendations for support groups that may meet your needs. You might want to attend a meeting or two for both in-person and online support groups to see which is the best fit for you.

LIVING

well

Find a support group All of these support groups are coordinated by volunteers. For more information on each support group, we encourage you to contact the support group leader.

Type 1 diabetes support groups The Telethon Type 1 Diabetes Family Centre offers support to children and their families to face the challenges of type 1 diabetes with confidence. The facility has many uses: meeting place, education space, diabetes clinic, chill-out space for adolescents, and a place to play. Contact the centre on 9446 6446 or www.telethontype1.org.au

Online

myD Group – Young adults with type 1 Contact: Specific Facebook page for young people with type 1 diabetes. http://myd.ndss.com.au

Online

WAIT (Western Australian Insulin Takers) 30+ year olds, but all are welcome.

Online support on Facebook.

Meet up socially, also hold occasional events.

Contact: Julie-Anne Watson 0439 288 879 westernaustralianinsulintakers@yahoo.com.au

Online

Type 1 Family Centre Parents Community Closed Facebook support group for parents or primary carers of young people with type 1 diabetes.

Contact: https://www.facebook.com/groups/T1FCparents

Online

Type 1 Family Centre Adults’ Community Closed Facebook support group for adults (18+) living with type 1 diabetes.

Contact: https://www.facebook.com/groups/t1fcadults

Online

Type 1 Diabetes and Pregnancy – Bump, Baby and Beyond (Australian Women) Closed Facebook support group for Australian women living with type 1 diabetes and pregnancy.

Contact: Jessica Ward (Perth contact) jessiw79@hotmail.com www.facebook.com/groups/1527899494122956

Online

WA Parents and Carers of T1 Children Social Events Contact: Jaclyn Workman Closed Facebook support group for carers and adults with www.facebook.com/groups/1380806035335673 type1 diabetes. Meets up socially and holds occasional events.

27

LIVING

well

Mixed support groups: type 1 and type 2 diabetes Online

DESMOND Diabetes Support Group Closed Facebook support group for people in WA living with type 2 diabetes who have attended a DESMOND workshop.

Contact: https://www.facebook.com/groups/ DESMONDDiabetesSupportGroup

Armadale

Diabetes Support Group Meetings at 1pm on fourth Friday of every month Armadale Library

Contact: Zara Secker 9498 2834 0425 358 233 zarasecker@gmail.com

Bridgetown

Diabetes Support Group Meetings 10.00am on first Tuesday of the month at the Old Convent.

Contact: Joyce Ingram 9761 4208

Rockingham

Diabetes Support Group Meet others with diabetes Monthly meetings at Spill the Beach Café, Esplanade, Rockingham

Contact: June Streeter 9527 3850 junehs@bigpond.com

Yanchep Two Rocks Area

Diabetes Support Group Meetings at 10.00am on 3rd Wednesday of month

Contact: June Sims 9561 1174 ljsims@bigpond.com

Perth

Young Adult Diabetes Committee For young adults aged between 16 – 35 living with diabetes.

Meets bi-monthly.

Meets at CCYP, 1 Alvan Rd, Subiaco

Contact: 6110 0570 yadc@perthdiabetescare.com.au

Special support group Peripheral Neuropathy

Support group for people with Peripheral Neuropathy Contact: June or Ron Gascoigne 2nd Monday of the month – the Niche in Nedlands (Passmore Room). 9296 7190 junegascoigne@westnet.com.au

Start a support group Support groups can be small or large, meet face-to-face or online, meet occasionally or regularly, but they all have the same objective; to support people living with diabetes.

other interested parties. We also provide training to current support group leaders annually, once your group is established.

If you are interested in setting up a support group, Diabetes WA would love to help. We can provide you with resources to help you start a group and promote your contact details to

For more information on support groups, or how to start your own group, email our Community Relations team: community@diabeteswa.com.au or call us on 1300 001 880.

How it helped me Ian says:

After years of battling sinus infections, fatigue and wounds that just wouldn’t heal, Ian Shaldon actually felt better after receiving his diagnosis of type 2 diabetes. He learned that he had a reason for his health issues and that they were related to his undiagnosed diabetes. While he managed his condition at first, an injury threw a spanner in the works. When things got tricky further down the track, Ian was looking for answers from others who were experiencing what he was experiencing.

28

“After my diagnosis, I changed my diet and started taking medication.

Everything was trucking along fine, then I aggravated an old knee injury, which required surgery and physio. I started feeling terrible again and my blood glucose levels (BGLs) were all over the place.

I wondered if my fluctuating BGLs could be related to my injury, so one night I went online and asked the question on a diabetes-related chat forum. I heard lots of similar stories from members and was told that being sick or injured can throw out your blood glucose.

While a doctor would have given me this information, it’s hard to go to your doctor or even your diabetes educator every time you have a question. But that night, when I was feeling frustrated with my levels, I could go online and find support from others who had experienced something similar. And people are glad to talk to you about it and share their story. Now I go on there regularly to also share my story and to find support when I am feeling a bit alone in my “battle” with diabetes. Although the support group members aren’t experts, their friendly, experienced advice is sometimes all the help I need.”

MOVING

well

A single workout can boost metabolism for days Though we all know that undertaking a regime of regular moderate exercise is recommended for maintaining fitness, studies have also shown that a single workout each week can still be effective in boosting metabolism and having a positive impact on fitness levels.

Recent research conducted by the University of Texas (UT) Southwestern Medical Center shows neurons in mice that influence metabolism are active for up to two days after a single workout.

The study, published in Molecular Metabolism (Dec 2018), measured the effects of short- and long-term exercise on two types of neurons that are shared by both humans and mice. One of the neuron types (POMC) is associated with reduced appetite, lower blood glucose levels, and higher energy burning when activated; the other type (NPY/AgRP) increases appetite and diminishes metabolism when activated.

“It doesn’t take much exercise to alter the activity of these neurons,” Dr Kevin Williams, a neuroscientist at UT Southwestern, said. “Based on our results, we would predict that getting out and exercising even once in a semi-intense manner can reap benefits that can last for days, in particular with respect to glucose metabolism.” (sciencedaily.com) Researchers measured brain circuit activity in mice given training regimes that went for between zero to ten days. Scientists found that a single workout (consisting of three 20-minute treadmill runs) caused a decrease in appetite that lasted up to six hours.

The longer-term effects of exercise were seen in the POMC neurons, which improve glucose metabolism when activated. These neurons remained

active longer if they also expressed a protein called the leptin receptor.

The findings offer new insight into the brain’s potential role in fitness and provide another avenue to research potential treatments to improve glucose metabolism in patients with conditions such as diabetes.

In a separate study, focused on resistance training, published in the Journal of the American Geriatrics Society (Apr 2015) a group of men and women, aged 65 to 79, were randomised to exercise programs of one, two, or three days a week. The program consisted of three sets each of eight different exercises, considered as high intensity training, for a period of six months.

covered the story, emphasising that, “The catch is, that 13-minute set has to be draining.”

Something that is important to keep in mind is that all these studies show that the intensity of this one single workout needs to be high to still expect a positive impact on fitness levels.

So, if you feel you don’t have time to exercise, or it all feels too hard to incorporate into your already busy schedule, the bottom line is that something is certainly better than nothing. A single workout can still reap great benefits that will last longer than the short time you are busy raising your heart rate.

The results of the study found that there was no difference in muscle strength gains between any groups.

Once a week had the same effect as two or three times. Though it is a small study, the results demonstrate that a single workout is still worthwhile, if that is all that someone is able to achieve in a week.

In a further example, another study, focusing on strength training (Med Sci Sports Exercise. Aug 2018), found that training less than 45 minutes a week produced the same strength and muscular endurance increases as training five times as much in resistance-trained young men. The 2018 study results attracted so much attention that The New York Times 29

Stuffed Cabbage Leaves Prep time: 30 mins Cook time: 1 hr 10 mins

Serves 4 (as a main meal)

60g (¼ cup) Doongara rice 1 tsp extra virgin olive oil 1 large brown onion, finely chopped 2 cloves garlic, finely chopped ½ large or 1 small savoy cabbage 500g lean pork mince 4 sprigs thyme, leaves removed, chopped Freshly ground black pepper 750g jar Mutti Passata with Basil 125ml (½ cup) water 2 tbsp light sour cream, to serve

Salad 100g mixed salad leaves 1 Lebanese cucumber, peeled into ribbons 1 large carrot, coarsely grated or cut into sticks 50g button mushrooms, sliced 50g snow peas, shredded 4 radishes, sliced 1. Cook the rice in a small saucepan of boiling water until tender. Drain well and transfer to a medium bowl to cool.

2. Meanwhile, heat the oil in a small non-stick frying pan over medium heat. Add the onion and garlic and cook, stirring often, for 6-7 minutes or until the onion softens. Bring a large saucepan of water to the boil. Add half the cabbage leaves to the boiling water and cook for 2-3 minutes or until tender. Place in a colander to drain any excess water. Repeat with the remaining cabbage leaves. Set aside to cool.

3. Preheat oven to 160°C (fan-forced). Combine the rice, onion mixture, mince, thyme and pepper in a medium bowl. Lay the cabbage leaves out on a clean surface. Divide the filling evenly between the cabbage leaves. Fold in the sides of the leaves and roll up firmly. Place in an ovenproof dish. Combine the passata and water in a jug.

Pour over the cabbage rolls. Cover with foil and bake for 50-60 minutes or until the cabbage leaves are tender and the filling is cooked.

4. To serve, transfer the cabbage rolls to serving plates. Spoon a little of the sour cream over each serving of rolls.

5. To make the salad, toss all the ingredients together.

6. Serve the cabbage rolls with the salad.

Nutrition Info

PER SERVE 1590kJ, protein 37g, total fat 9g (sat. fat 4g), carbs 32g, fibre 10g, sodium 629mg • Carb exchanges 2 • GI estimate low • Gluten free

30

Cheesy Macaroni Bolognese Pies Prep time: 20 mins Cook time: 1 hr

Serves 6 (as a main meal)

1 tsp olive oil 1 brown onion, chopped 250g mushrooms, chopped 300g extra lean beef mince 2 carrots, coarsely grated 350g zucchini, coarsely grated 400g can no-added-salt brown lentils, rinsed and drained 2 x 400g cans no-added-salt chopped tomatoes 1 tsp dried mixed herbs

Macaroni and cheese 120g dried macaroni or gluten-free pasta 3 tbsp light margarine 3 tbsp plain flour or gluten-free flour 500ml (2 cups) skim milk 110g (1 cup) reduced-fat grated cheese ½ tsp smoked paprika

1. Heat the oil in a large, deep nonstick frying pan over medium heat.

Add onion and mushrooms. Cook, stirring occasionally, for 6-7 minutes or until mushrooms soften.

Increase heat to high. Add mince.

Cook, stirring often, for 2-3 minutes or until the mince changes colour.

2. Add the carrot, zucchini, lentils, tomatoes, 1 can of water and mixed herbs to the pan. Cover and bring to a simmer over medium heat.

Reduce heat to medium-low and simmer, covered, for 20 minutes.

Remove the lid and increase heat to medium. Simmer, uncovered, for a further 10 minutes.

3. Preheat oven to 180°C (fan-forced).

Meanwhile, to make the macaroni and cheese, cook the pasta in a medium saucepan of boiling water for 10-12 minutes or until the pasta is al dente. Drain well. Melt the margarine in a medium saucepan

over medium heat. Once melted, quickly whisk in the flour. Cook, whisking, for 1 minute. Remove the pan from the heat and gradually whisk in the milk. Return the pan to the heat and stir over medium heat until the sauce thickens and comes to a simmer. Simmer for 2 minutes.

Remove the pan from the heat and stir in 1/3 cup of the cheese.

4. Divide the mince mixture between 6 x 500ml (2 cup) ovenproof dishes.

Place the dishes on a baking tray.

Divide the macaroni and cheese between the dishes. Sprinkle with the remaining cheese and paprika. Bake for 20 minutes or until the top is light golden brown and bubbling. Serve.

Nutrition Info

PER SERVE 1650kJ, protein 29g, total fat 13g (sat. fat 5g), carbs 36g, fibre 8g, sodium 250mg • Carb exchanges 2½ • GI estimate low • Gluten-free option

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2

TIPS TO

Need a weight loss jumpstart? Try tinkering with your everyday routine to drop a few kilos and gain energy

SAVE

41%

Fill up on fruit and veg

3 Enlist help

Reduce kilojoules (and carbs) by sprinkling blueberries instead of croutons onto green salads and mixing in lots of capsicum, celery and cucumbers. Non-starchy vegetables such as broccoli, greens and tomatoes contain less carbohydrates than other vegies but still pack a nutritional punch.

6

Get your zzzzzzs

1

Walk it off

Thirty minutes of walking burns about 630 kilojoules – and you don’t have to do it all at once.

Briskly stroll to a nearby park to eat your lunch. Or, instead of watching your kids’ or grandkids’ sporting events from the sidelines, keep an eye on the action while walking around the field.

Make sure you check your feet before and after walking, and always wear sneakers to protect from injury.

TIP

Take extra carbohydrates before and during exercise to prevent hypoglycaemia. Discuss with your doctor or dietitian first.

Make an appointment with a dietitian or nutritionist to work up a meal plan that can help you lose weight. And, if you haven’t exercised before, ask your health care provider to time your medication and meal schedules to suit your workouts.

5

4

Skimping on sleep can cause weight gain, add stress and compromise your immune system.

When University of Chicago researchers restricted 10 dieters’ sleep to less than six hours a night, the dieters lost only half the amount of fat (and more muscle) than when they got more than eight hours.

Sufficient shut-eye is also key for blood glucose control.

healthy healthylife SHALL WE PLAY A GAME MC:T1 – a modified version of the popular digital game Minecraft – is the brainchild of a Brisbane father who was inspired by his son’s diagnosis with type 1. Designed to help PWD learn how to manage their condition, the game sees players walk around the Minecraft world, but with the addition of monitoring their insulin and blood glucose. The father’s start-up was recently given a grant by the Queensland University of Technology to build the game MC:T1 (Minecraft for Type 1 Diabetes) and develop an educational plan for health professionals and parents. Visit magikcraft.io and research.qut.edu.au/dmrc for more.

Look at your blood glucose-lowering medications with your provider. Some newer medicines, such as Liraglutide and Byetta, may aid in weight loss.

Turn off the TV

7 Get fit during the commercials When watching TV, get up and do one minute of jumping jacks or a minute of knee raises when the commercials come on. Researchers at the University of Tennessee, Knoxville, found that stepping in place during commercials burns an average of 620 kilojoules in about 25 minutes.

84 JANUARY/FEBRUARY 2017 diabetic living

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&

The latest facts & global news on diabetes, body image, broccoli & positivity

Review your medications

A recent review of more than 50 studies confirms that too much screen time is linked to consuming fattening fast foods, energydense snacks and high-calorie drinks.

Latest News

YOUR

Q

15 tune up

living well

Blog life

From online forums for PWD to advice from professionals, these inspirational blogs cover the daily struggles of PWD, as well as giving tips on how to live a healthy life with diabetes.

• DIABETES STOPS HERE (diabetesstopshere.org) Produced by the American Diabetes Association, and born from their movement ‘Stop Diabetes’, this blog shares stories of courage, love and resilience from people living with both type 1 and type 2 diabetes.

• DIABETIC FOODIE (diabeticfoodie.com)

Shelby is a keen foodie who also has type 2 diabetes. Firmly believing “a diabetes diagnosis is not a dietary death sentence”, she shares many healthy, delicious and diabetic-friendly recipes for readers to enjoy.

• DIABETES SISTERS (diabetessisters.org/blogs)

There are separate blogs for type 1 and type 2 diabetes, with the goal of helping readers living with diabetes have healthier, fuller lives. The online forums are a safe place for women to freely share information.

STEP 1

Over the past 20 years, University researchers at Finland’s on a of Tampere have worked could potentially prototype vaccine that developing in prevent type 1 diabetes is not a cure, nor children. Although this altogether, it will it eliminate diabetes immunity. Clinical will, hopefully, provide 2018, although trials are set to begin in the results will not be apparent for about eight years.

A

ASK

SH

Health & Fitness

A DR M

R

Should I avoid bread if I have diabetes and am trying to lose weight?

Let’s get physical Aerobic exercises (such as walking, jogging and light cycling) are associated with a reduction in glycemia, in comparison to a temporary increase in glucose levels during anaerobic exercises (such as sprinting, heavyweight lifting and interval sports, such as hockey). Both forms of exercise produce hypoglycemia in the

88% of Australian girls with type 1 desire a slimmer body, and 76 per cent of boys were not happy with their bodies. The stats came from a study conducted by Deakin University researchers of Australians aged between 13 and 19 who have lived with type 1 diabetes for more than 12 months. It further found that only 43 per cent of the boys studied specifically wanted to lose weight.

individual’s late recovery, which often occurs while sleeping.

However, it is less common for PWD who are more physically active to get diabetic-related eye disease and kidney disease, and they also have a better chance of reaching the ideal targets for blood pressure levels, glycated haemoglobin levels and a healthier body mass index (BMI).

Confused about glucose?

Diabetes Australia has recently launched a new Position Statement on the importance of glucose selfmonitoring. Being a rapidly changing area, the new Position Statement makes it easier for individuals to better selfmanage their condition, discuss the technologies available for glucose monitoring – as well as the pros and cons – and the evidence behind them.

It’s all online for your perusal. To read the new Position Statement, visit diabetesaustralia.com.au.

Dr Marsh says: I get asked

this a lot. Many people think bread is something to avoid, yet the right type of bread can be a healthy carb choice.

It is often lower in carbs and glycemic index (GI), and higher in fibre and nutrition than other carb choices such as cracker biscuits, rice, pasta, potato and many processed breakfast cereals.

The best choices are dense, grainy breads – the ones with lots of visible grains and seeds. These breads have more nutrition and fibre, and when the grains are still intact, rather than milled into flour, they have a lower GI. If you don’t like grains, or can’t manage them due to dental or digestive problems, wholemeal sourdough bread is the next best option. There’s good evidence that eating more wholegrains can help with weight management. They also provide important vitamins and minerals.

Bread is an easy way to get more grains in your diet. ➤ Dr Kate Marsh, advanced accredited practicing dietitian and credentialled diabetes educator Email your questions to: diabeticliving@pacificmags.com.au Post: Diabetic Living, Q&A: Health, GPO Box 7805, Sydney, NSW 2001.

12 JANUARY/FEBRUARY 2018 diabetic living

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Scott at Jacobs Ladder

Scott’s Stepping Up for Diabetes On 5 April, Scott Drysdale will be climbing Jacob’s Ladder – a well-known steep set of stairs in West Perth – for 24 hours straight in a bid to raise money and advocate for people living with diabetes.

“Diabetes has had a substantial impact in my life over the last couple of years” Scott says. “My dad is living with type 2 and his health has been greatly affected by it. It’s something I wish on no one.”

both men would not be experiencing as many health concerns if they had known how to better take care of themselves and had received more education and support.

Over the last year Scott’s father has had serious kidney complications, suffered a heart attack, and has been hospitalised twice due to complications from heart failure.

To celebrate his dad’s birthday, Scott will be climbing and descending Jacob’s Ladder from 6pm Friday 5 April to 6pm Saturday 6 April. He hopes to complete

“There is no doubt that had my dad taken better care of his diet and exercise, he would not be facing the same health issues he is today.”

Fundraising Page: To support Scott and contribute to his fundraising efforts visit everydayhero.com.au and search for Scott Drysdale or Scott Steps Up for Diabetes.

You can also follow A REASONable Adventure on Facebook for regular updates on Scott’s training and preparation in the lead up to the big climb.

Scott’s step-father is also living with type 2 diabetes and Scott believes

Burning Questions Q: I haven’t eaten in the middle of the night so why are my blood glucose levels so high in the morning?

Barry, type 2 diabetes

200 circuits of the ‘ladder’, which consists of 242 steps and is 43m high.

The total, 8,000m, is almost the height of Mount Everest.

Scott is aiming to raise $5,000 for Diabetes WA, so that we can continue to provide support and education for people at risk, living with, or affected by, diabetes in Western Australia.

A: DWA Diabetes Educator Carly Luff says…

It is frustrating isn’t it, as you haven’t even enjoyed a snack but still your BGLs are rising.

Due to normal daily changes in our body’s release of hormones during sleep and wake cycles, blood glucose typically starts to rise in the very early morning, when hormones are released that cause the liver to release extra glucose. For people without diabetes, insulin production increases and takes care of the rising blood glucose. However, for people living with diabetes, unless there is medication on board to cover this early morning rise, blood glucose can rise out of target range by the time they wake up. A late-night, high-carb snack or a large late-night dinner high in fat may also affect blood glucose levels. These may delay digestion and absorption of the carb content of the food enough so that your post-meal rise in blood glucose is kicking in at the same time as your early morning rise is happening.

If you have a burning diabetes-related question that you would like answered, email it to info@diabeteswa.com.au.

Alternatively, you can speak to a member of the Diabetes WA Education Team. Call the Diabetes Helpline between 8.30am and 4.30pm weekdays on 1300 001 880.

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SHARED

pathways

Smarts in the Regions In a first for Western Australia and Diabetes WA, our Smarts workshops commenced delivery in regional WA with the inaugural sessions being very well received.

The Smarts program is a range of short group education workshops, free to NDSS registrants and Diabetes WA members, designed to help people better manage their diabetes. Consisting of CarbSmart, MedSmart, FootSmart, ShopSmart and MeterSmart, the program, funded by the NDSS, is a suite of topic-specific workshops for people living with all types of diabetes. CarbSmart and MedSmart were the first workshops to be delivered in Geraldton, due to high demand in the area.

Offering practical tips and information, the three-hour CarbSmart workshop discusses the myths and facts of carbohydrates, with participants learning about the different types of carbs and the amount that is best for them.

The MedSmart workshop, two hours in length, helps participants living with type 2 diabetes to understand what their medications are and how they work and gives them the opportunity to ask personal questions, individual to their situation, and to address any concerns they may have.

“It’s great to be able to bring these programs to people out in the regions who haven’t been able to access them previously,” Kelly Harris, Diabetes WA self-management coordinator said. “We have had so many requests from people in more isolated areas, that it is great to be able to finally provide them with the information they are seeking,”

“I think that the participants thoroughly enjoyed the sessions,” said a local Geraldton educator who observed both the sessions, “There was a really good turnout for both and the group dynamics really worked well. I think the Smarts sessions are great either on their own, or even when incorporated as an ‘add-on’ for those who have completed a DESMOND program as individual refreshers.”

Regional DESMOND, a more comprehensive full-day type 2 diabetes self-management education program, has been operating in regional WA for a year.

“We are working with the local regional DESMOND educator/s to obtain referrals and to allow them to observe the sessions in their regions,” said Kelly. “We are hoping to then train these local health professionals to continue delivering the Smarts workshops in their own area.”

Further workshops are scheduled over the next few months in Bunbury, Bruce Rock, Albany, Kalgoorlie and Narrogin, with new regional areas and workshops being added to the schedule weekly.

For information about future workshops taking place in your regional area, flick to our Workshop Calendar on page 22 or call the Diabetes Helpline on 1300 001 880.

The Geraldton workshops consisted of 20 participants and feedback from the group was very positive.

33

well Pictured: Leaf of the stevia plant

EATING

Substituting Sugar Avoiding sugar can be tricky, especially when it’s in almost everything we eat. Food science research reveals that the increase of hidden high-sugar foods in our diets is significantly damaging our health.

Of course, many believe that people with diabetes should always avoid sugar, but we know better! It is possible to enjoy the sweet stuff, in moderation.

A minimal amount of real sugar as part of a balanced diabetes-friendly diet is a good approach.

That being said, man-made sugar substitutes offer sweetness while managing carbohydrate intake and blood glucose. There are many sugar substitutes to choose from, but they’re not all kilojoule-free and they vary in terms of their impact on blood glucose levels.

Honey, maple syrup and rice malt syrup, among others, are also natural sweeteners, but these natural sweeteners remain first and foremost a concentrated source of carbohydrates.

For example, one tablespoon (15 ml) of maple syrup contains about 15g of carbohydrates. This is as many carbohydrates and kilojoules as an equivalent amount of white sugar.

34

One option for a sugar substitute that has become popular is sugar alcohols, or polyols, such as sorbitol, mannitol and xylitol. They are derived from the natural fibres in fruits and vegetables and, while they do contain some carbohydrates and have some effect on blood glucose levels it is minimal. The carbohydrates in sugar alcohols are not fully absorbed and therefore, one of the most common sugar alcohols, xylitol, is a good low-carb choice.

Stevia and Splenda are also good options for sweetening up the lives of people living with diabetes.

Splenda is a brand name for sucralose, a non-nutritive or artificial sweetener, which is excellent for people with diabetes — type 2 diabetes in particular. Splenda is 600 times sweeter than sugar but has no effect on blood glucose and passes through the body with minimal absorption.

Stevia is derived from the leaf of the stevia plant (pictured) that is native

to Central and South America. It is kilojoule-free and has been shown to have little to no impact on blood glucose, making it an excellent sugar substitute for people with diabetes. Stevia extract is commonly used nowadays as a sweetener in commercial foods and beverages claiming to be natural.

Be Aware Do be careful of which sugar substitutes you are choosing.

Although their low kilojoule reputations are appealing for many people needing to monitor their sugar intake, some have been linked to negative side effects such as indigestion, bloating, diarrhoea, headaches and some research has even shown links to more serious health issues. So, do your research and read your food labels before consuming in great quantities.

EATING

Sugar-Free Home Preserving In this edition of Eating Well, we feature recipes from Valerie Pearson’s book Sugar Free Home Preserving. Valerie uses xylitol in many of her recipes to sweeten her homemade preserves, jams, conserves and fruit butters.

Valerie Pearson has over 25 years’ experience in teaching the art of preserving and pickling to budding cooks across the country. When Valerie’s daughter was born with an extreme chemical sensitivity, she armed herself with the knowledge and tools to take back control of her family’s diet, becoming a conscious home-cook, delving into the science behind cultured foods and other preserving techniques.

Her book features simple sugar-free and low sugar recipes, as well as tips for hygiene, sustainable storage and all the equipment needed for home preserving.

When you make your own preserves, you control the ingredients – ensuring you are eating pure and wholefoods, without any additional sugar, additives and preservatives.

Arriving back in Australia after a successful 25-year career in the US, Valerie turned her passion for food into a business, starting Green Living Australia.

She also has a brother-in-law with type 2 diabetes and a son-in-law with type 1 diabetes, so she is all too familiar with supporting people with special dietary needs. Read about her experience supporting her family in our feature on page 15.

“Home preserving has, for many of us, become a lost art,” says Valerie in her book. “I first learned about home preserving as a child from my mother. It was something that was common practice in those days …

I can still remember those times sitting around the kitchen table helping Mom with the fruit for a jam she was making. These are precious memories I never want to forget and the kind of memories I wanted my own children to have.”

So, pick some lemons from the tree, grab some strawberries and pears from the supermarket and start preserving!

Turn to our competition page in the Members’ Area of the magazine for your chance to win a copy of Valerie’s book.

Be Mindful of your Accompaniments Remember, while the preserves and conserves are low sugar and lowcarb, you generally wouldn’t eat them on their own by the spoonful, so be mindful of what you are spreading them on or eating them with.

Homemade chutney is a great low-kilojoule alternative to mayonnaise, butter or store-bought chutneys and sauces, but still adds moisture and flavour to a sandwich. You can also add it to fish, chicken or steak dishes as a substitute for heavy sauces.

Berry conserves and apple butter is fabulous on toast but try to make a healthier choice and spread it on grainy toast or even add a spoonful to yoghurt as a more natural sweetener.

Speaking of yoghurt, natural yoghurt is a great accompaniment to those preserved pears (see page 36). Dollop it on and serve it as a treat when you get a craving for something sweet.

well

Valerie’s Story: “My daughter, Angela was a very healthy and happy baby, but she became very ill and ended up in hospital having all kinds of tests, trying to figure out what was wrong.

She was losing weight, was sick all the time and we thought we were going to lose her. Eventually she was diagnosed with hyper-chemical sensitivity. I think they now call it Multiple Chemical Sensitivity. It turns out that she reacts to all artificial colours, flavours and common preservatives used in foods. For her to live, we have to change our lives and live a chemical-free life and only have all-natural foods with nothing artificial and no preservatives.

She also reacts to chemical cleaning products, paints and numerous other toxic substances we all run into every day.

This was 30 years ago and there was not a lot of foods available that met the chemical-free criteria. Back then health food stores were few and far between and did not have much in them. That meant that I had to learn how to make everything from scratch, something I did not know how to do. I learned to make all my own foods, bread, jams, soups, pasta sauce, cheese, butter, yoghurt, dips crackers, biscuits ... everything. We grew as much organic food as possible and then preserved it using old fashioned preserving techniques that were around before man-made chemical preserving agents (bottling, fermenting, drying etc).

This was all learned from the locals living in the farming district in Pennsylvania USA, where I had a farm we had moved to, trying to remove Angela from the chemical environment that was making her sick.

In 2002 I returned home to Australia. In 2004 I started Green Living Australia because I was having a hard time finding supplies to be able to continue my chemical-free lifestyle. I thought, if I am having this problem, there must be other people who want to make everything themselves and are having the same problem as I am. So, I started Green Living Australia with my brother as my business partner. It started small, from our house, but eventually grew into a thriving business dedicated to helping people take back control of what they put into and onto their bodies.”

35

EATING

well

Prepare your jars

Before embarking on any of these recipes, you must ensure the jars you use are sterile.

Prepare your 250 ml jars and lids by sterilising them in boiling water for ten minutes.

The sterilisation step can be skipped and you can use washed, rinsed, hot jars, but ensure you then process the jar filled with conserve or jam for 10 minutes or more in a boiling water bath at the end of the recipe (in addition to the 5 minutes that Valerie recommends in each recipe).

Very Berry Conserve

Makes: 5 x 250ml jars Serving size: 1 tbsp or 20g 1 kg mixed berries (blackberries, raspberries, gooseberries or loganberries) 300g to 400g xylitol 2 tsp Pomona’s Pectin 2 tsp calcium water 3 tbsp lemon juice

Makes: 5 x 250ml jars Serving size: 1 tbsp or 20g 1kg ripe tomatoes 4 tbsp lemon juice 400g xylitol 2 tsp calcium water 2 tsp Pomona’s Pectin

1. Rinse off the berries and place them into your preserving pan or a wide, heavy-based saucepan. Place over medium heat and bring to the boil.

2. Use a potato masher to crush the berries, releasing some juice and natural pectin. Add a little water if necessary, to prevent your berries from sticking. Stir frequently.

3. In the meantime, mix your Pomona’s Pectin with 100 grams of your xylitol.

Slowly add your xylitol-pectin mixture, stirring constantly to ensure that it is evenly distributed throughout your fruit mixture.

4. Add your lemon juice, calcium water and the remaining xylitol and mix in well.

5. Using a high heat and stirring occasionally, bring your conserve mixture to a full rolling boil and boil for one to two minutes. Remove from heat.

6. Using a ladle and funnel place your conserve into your hot, 250ml jars, leaving a one and a half centimetre headspace. Clean the rims of the jar to ensure you get a good clean seal and cap with your lids. Process your filled jars in a boiling water bath for five minutes.

1. Remove the skin from the tomatoes by dropping them into boiling water for 30 seconds and then placing them in a bowl of ice water. The skins will loosen and slip right off.

2. Chop your skinned tomatoes and place them into your preserving pan, along with the lemon juice. Simmer over a low to medium heat until you have a pulpy consistency.

3. Mix your pectin in with your xylitol and then add this to your tomato, mixing in well and ensuring it is dissolved. Add the calcium water.

4. Using a high heat and stirring occasionally, bring your jam mixture to a full rolling boil and boil for one to two minutes.

Remove from heat.

5. Using a ladle and jar funnel place your jam into your hot, 250 ml jars, leaving a one and a half centimetre headspace.

Clean the rims of the jar to ensure you get a good clean seal and cap with your lids. Process your filled jars in a boiling water bath for five minutes.

Nutrition Information per serve

Nutrition Information per serve

Energy 126.3 kJ Protein 0.3 g Fat, total 0.1 g — saturated 0g

36

Tomato Jam

Carbohydrate 2.1 g — sugars 1.2 g Sodium 3.8 mg Fibre 1.0 g

Energy 195.8 kJ Protein 0.4 g Fat, total 0g — saturated 0g

Carbohydrate 1.3 g — sugars 1.1 g Sodium 10.5 mg Fibre 1.4 g

Pears with Cinnamon & Star Anise Makes: 3 x 750ml jars Serving size: 125g

Cook’s Tip

Adding a twist of spice is what makes these pears so special. The lemon peel, cinnamon and star anise infuse the fruit with a rich colour and flavour during the processing time.

6 pears 2 litres water 400g xylitol 3 sticks cinnamon 6 whole star anise 1 lemon (for the peel) 1. Prepare your 750ml jars and lids by sterilising them in boiling water for ten minutes.

2. In a large pot combine your water and xylitol and bring them to a simmer.

3. Peel and halve your pears and remove the cores. Place the pears into your hot xylitol syrup and bring them back to simmer. Simmer for two to five minutes.

4. Once simmered, using tongs, place the pears into your previously prepared, hot jars. To each jar, add a cinnamon stick, two whole star anise and some fresh lemon peel.

5. Top up with the liquid you cooked the pears in, leaving a two-centimetre head space.

6. Process your filled jars in a boiling water bath for 20 minutes.

Nutrition Information per serve Energy 349 kJ Protein 0.7 g Fat, total 0.5 g — saturated 0g

Carbohydrate 5.9 g — sugars 2.9 g Sodium 1.1 mg Fibre 1.4 g

Diabetes WA Autumn Sudoku Fill in the grid with numbers so that every row, every column

MEMBERS

7 1 4

9 1

Answers can be found at the bottom of page 24

3

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includes the numbers 1-9, without repeating any.

8

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1

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Competition

Autumn

Avoiding sugar can be tricky, but Valerie Pearson’s new recipe book, Sugar Free Home Preserving, is a simple, step-by-step guide to making delicious jams, conserves, fruit butters and curds, with no added sugar.

Valerie has over 25 years’ experience in teaching the art of preserving and pickling to budding cooks across the country. In her book, she demonstrates that low or no sugar doesn’t have to mean boring and bland. Valerie equips the reader with the tools to create deliciously healthy conserves. From the classic, Very Berry Jam, to the unusual yet extremely tasty, Pear, Ginger and Walnut Conserve, home preserving is about taking the time to slow down and enjoy the process of creating and making. There is nothing more rewarding than enjoying the delicious results of your own labour – additive, preservative and sugar free.

A few of Valerie’s delicious recipes are featured on the opposite page for you to try, but for your chance to win a copy of Sugar Free Home Preserving enter our competition below.

Publisher: The Pearson Family Trust RRP: $39.99

To enter, complete the competition slip below and mail to: Membership – Home Preserving Competition PO Box 1699, Subiaco WA 6904 or email your entry and details to membership@diabeteswa.com.au

Good luck!

Name:

Diabetes WA Membership Number:

Address: Contact number:

Email address:

Entries close 1 June .

37

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39

We’re with you every step of the way.

Learning how to best manage your diabetes can be daunting.

But you don’t have to go it alone.

Whether you’ve just been diagnosed with diabetes or have lived with it for years, Diabetes WA is here to support you. Call our free helpline to speak to our credentialled diabetes educators.

2019-025

Come along to a free workshop Diabetes WA also has a range of free workshops that put you in the driver’s seat for self-managing your type 2 diabetes.

DESMOND: Meet people who are just like you and learn everything you need to know about type 2 diabetes, including information on food choices and medications.

Connect with Diabetes: Are you not ready yet to attend a workshop but want to learn more about diabetes? This information session is for people with type 2 diabetes, carers and those at risk of diabetes.

The Smart Series: A series of topic specific education programs to help you manage your diabetes and improve your health.

CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass.

FootSmart – everything you need to know about caring for your feet.

MedSmart – everything you need to know about your medications.

Call our diabetes helpline on 1300

MeterSmart – master the art of blood glucose monitoring.

ShopSmart – this supermarket tour helps you decode food labels (‘Classroom’ format also available).

001 880. For more information,

see inside Diabetes Matters for our workshop calendar

1300 001 880 bookings@diabeteswa.com.au diabeteswa.com.au