Winter 2017 $6.95
CGM Funding for under 21s Technology and Social Media Special Feature
Dr Google NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS
From the Editor of progress in medical As technology continues to drive the pace l line between engineering tiona tradi research and healthcare, the er. and medical science grows ever thinn etes Matters of ‘change Diab for e them al Staying with our annu ss how developments discu we the way you think about diabetes’, ging people’s chan on ct impa huge a had in technology have 8). e (pag approach to diabetes management ity that is affecting how There is also a whole online commun nt information and support Insta . ition people deal with their cond it easier to get advice and is available at our fingertips, making enience can come conv this with share our experiences. But curate advice. We discuss confusion and unsolicited and often inac d on page 17. worl this of ugly the good, the bad, and the nology too with tech on eye The Federal Government has their of CGMs ision prov the for idy subs a of t men their announce initiative This etes. diab 1 type for people under 21 years with le and is peop g youn y man of lives the ge chan will dramatically more Read WA. etes Diab by warmly welcomed and supported 22. about it on page Diabetes Week, a reflection For us, winter brings with it National Rock Star kids’ camp, on the HBF Run for a Reason and our Lunch and another orate Corp ual preparation for our Ann 35). Technology may fundraising raffle to enter (page 6 & sometimes we also just but , ways y man enhance our lives in so want some good old-fashioned fun! the medical world is So read on to discover more about how ge. Just think: One day, chan gical racing to keep up with technolo ildren may ask you what a your grandchildren or great-grandch even… “What was diabetes?” aps perh blood glucose meter was, or Enjoy,
WINTER 2017 Editor Natasha Simmons Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA 6904 Email email@example.com 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. Thanks to Princess Margaret Hospital, Sherl Westlund, Tony Lester, Matt Pontel, Carly Pink-O’Sullivan, Nicole Lester, Tim & Isabelle Skinner, Murdoch Books, Helen Edwards, Jake O’Brien Photography DWA staff, ambassadors and contributors, Shutterstock, Matt Pontel, Murdoch Books, AMSL Diabetes
Matt the blogger
From the President.........................................................3 Perspective .....................................................................4
Diabetes News HBF Run 2017..................................................................5 Corporate Lunch ............................................................6 DESMOND Update.........................................................7
Technology Feature Technology and Diabetes Management......................8
Evaluation Measuring our Impact..................................................12
Telehealth Technology in Action....................................................14
Online Media Dr Google .....................................................................15 Social Media .................................................................17
Education Planner Plan Your Sessions.......................................................18
Research News Research Round-up......................................................20 Diabetes Research WA Update...................................21
In the Community CGM Subsidy................................................................22 Rock Star Kids...............................................................23 DESMOND in the Pilbara.............................................24 Q&A................................................................................25
Living Well Matt the Blogger ..........................................................26 Emojifit App...................................................................27
Let’s Get Technical.........................................................28 Recipes...........................................................................30
Print Quality Press
Moving Well Winter Fitness Mojo.....................................................32
Diabetes WA www.diabeteswa.com.au
Diabetes WA – Subiaco Office Level 3, 322 Hay Street, Subiaco WA 6008
Diabetes Information and Advice Line: 1300 001 880
Postal Address: PO Box 1699, Subiaco WA 6904
Diabetes WA – Belmont Office 172 Campbell Street, Belmont WA 6104
Members’ Competition and Puzzle ...........................33 Member Partners .........................................................34
Postal Address: PO Box 726, Belmont WA 6984
Rocking Kid s Camp
What’s on Dates for Your Diary .....................................................35
From the President
reatment of diabetes, like most areas of medicine, has changed considerably over the years as a result of technological advances. From the discovery, purification, and mass production of insulin to the development of less painful ways to deliver it, the lives of people with diabetes have been improved – and sometimes greatly extended – by both diabetes-focused research and broader improvements in medical care.
Dr Moira Watson Diabetes WA President and Board Chair
This issue of Diabetes Matters explores these advances in technology and how it has affected the way people living with the condition, and those supporting them, approach the treatment and management of diabetes today. Here at Diabetes WA, it feels like winter is going to be a busy time for us. We are taking our DESMOND program and venturing into the Pilbara with a pilot project focusing on the training of local health professionals and the delivery of programs in that region. Read more about it on page 24. And, as we discussed in the autumn issue of the magazine, it is time to change the way we think about diabetes. Along with the diabetes community, Diabetes WA is also going through an evolution. Recently our bi-annual strategic planning day was held between the Diabetes WA board and the senior management team. These sessions are a great opportunity to focus on the future of the organisation and concentrate on our growth to enhance our programs and services. One of our strategic focuses has been moving towards a company limited by guarantee. This change in structure will allow Diabetes WA to further embrace future opportunities for the betterment of people living with diabetes, such as potential new technologies, new program and service activities and new partnerships. I’m pleased to update you with the success of Diabetes WA’s special general meeting, held on 12 April 2017. Members voted 96 per cent in favour of the special resolutions either in person or by proxy, to apply for registration as a company limited by guarantee and to adopt a new constitution. We thank you for your involvement and support in this process and we will continue to keep everyone up to date as this development continues and the changes come into place with the new financial year. We have also been busy consulting with our team of dedicated staff to develop company values that aim to build an organisational culture based on common goals and ideals. The image top right is our vision of the cultural objectives and priorities for the team at Diabetes WA. A few key events for Diabetes WA have taken place, or will be taking place, as you read this issue. Our biggest fundraising event for the year, the HBF Run for a Reason, was held just prior to our publish date, which was a great success! We had some incredibly generous and enthusiastic fundraisers and ambassadors that make us proud and thankful. You can read about our supporters on page 5. National Diabetes Week is another important event in the
community calendar and is taking place July 9-15. Look out for events in your area in which you can get involved. And finally, don’t miss out on the opportunity to hear about the latest developments at the Perth Stadium from keynote speaker, Ron Alexander, at our annual Corporate Lunch in September. Get in touch with the DWA team – on our new number (see box below) – to book a table for this unmissable event. Until next time…
Dr Moira Watson President and Board Chair
Need to call us? We have a new number!
iabetes WA has introduced a new free call number for all enquiries. The new number is 1300 001 880 and is active now. The number can be accessed from anywhere in WA for all calls, including program bookings and any other service enquiries. All calls to the number will be answered by our local team of diabetes professionals. With this issue of Diabetes Matters you’ll find a handy magnet to pop on your fridge to remind you.
n a bid to offer you a fresh perspective on the diabetes arena, we will be replacing our Current Matters message, previously written by our CEO Andrew Wagstaff, with a contribution from a guest writer with expertise in the area of our special feature. We launch this feature with a piece written by Tony Lester, Diabetes WA Board Member and Director of Lester Blades. Firstly, I should introduce myself. My name is Tony Lester and I am a board member of Diabetes WA. I have type 1 diabetes as does one of my children. My greatest wish is that this awful condition did not exist! That the lives of so many people could be freed of the constraints of finger pricking, counting carbs, injections or cannula insertions, having to wake up through the night for blood checks, the fear of hypos, and the aligned expenses involved in having to do all of these dreadful things. This winter issue of Diabetes Matters is addressing the area of technology, media and the online space. I am heartened by the advances we have seen over the last few years with technological developments around insulin pumps, continuous glucose monitoring and other new products that now allow us to access blood sugar information with the swipe of a meter over a sensor inserted into our arms. Based on these significant advancements, I am excited as to what the future holds. With future instalments in technology enhancements in the wings, such as blood glucose monitoring through a continuous glucose monitoring system, which not only cuts off insulin supply when blood sugar levels drop below a certain point, but also identifies and actions the supply of additional insulin to meet increased blood sugar glucose levels, management of this disease should become a little easier. The possibility of wearing a watch or a digital, multi-sensor contact lens that measure blood glucose levels are also very exciting prospects. An observation I have made is that, while the great work done by the multinational companies which have the ability to invest large sums of money into research and product development is critically important, it is also exciting to see the smaller, more agile entrepreneurial research and development companies moving into this space with new products and technologies.
Social media plays a valuable role in disseminating information to people living with diabetes. To be able to access information immediately about products or issues relevant to diabetes management is great. However I, like many others, have concerns about the influence of social media, in that there are no real filters around the accuracy of the information we can view. An example that comes to mind is advertising and sponsored sites recommending “low fat” products – products that may be 95 per cent or 100 per cent fat free, but have higher sugar and carbohydrate content than the corresponding “normal” version of the same product. One thing is for sure, the times ahead are exciting for diabetes management. We are seeing great advancements in technological developments and improvements to help people manage their diabetes. My hope is that there will be corresponding advancements towards the ongoing research and identification of a means of ultimately finding a cure for diabetes. I sincerely believe that this will happen.
Tony Lester is a founding Partner of Lester Blades, a Western Australian executive search and recruitment firm. He has worked in international executive search and selection for over 25 years. Tony has been on the Diabetes WA Board since 2011. He is a fanatical runner and snow skier, and passionate about not letting his type 1 diabetes limit his enjoyment of life.
Half-marathon only the beginning O
n May 28, thousands of people braved the cold to take part in the HBF Run for a Reason. More than $1million was raised for various charities, with Diabetes WA being one of the beneficiaries. Diabetes WA had many amazing volunteers, fundraisers and supporters throughout the event. Here are the stories of just a few. The greatest challenge Jake O’Brien faced at the HBF Run for a Reason wasn’t the gruelling 21km half-marathon. It wasn’t competing solo at just 16-yearsold. It wasn’t even managing his blood glucose levels. The greatest challenge – like many other teenagers his age – was waking up early. “I was walking to the train station and it was so cold,” the Mazenod College student, who has type 1 diabetes, shared with Diabetes WA after the race. “I got up, had a normal breakfast like any normal day would be, and just did the run. So the hardest part was actually beginning. Once I got over that it was pretty much easy.”
Hot on Jake’s heels was fellow Diabetes WA fundraiser Georgia Evans, 24, who ran her first half-marathon for her sister Maya, who was diagnosed with type 1 diabetes five years ago. “I feel pretty exhausted actually,” Georgia said following the race. “Six months of training–it’s been a big effort, but I had a lot of support. I’m pretty happy that it’s all done and I actually managed to finish. I’m starting to think I should train for a marathon now.” Maya said she hadn’t caught the running bug from her big sister. “I got up at 5am this morning when it was nine degrees – so I think that’s good enough support,” she said with a laugh. “I was there at the finish line, cheering her on. I could probably do the walk next year … maybe.”
Our Fundraising Superstar
ust a few weeks before the run, Carly Pink-O’Sullivan was afraid she might not reach her $800 fundraising target. The Margaret River local ended up raising almost 10 times that much, scoring the No. 4 spot on the HBF Run for a Reason individual’s leader-board with an amazing grand total of $7,340. Setting herself the running challenge was part of Carly’s ongoing campaign to raise awareness about the difference between type 1 and type 2 diabetes and share the realities of the condition. “I get frustrated when people find out I have diabetes and make assumptions and comments,” she said. “Having type 1 diabetes shouldn’t stop you from leading a healthy and active lifestyle. It’s been hard, but diabetes has changed my life for the better. Now I’m working towards a career as a diabetes educator.”
Clocking in a time of 1 hour and 49 minutes may sound impressive, but it’s just a starting point for Jake. “It was my first half-marathon, so I’m really happy with it,” he said. “But hopefully I’ll beat it next year.”
her Georgia (right) with sister Maya
Diabetes WA fundraisers collected an incredible
$40,364 and counting!
Jake with his med al
Carly (right) and her friend Clare after the run
2017 Diabetes WA Corporate Lunch Don’t miss out on the annual Diabetes WA Corporate Lunch. When: 11.30am – 2.30pm Friday 8 September 2017
Cost: $165 per ticket, or $1500 for a table of 10
Venue: Fraser’s Kings Park
To book a table: e: firstname.lastname@example.org p: 08 9436 6204
Keynote Speaker: Department of Sport and Recreation director general Ron Alexander will be speaking to the role that sport plays in the community and will include the latest updates on the new Perth Stadium.
National Diabetes Week It’s About Time Many people live up to seven years with type 2 diabetes – and develop at least one serious complication – before being diagnosed. Meanwhile, one in five people end up in hospital with diabetes ketoacidosis after they fail to recognise the early symptoms of type 1 diabetes such as fatigue, thirst and weight loss. National Diabetes Week is just around the corner from July 9-15 and this year’s theme is ‘It’s About Time’. Diabetes WA is striving for greater awareness of symptoms, earlier diagnosis and better long-term health outcomes for every person at risk of developing or already living with diabetes. It’s about time Western Australians prioritised their health.
An update on DESMOND D
ESMOND is the National Diabetes Services Scheme (NDSS) endorsed one-day structured self-management education program designed to support people with type 2 diabetes. The arrival of the DESMOND program in Australia in 2011 was the result of close collaboration between Diabetes WA and DESMOND UK. Since its introduction, we have had almost 2,100 people attend Diabetes WA DESMOND programs, with 398 people attending in the metro area in the last 12 months.
Take a look at our Education Planner on page 18 to find out when DESMOND is being offered in your area. Or to learn more contact email@example.com
“DESMOND is quite unique,” says Kelly Baxter, Diabetes WA’s DESMOND program coordinator. “It’s an education program designed to recognise that individuals are experts in their own condition. Our diabetes educators are there to help increase knowledge and understanding of what having diabetes will mean for the individual. It’s about handing the control to the person living with diabetes, so they complete the program feeling confident in their own ability to make their own decisions.”
In some exciting news for the DESMOND team, a pilot project is being undertaken in the Pilbara, with training being provided to local health professionals in order for them to deliver the program in the region. See page 24 for an outline of DESMOND in the Pilbara.
Rocking on at Kids Camp T
here were air guitars aplenty when a group of 11–12 year old kids with type 1 diabetes got together in Point Walter for our Rockstar Kids Camp, run in conjunction with Princess Margaret Hospital. The kids learned about managing their diabetes while having loads of fun with Sports Challenge activities. Acknowledging the new government funding of continuous glucose monitors (CGMs) for under 21s, every child on the camp was offered the opportunity to use a CGM for the entirety of the camp. Most of the kids took up this opportunity and some were using the device for the first time. Read more about the Kids Camp and what the kids thought of using a CGM on page 23.
Technology and Diabetes Management S
ince the early days of the first commercially available animal-derived insulin in 1921, research progress has made vast improvements to the lives of people with type 1 diabetes. From urine testing for blood glucose levels to tiny smartphone-compatible blood glucose meters, from large boiled steel needles to insulin pumps and insulin pens, technological advances – such as insulin pumps and CGMs – have made life with type 1 diabetes much more manageable. Diabetes is a constantly growing condition. However, the development of new tools for treatment and management are literally changing the way that diabetes self-management is done across the board. From providing more accurate information, to more easily facilitating monitoring and medication delivery, technology is making care simpler and more effective in nearly every way imaginable. With continued research and development, care is only expected to expand.
Eight ways technology is changing the face of diabetes management 1. Maintaining Accurate Information Keeping an accurate record of daily blood glucose levels, food, activity, medication, etc. can be a challenge, but technology is making that all easier. Instead of trying to track it on paper, there are many options of mobile phone apps that can now be used. The point of these apps is to streamline the management of blood glucose levels and to help people keep accurate records of pertinent daily information. Diabetes WA diabetes educator and exercise physiologist Marian Brennan lists some of her top diabetes management apps: App Name
What it does
Diabetes Australia App
Location of health providers, news, recipes, directory of programs and services in your area.
MedicineList+ NPS MedicineWise
Reminders of when to take your medicine and when prescriptions need re-filling, listing your medicines, provides vital information in an emergency situation.
Verified to clinical standards, the CalorieKing Food Database contains over 22,000 Australian foods including many popular fast food chains and restaurants, allowing for a quick comparison between foods of their kilojoules, calories, carbs and fat.
The app auto-logs your blood sugars, carbs, bolus, CGM, hypos, and activity data via connected devices. Add meds, HbA1c results, notes, pics and additional blood glucose levels.
Not diabetes specific but could help those wanting to keep track of exercise and dietary intake.
The app allows you to record glucose readings, insulin doses and carbohydrate intake, supporting both mmol/L and mg/dL units for glucose readings and a fully customisable list of insulin types.
SquareMed Software GmbH
Administer all your diabetes data, suitable for type 1 and type 2, support for mg/dL and mmol/L, track your meals as bread units, carbohydrate units or carbohydrates, get important medical statistics within the app, synchronisation over multiple devices.
2. F acilitating Ongoing Glucose Monitoring Continuous glucose monitors (CGM) provide a more complete picture of blood glucose levels. Despite becoming available in Australia in 2006, it’s only in the last few years that CGMs have been more widely used. This method of monitoring measures blood glucose levels in real-time throughout the day and night using a tiny electrode or glucose sensor inserted under the skin. The monitor alerts you if your reading is too high or low. This ongoing monitoring makes it easier to make adjustments before your body reaches a level that is one extreme or the other. That in and of itself is a benefit that can change, and even save, lives.
The downside of advances in technology is often the cost of the new tools, which can be prohibitive for many people. Diabetes WA educator Sophie McGough, said it was hard knowing there was technology available that could help people but for it to be financially out of reach. “The worst thing is to have someone sit in front of you saying ‘I can’t work out what is happening with my diabetes’ and they are struggling and you know that there is this great technology that could help them to manage their diabetes and get it back under control and yet they can’t afford it,” she said. Continuous glucose monitors (CGMs), which have been hailed a major breakthrough in diabetes self-management, cost about $5000 a year to operate, with no rebates from Medicare or private health funds. In good news though, as you will read on page 22, the Federal Government has recently committed to subsidising CGMs for people aged under 21, which is an exciting development for young people living with diabetes.
TECHNOLOGY 3. Improving Pumps While insulin pumps have been available since the 1990s, technology is improving, making them more accurate and effective every day. Pumps are worn close to the body and release insulin as needed via a catheter located under the skin. Previously, pumps were cumbersome and frequently experienced clogs, but recent developments in the technology have improved insulin delivery as well as better monitoring. In fact, new pumps can even stop delivery of insulin before blood glucose levels become too low and start it again once levels begin to climb. For the 10 per cent of Western Australians now using an insulin pump, which cost about $10,000, the full out-of-pocket costs of necessary consumables such as infusion sets and reservoirs/ cartridges is around $270 per month. The cost of pumps can be covered by private health insurance or subsidised by some government programs depending on the patient, and there are programs to subsidise consumables for some people.
4. Artificial Pancreas Creating a device that would regulate blood glucose levels on its own, in effect creating an artificial pancreas, has long been a goal of diabetes researchers. Now, however, such devices are actually being built and undergoing testing. The advent of continuous glucose monitoring has been crucial to this process, since an artificial pancreas is the combination of an insulin pump, a continuous glucose monitor and a computer program that calculates how much insulin the user needs at any moment based on his blood glucose level. It must be kept in mind that there are also personalised factors that need to be considered, such as how stress and certain activities affect blood glucose levels and insulin needs. These cannot be accurately determined by a piece of mechanical equipment, no matter how sophisticated. Though an amazing development, once they become a reality artificial pancreases may still require the entry of some information by the people who use them.
5. Improving Access to Information As with any chronic health condition, having as much information as possible is one of the most important components of managing blood glucose. There are tons of resources available for people living with, or at risk of, diabetes which offer blogs, videos, and a diabetes awareness-screening program to provide information to individuals and improve care and treatment. This information, as well as the other resources available online and elsewhere, provide valuable insight into managing the condition and managing it most effectively.
6. Streamlining Monitors In the past, glucose monitors were big, bulky machines. With current technology, though, these devices are as sleek
and simple as an iPhone. They also have the capacity to facilitate better monitoring by using app integration and smart meter connection to measure blood glucose levels and input the information into an app for more accurate monitoring. Most of these devices are also compatible with Apple devices, making them even more functional.
7. Identifying Causes and Treatments Another way technology is contributing to improved treatment is through research and development. Technology is improving the way information is collected and is giving us access to better information. This research is fueling treatment options that rely on a data-driven approach to diabetes management and uses a versatile app to provide food and lifestyle data. There are also other projects in the works to improve care provision on an even larger scale.
8. Creating New Care Possibilities Technology is not only improving individuals’ diabetes management, it has also improved the way doctors collect, track, and analyse data to provide more effective care. Telemedicine is one such option that is saving individuals’ time and allowing healthcare systems to provide more effective care for those who are isolated. This type of care is provided remotely to give more patients access to facilities that may not be available to them. It also provides more immediate responses to concerns and more productive interactions between healthcare providers and their patients. To read about how Diabetes WA’s Telehealth program has been operating in this arena for two years, see page 14. As health care becomes digitised, many activities, ranging from diagnostic imaging to the manipulation of laparoscopic instruments, are rendered practically borderless. The first step in long-distance robotic surgery was taken on 7 September 2001, when surgeons in New York removed the gallbladder of a 68-year-old woman in France using a high-quality telecommunication system and a three-armed robot. One arm held a camera, and the other two held laparoscopic surgical instruments. On a more local level, many operating rooms now have robots that are manipulated by surgeons on-site. This form of robotic surgery is useful to perform minimally invasive procedures, since robots can perform smaller tasks with more precision than any human can. With so many new technologies coming into existence, diabetes care has the potential to become a distant relative of what it was even a decade ago. All signs are that technological developments will continue and probably even accelerate, given the expected increase in the number of people with diabetes. While a miracle cure is unlikely, at least in the near future, advances in medical technology – both directly and indirectly related to diabetes – can make diabetes control easier, more convenient, and more accurate for everyone.
Advances in Technology Minecraft morphed into game to help kids and parents deal with onset of diabetes
father has designed a version of the video game Minecraft to help kids like his son learn how to live with type 1 diabetes.
Josh Wulf’s son Prahlad has type 1 diabetes, so he worked together with volunteers to develop a modified version of Minecraft – the massively popular game where blocky-pixelated characters explore, build, and live in a limitless blocky-pixelated world – that can help kids learn how to manage their condition through the game. Prahlad was diagnosed at the age of eight, and spent two weeks in hospital learning how to manage the condition via the rituals of daily injections, blood glucose checks and watching what he eats. “I was really young then so I didn’t really understand most of it, it was a little bit scary,” Prahlad said in a report on ABC News. The experience stuck with Mr Wulf, who now runs programs helping children learn coding through Minecraft. “I realised we could make a difference for children and families living with type 1 diabetes in terms of learning how to manage their condition in a safe way, and a fun way,” he said. In the modified version of Minecraft, players walk around the world and play through stories, with the added challenge of monitoring their blood glucose and insulin. “They focus on playing, they focus on the story, they focus on the magic, and they just learn how to manage diabetes in the course of that,” Mr Wulf told ABC reporter Nick Wiggins.
He hopes the finished game will help children with type 1 diabetes connect online, as well as help their friends without diabetes better understand the condition. The project has attracted international attention, with a Danish pharmaceutical company that manufactures insulin approaching Mr Wulf after hearing about the project. “We’re working with their scientists on the modelling of the metabolism in the game, and we’re going to visit them in Denmark to talk further about that,” he said. Prahlad said if the game existed when he was diagnosed, it would have helped. “It would’ve been easier for me to understand what it is, ‘cause it’s in simpler terms instead of all this scientific mumbo jumbo,” he said. “Someone who newly has type 1 diabetes – it would help them a lot.”
Source: ABC News
Smartphone-controlled cells help keep diabetes in check
ells engineered to produce insulin under the command of a smartphone helped keep blood sugar levels within normal limits in diabetic mice, a new study reports. Human cells can be genetically engineered into living factories that efficiently manufacture and deliver hormones and signalling molecules, but most synthetic biological circuits don’t offer the same degree of sensitivity and precision as digital sensors. Combining living tissues and technology, Jiawei Shao et al. created custom cells that produced insulin when illuminated by far-red light (the same wavelengths emitted by therapy bulbs and infrared saunas). The researchers added the cells to a soft bio-compatible sheath that also contained wirelessly-powered red LED lights to create HydrogeLEDs that could be turned on and off by an external electromagnetic field. Implanting the HydrogeLEDs into the skin of diabetic mice allowed Shao and colleagues to administer insulin doses remotely through a smartphone application. They not only custom-coded the smartphone control algorithms, but designed the engineered cells to produce insulin without any “cross-talk” between normal cellular signalling processes. The scientists went on to pair the system with a bluetooth-enabled blood glucose meter, creating instant feedback between the therapeutic cells and the diagnostic device that helped animals with diabetes rapidly achieve and maintain stable blood glucose levels in a small pilot experiment over a period of several weeks. The authors say that successfully linking digital signals with engineered cells represents an important step toward translating similar cell-based therapies into the clinic.
Source: American Association for the Advancement of Science.
Apple ‘may’ be working on non-invasive glucose tracking
recent story on American news channel CNBC, claims that Apple has been quietly working on sensors for measuring blood sugar, which could be a significant breakthrough for people living with diabetes. According to a new report, the technology company has hired a small team of biomedical engineers to build a non-invasive sensor for monitoring glucose levels and has even started clinical trials in the US, while working with consultants to navigate tricky health regulations. The report says that the project has been ongoing for at least five years, initially envisioned by late Apple co-founder Steve Jobs, and, as of a year ago, had as many as 30 people on the team. It goes on to state that the device would use optical sensors to shine through the skin and read blood glucose levels – the Apple Watch being the most likely vessel for this technology.
Accurately detecting glucose levels non-invasively has been such a challenge that one of the top experts in the space, John L. Smith, described it as “the most difficult technical challenge I have encountered in my career.” The space is littered with failures, as Smith points out, but that hasn’t stopped companies from continuing to attempt to crack this elusive opportunity. There are other routes being taken: website wareable.com spoke to engineers at Oregon State University who have created a contact lens they claim will be able to predict glucose levels with tear fluid as accurately as a finger prick. Google has also been working on something
similar, but it is understood the project is currently on hold. The need for thorough research and numerous clinical trials to assess the accuracy of the device is recognised though. When it comes to heart rate sensors for fitness it can afford some degree of inaccuracy, but with glucose monitoring there’s less margin for error. Though Apple has declined to officially comment, if successful, the advance could help millions of people living with diabetes and turn devices like the Apple Watch into a must-have, rather than a luxury item.
Stem cells grown in space could benefit type 1 diabetes
tem cells cultivated in low-Earth orbit at a US national lab aboard the International Space Station could advance therapies aimed at regenerating insulin-producing cells in type 1 diabetes. Researchers are looking at two main ways of using stem cells for treating type 1 diabetes: as beta cell producing factories or as cells that support beta cell repair. In both cases, the goal is to cultivate stem cells that are best suited for the job. To that aim, Dr Abba Zubbair, a researcher from the Mayo Clinic in Florida, is testing a new way of growing stem cells to improve their quality: sending them to outer space. Dr Zubbair’s experiment consisted of shooting a bio-engineering tool, ordinarily used to cultivate stem cells, 250 miles above the Earth’s surface inside a satellite womblike capsule so the cells experience the absence of gravity. The argument goes that stem cells behave very differently in space than when grown in an earthly lab. When they replicate in
a lab, on a flat surface, many of the stem cells develop imperfections and have to be discarded. In contrast, the kind of weightlessness experienced in space, called microgravity, has an effect on cell proliferation and survival. It mimics the beneficial environment in which foetuses develop in the womb, as they float in amniotic fluid. Dr Zubbair’s unmanned space flight experiment set out to test whether the donated adult stem cells do indeed proliferate faster in micro-gravity without suffering any side effects. “Up there, one of the astronauts helped us to image the cells, harvest the cells and freeze them in a way that we can use them here on Earth and compare them to cells we grew here in the lab,” Dr Zubbair told the website Salon.
The next step for Dr Zubbair and his colleagues is to analyse the data collected during and after the space trip, including which genes were turned on or off and the cells’ structure, and compare these results to those of lab-grown cells. If it is proved that stem cells can grow faster in space, research teams around the world working on stem cell therapies could use floating labs as a way to produce the cells in the quantities needed for treating type 1 diabetes.
Measuring our impact: Evaluation and its role in diabetes management T
echnology does not only have an impact on innovation in medicine. Evaluation techniques have also been affected by the advancement of technology; with the introduction of online surveys, social media, groundbreaking computer programs and new, easier methods of communicating with those providing feedback. One of the key ways in which Diabetes WA support people living with diabetes is through our various group education programs. We want to ensure these programs are as effective as possible, helping participants to make real improvements on the way they manage their diabetes. For this reason, Diabetes WA is proud to be involved in the development of the NDSS National Evaluation Framework. The project is funded by the NDSS through Diabetes Australia, but is managed and coordinated nationally by a research and evaluation team based in Western Australia. It involves developing a set of national quality standards for diabetes structured group education and an accompanying evaluation framework for all programs and services delivered with NDSS funding. The end goal is to ensure all programs and services are relevant to the person with diabetes, consistent, evidence-based and of a high quality.
The National NDSS Evaluation team worked with other diabetes organisations around the country and a panel of experts, seeking their input and feedback on the processes and reporting tools that will underpin the standards and evaluation framework.
to evaluate efficacy before it is put to the consumer.”
The DESMOND Foundation program was the first of Diabetes WA’s programs to be assessed under the National Evaluation Framework last year, and it performed well against the standards. Based on this, and on other positive outcomes, we know we are delivering a program that genuinely and practically helps people to understand and self-manage their type 2 diabetes.
“You look at safety ratings – based on standards – you look for fuel efficiency; you might look at Choice as a consumer watch dog to see what others think; you may analyse the cost of running the car and question whether it will suit your lifestyle. It is a big investment, something you will use every day and you need it to work every time you get into drive. In doing your research you are looking for some degree of certainty.”
“Evaluation and ensuring quality is part of the Diabetes WA culture and strategic direction,” said Diabetes WA health services general manager Helen Mitchell. “Our programs need to be valuable to any person that accesses them. We don’t have the luxury of trying something first and seeing if it works, as money is not renewable. It needs to be researched
Helen likens choosing a suitable health program to a significant purchase in your life. “When you are buying a car, you would do your research before purchasing one that is right for your needs,” she said.
She says choosing a self-management program is very much like this. “What standard does it meet? Will it be effective (research/evidence-based)? Does it deliver consistently for multiple consumers (evaluation – Net Promoter Score)? Can you guarantee quality most of the time (ongoing evaluation)?”
We asked Diabetes WA research and evaluation manager Natasha Watson, who leads the national program, why evaluation is so important in the development of diabetes self-management programs, and the impact that technology has had on Diabetes WA’s approach to this area.
Why is evaluation so important? Evaluation allows us to monitor the quality of our programs and services and their suitability and relevance to our target audience. It provides the opportunity for reflection and continuous quality improvement to ensure our programs and services meet the needs of our consumers and assist them in their journey with diabetes.
Explain our involvement in the establishment of the NDSS National Evaluation Framework. Diabetes WA is home to the National Evaluation Team, who developed the NDSS National Evaluation Framework. This framework helps to categorise services delivered under the NDSS and guides evaluation processes based on the domains of the framework that are being addressed. The framework provides a series of tools to standardise not only the evaluation of programs and services, but also quality
standards that programs must be measured against, and meet, in order to be delivered using NDSS funding.
What are some other evaluation techniques we use when measuring the work we do? Guided by the framework, the primary outcome measures for our DESMOND program are Diabetes Distress and Diabetes Empowerment. Both of these measures are identified by using a questionnaire to indicate an individual’s position on a recognised scale.
TECHNOLOGY We know that people coping well with living with diabetes and who are empowered to self-manage have better health outcomes and fewer complications in the long term. This is ultimately the goal of everything we do at Diabetes WA. The SMARTs series program that we also offer (see our Education Planner on page 18) focuses primarily on Diabetes Empowerment as an evaluation outcome. Self-determination means that the person is enabled to make their own decisions regarding their diabetes self-management. The delivery style of the SMARTs series supports them to do so, therefore promoting a sense of empowerment. Finally, the Net Promoter Score (see below for details) lets us know how likely someone is to recommend a program or service to others. This is a great indicator
of consumer satisfaction and lets us know if we are getting to the heart of issues that matter to people living with diabetes.
How do you think technology has affected evaluation processes and our approach to evaluation at Diabetes WA? We have a web-based diabetes prevention program, My Healthy Balance, which is an innovative and interactive healthy lifestyle program that equips people with the knowledge and confidence to make informed decision about their health. When we developed this program, evaluation was structured into the coding. The relevant data is then generated, according to the goals that are set and the modules that are used, within the program
that the participant themselves create. We also use Google Analytics to assess traffic to the site. Just recently, we have started using online survey software. This has streamlined evaluation processes through its ability to automate pre, post and three-month follow up evaluation. It can also automate reminder emails in the event a survey is not submitted. Most importantly, it provides a number of ways in which participants can interact with the evaluation process, thereby maximising the user experience and increasing response rates. The use of QR codes assists with increased accessibility, allowing surveys to be completed on mobiles and tablets. The program meets strict data storage and security standards, and offers true confidentiality in survey responses.
Net Promoter Score – What is it? T
he Net Promoter Score (NPS) is a measure of the likelihood that someone will recommend a product or service to others. It is calculated based on the responses received by asking customers one simple question. In the case of Diabetes WA, that question is: “On a scale of 0-10, how likely is it that you would recommend this program, product or service to others?” The question is asked after a product or service has been used. Again in our case, that is attendance at a Diabetes WA self-management program. The individual responses to the question are then divided based on predefined criteria: • 9-10 – Promoters: They love our programs or service and are likely to refer these to others. They are also more likely to engage with our services in the future. • 7-8 – Passives: They don’t spread any negative word-ofmouth, but would easily switch if they have a better option. While they won’t spread negative word, they won’t be too enthusiastic to promote it. • 0-6 – Detractors: They are unhappy with our program or service and likely to damage reputation with negative word-of-mouth publicity. Based on the division of the individual responses, the NPS is then calculated by subtracting the percentage of detractors from percentage of promoters. Here’s the formula for calculating the NPS score:
A Google search of Net Promoter Scores produced data from three well-known brands, Apple, Netflix and Amazon. Each company had an NPS that was significantly above average for its industry: 1. Apple has a NPS of 72, which is 40 per cent above average for the computer hardware industry; 2. Amazon has a NPS of 69, which is more than 30 per cent above its industry average; and 3. Netflix has a NPS of 68, positioning themselves above the competition. So how do Diabetes WA’s education programs stand up to the big guys?
Net Promotor Score = (% of Promoters) – (% of Detractors)
The score is a number that ranges from -100 to +100. If we have an NPS score of 100, that essentially means all our consumers are promoters (best case scenario), while a score of -100 implies that all our consumers are detractors (worst case scenario).
Our NPS is regularly calculated by our evaluation team at intervals throughout the year. The above are our latest results and we’re pretty proud of them!
Telehealth – Video-conferencing technology in action H
ow has the technology of video-conferencing impacted those needing specialised diabetes care in the more isolated areas of WA?
Out of the 120,000 Western Australians currently living with diabetes, over 28 per cent reside outside major cities. The Diabetes Telehealth Service for Country WA commenced in January 2015 and was designed to fill the gap in regional and remote WA, where the opportunity to have a consultation with a diabetes educator was limited or did not exist. Funded by the Western Australian Country Health Service (WACHS) Southern Inland Health Initiative and subsidised by the State Government’s Royalties for Regions program, the core element of the service is the use of video-conferencing technology. Video-conferencing is like having a face-to-face appointment with a diabetes educator but can occur via a computer, television, tablet or phone screen with consultations taking place at local hospitals, health centres, doctors’ offices or at community resource centres. The Diabetes Telehealth Service also provides upskilling for health professionals in country WA. Delivered by Diabetes WA, Diabetes Telehealth builds diabetes management capacity in country WA by providing regular updates for health professionals with patients living with diabetes. The upskilling is delivered via video-conferencing technology (Telehealth). Every month different diabetes-related topics are comprehensively covered, sometimes by staff within Diabetes WA, and sometimes by guest experts. In its first two and a half years, the free service has proven to be a great success and participant feedback has been outstanding.
Who has Telehealth helped? (Total statistics to April 2017) • • • •
Total referrals: 680 Occasions of service: 1315 Aboriginal community referrals: 68 Attendance at upskilling of health professionals: 913
Referrals per region • • • •
South-West: 107 Wheatbelt: 152 Great Southern: 177 Goldfields: 122
• Midwest: 29 • Pilbara: 87 • Other: 4
Feedback from Telehealth clients: What did you find most helpful about the Telehealth session with a diabetes educator? “The educator showed understanding of my problems with diabetes.”
“Just to be able to talk to someone and know you are doing the right thing.”
“The confidence and reassurance that I lacked, and lifted my spirits and self-esteem muchly.” “Being able to talk to a professional who seemed to be caring, interested, sympathetic and informative without having to travel!”
“Dr” Google F
eeling ill? Don’t rely on your fingers to ask Dr Google, as DIY diagnosis can leave you feeling MUCH worse.
You’re sick. Your head is pounding, the sunlight is too bright, you’re nauseated and vomiting and feeling very sorry for yourself. What do you do? You jump online and through blurred vision you Google ‘migraine’ looking for your symptoms.
‘While the internet is a great source of information, it is difficult to know how credible that information is,” says Diabetes WA educator Sophie McGough. “Advertisers know that the diabetes market is big money, so people with diabetes are vulnerable to being targeted with new ‘cure all’ products or the latest food fad.”
‘DIY diagnosis’ is now a growing trend and a worrying new survey for The Royal Pharmaceutical Society (RPS) in the UK found 43 per cent of people admit to using painkillers that have been prescribed to someone else after diagnosing themselves online. According to Sky News, three in five Australians look up their symptoms on the internet instead of seeing a doctor in person.
“Remember that some websites are not there to help your health, their purpose is to make money from advertising. Finding credible diabetes advice online, can be like digging for gold – you know it’s out there, it’s just knowing how to detect it. It is better to talk to someone like our diabetes educators, who can help you sift through the impurities to find the gold nuggets of advice that will add real value to your health.”
In this age of instant access, and possibly a negative bi-product of the expansion of technology, it’s not surprising that Google is the first port of call for many people with worrying symptoms.
Here are 10 of the most commonly searched for health symptoms, the suggested causes Google searches come up with, and the conditions a UK expert say are more likely to be behind them.
Many doctors are concerned that self-diagnosing runs the risk of taking misleading advice or missing key symptoms for potentially serious problems or, at the other end of the scale, of becoming seriously distressed when you self-diagnose a life-threatening condition that you don’t have.
Google: Hepatitis, head injury, vertigo
Google: Meningitis, measles, skin allergy
What the experts say: While these three are all possible causes of nausea, they are relatively rare in comparison with food poisoning, which is by far the most common reason for feeling sick and vomiting. Pregnancy is another possible cause in women of child bearing age. Feeling sick (not necessarily only in the morning) is one of the first symptoms to occur. If nausea persists, or if vomiting is severe, seek medical advice.
Chest Pain Google: Heart attack, indigestion, pulled muscle Experts say: An excellent example of how dangerous googling can be, as the treatment for a pulled muscle and heart attack are very different! One is an emergency situation, the other simply uncomfortable. Seek urgent medical advice if you have a tight or uncomfortable pressure in the centre of your chest, pain or discomfort in one or both arms, which may radiate up to the neck, shortness of breath, or chest pain that lasts more than a few minutes or makes you break out in a cold sweat, feel sick or lightheaded.
Experts say: A pink viral rash is common in babies and young children when they first get colds and infections. If it isn’t raised when you touch it and disappears when you roll a glass on it, it isn’t likely to be a meningitis rash (which actually occurs late in meningitis – by which time a child will be very sick). Ask yourself ‘Is my child very poorly?’. A child who has a cough and a temperature but is playing happily is not a cause for concern.
Feeling tired Google: Cancer, not getting enough sleep, over-exercising Experts say: Although extreme tiredness can be a symptom of cancer, there are many more common underlying medical conditions that a GP would want to rule out first. Top of the list is stressful life events, but conditions such as anaemia, diabetes, an underactive thyroid, heart problems, hidden infections and other immune disorders need to be ruled out.
Itchy Spot Google: Eczema, skin cancer, dandruff Experts say: Yet another case when you need an experienced medical eye. A doctor needs to look at – and ideally feel – the offending bump, in person, to diagnose exactly what is causing it to avoid unnecessary worry, and to avoid missing something serious such as a melanoma.
Google: Throat cancer, throat infection, acid reflux
Google: Lung cancer, asthma, cold or flu
Experts say: Sore throats, especially following colds and flu, are usually due to a viral infection and are self-healing. You only need to see your GP if they don’t improve after a week, or you have a persistent temperature that medication doesn’t bring down.
Experts say: Most coughs that come with colds and flu don’t need to be seen by a doctor – unless they go on for longer than three weeks without improvement. Lung cancer is rare in those under 50, even rarer in non-smokers.
If you’re over 50, especially if you’re a smoker or former smoker, see your doctor if you have a change in your voice or hoarseness that’s unrelated to a cold, or if you’re having trouble swallowing, as these can be linked to throat or oesophageal cancer.
It is coughs that are new and don’t accompany a cold that GPs need to see, or those in smokers over 50 that don’t clear up. Persistent night coughs in children that aren’t related to a virus can be a sign of asthma so should also be investigated.
Google: Brain tumour, meningitis, brain bleed
Google: Bowel cancer, IBS, food poisoning
Experts say: This is one of the most common health symptoms, but thankfully isn’t usually serious. It’s most often caused by stress or simple dehydration and can be treated with paracetamol. See your doctor if you’ve never suffered from headaches but have started getting them regularly – or if they’re accompanied by other worrying symptoms such as numbness or tingling in the arms, speech problems, vomiting or visual disturbances.
Experts say: Many people have dodgy bowels all their life, but doctors want to see patients, especially those over 50, who’ve had a change in bowel pattern that’s unusual and lasts more than two weeks. Don’t put it off, even if it settles by the time your GP appointment comes around, which can happen even with cancer. Bowel cancer is far easier to treat in the early stages when bowel disruption is the only symptom, rather than by the time you notice blood in your stools or weight loss.
Back Pain Google: Slipped disc, bone cancer, spine tumour, sciatica Experts say: Nearly everyone has back pain at some point but it can mostly be treated with painkillers, and remaining as active as possible. See your GP if the pain hasn’t improved after six weeks or if you’ve any “red flag” symptoms: weakness or numbness in either leg, pain causing immobility, pains shooting down the leg, difficulty with, or loss of bladder or bowel control, or numbness or pins and needles at the base of the spine or between the legs.
Keep in mind, even these expert answers are all hearsay until a medical expert has seen and diagnosed a condition with a face-to-face assessment of your symptoms. If in doubt always visit your GP or diabetes specialist.
But wait… Google has released a new service in Australia that promises to help us avoid dodgy health advice online. The search giant has launched health condition cards in Australia, designed to answer users’ health-related questions, queries and curiosities for 900 common health complaints, such as coughs, infections, rashes and bites.
health cards are meant to do is provide accurate and reliable information created in a partnership with medical doctors and to make sure there is a source of information online that people can trust,” Ms Solaqua said.
“With the introduction of the new program, when Australians search for common health conditions, such as asthma, they will start to see health cards appear in their search results,” Google project manager, Isobel Solaqua, said. Users will be provided with an outline of the condition’s symptoms, diagnosis, treatment pathways and prevalence.
The Australian version mimics the US health cards launched in February 2015. But Google hopes to partner with Australian groups to tweak them to better fit the local health scene, and provide Australia-specific prevalence data.
The service has had expert help from doctors and are not aligned with any pharmaceutical companies, however, the cards are not intended to provide medical advice. The goal of the new feature is to offer help for medical conditions, but only as information. “Instead of trying to pretend that there isn’t a problem and that people aren’t finding bad information on the internet, what the
It could be a potent antidote to dodgy websites and fraudulent health ‘gurus’ peddling incorrect health advice and treatments that are at best ineffective and at worst dangerous. Google stresses that people with a medical condition should still contact their doctor to get actual medical advice or care.
Social Media: the Good, the Bad, the Ugly
ocial media has been responsible for many changes in both personal and community health, particularly by making it easier for large numbers of people to rapidly share information and find support.
As discussed in our article about “Dr Google”, this has brought with it both positives, such as the ability to have preventative and diagnostic information widely available, and negatives, such as the potential for misinformation to quickly circulate without the input of health practitioners, experts and professional organisations.
Beware the Trolls There is also the risk of receiving unsolicited and unwelcome advice on what can feel like a very personal situation. The term “troll” has developed an alternate meaning to the traditional green hairy creature for the online community. Wikipedia defines an internet troll as “someone who posts inflammatory, extraneous, or off-topic messages in an online community, such as a forum, chat room, or blog, with the primary intent of provoking readers into an emotional response.” Such public and often ill-informed judgement can weigh heavily on those involved in the online discussion. According to the 2015 Sensis Social Media Report, 49 per cent of Australians use social media at least once a day. These elevated numbers have raised concerns about the negative risks that social media poses on our health, with cyber-bullying, depression and sedentary behaviour all linked to its use. While these issues are worthy of attention, it’s also important to acknowledge its positive – and often under-reported – benefits.
A Global Village The most widely recognised benefit of engaging in social media is its effective and efficient ability to create and nurture community. These technological advances in communication promote the idea of a global village, expanding and extending the power of the individual to ‘be’ anywhere at any time, facilitating instantaneous strong bonds between people worldwide. Recent studies have analysed health-seeking behaviour and information sharing on popular social networking websites by people living with diabetes. Some analyses have shown that people with diabetes, family members, and their friends use social platforms to share personal clinical information, request conditionspecific guidance and feedback, and receive emotional support.
Ground-breaking Blogging Helen Edwards runs website, diabetescantstopme.com, a blog and online community all about creating a happy healthy life with diabetes. She has also recently started up a Facebook support group with weekly live chats on a range of diabetes-related topics (search diabetescantstopme on Facebook). Helen has been living with type 1 diabetes from the age of 12 and has worked in diabetes for more than 15 years.
“Since starting my first online counselling website in 2001, when there was very little online diabetes support, I have seen many positive changes,” Helen says. “There are now lots of blogs, support groups, and communities online.” Helen was a ground-breaker in this area when she first started, and won many grants and awards for her work in diabetes, including being awarded a state finalist spot in both the Australian of the Year awards and the Telstra Business Woman of the Year awards. “I felt that more needed to be done for the wellbeing and mental health of all people with diabetes,” she says. “People with diabetes suffer up to twice the rates of depression compared to the rest of the population, along with reduced wellbeing and increased stress and anxiety. We can live wonderful lives, but support from health care professionals, loved ones and other people with diabetes is vital. “The biggest thing I have found over the years, is the power of connections and knowing you are not alone. A conversation on Facebook could be the thing that ensures someone feels better about their life with diabetes, and makes positive steps towards change.” “Like anything, social media can also have its downfalls such as bullying, trolls, becoming too reliant on social media, and asking for medical advice when the person should really seek urgent face-toface help. Mostly though, my experiences have been resoundingly positive.” Among experts, questions also remain about the extent to which private pharmaceutical brands and other organisations promote their products in this unregulated environment. Furthermore, many physicians and patients are unaware of the extent to which information on social media is clinically accurate and whether patients receive advice to engage in potentially harmful activities.
Proceed with Caution As the social media boom continues, clinicians will also need to change how they provide care for patients with diabetes who use these platforms. Accepting social media, understanding how patients use it, and finding ways to incorporate it into patient care may help reduce the burden of diabetes in the future. This new, digitally powered world is changing the face of communication and the underlying message appears to be embrace it, but with caution. Welcome the support, advice and sense of community you may find through social media networks, but remain vigilant with the medical aspects of your diabetes management. Information and advice found online should never take the place of the advice of your doctor or medical team and always see your diabetes specialist if you have concerns about your diabetes care.
Education Planner The Smart Series 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.
JUNE 2017 Mon
MedSmart – everything you need to know about your medications.
22 Classroom (Joondalup)
Albany (2nd half)
Mirrabooka/ South Hedland/ Albany (1st half)
JULY 2017 Mon
Rivervale / Bunbury Hospital
MeterSmart – master the art of blood glucose monitoring. CarbSmart – unravel the mystery of carbohydrates wit this carb counting masterclass.
ShopSmart – this supermarket tour helps you decode food labels ('Classroom' format also available). FootSmart – everything you need to know about caring for your feet.
23 June 1–5pm Medications and insulin update for nurses Specifically for nurses, this workshop aims to increase knowledge about diabetes and the services available to patients, with a particular focus on medications, insulin and the NDSS.
DESMOND One day workshop DESMOND – Diabetes Education and Self-Management for Ongoing and Newly Diagnosed is a program 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.
Diabetes WA now offer a 15 per cen t discount on health professional train ing and updates to members.
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
AUGUST 2017 Mon
The Diabetes Telehealth Service upskilling sessions are typically 1–2 hours in duration and are easily accessed via a desk top 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 go to our website.
SEPTEMBER 2017 Sun
Mirrabooka / Bunbury Hospital
Refer to event in blue box
For more information or to book into any of these workshops, visit www.diabeteswa.com.au, call 1300 001 880 or email firstname.lastname@example.org
Research Round Up The latest in diabetes research
It’s great news for social people who like company
An Australian review, published in the journal Diabetes Medicine, has found that group-based education for people with type 2 diabetes can not only help reduce HbA1c but also lead to participants experiencing positive lifestyle and social changes.
It’s good news for metformin users Dr Tongzhi Wu, from the University of Adelaide, has been awarded a Diabetes Australia Research Program grant to study how metformin is absorbed into the body and possibly develop new ways of administering the drug, avoiding the gut and thereby reducing the side effects, such as tiredness and nausea.
It’s bad news for night owls A new review of scientific literature on the importance of sleep in youth suggests that a lack of sleep can lead to decreased appetite control and body weight regulation, all of which can raise risks for the development of type 2 diabetes.
3D bioprinted artificial pancreas for type 1 diabetes on the horizon
tudent researchers from Boston University have figured out a way to make a three-dimensional (3D) print of a functional pancreas with stem cells and other materials. Though it could be another decade before the project is fully realised, the idea originated from Thomas Hays, a senior biomedical engineering student who, along with fellow students Kyle Reeser and Sebastian Freeman, put together a prototype for 3D printing an artificial pancreas (AP). The 3D printed AP model consists of superposing layers of cells taken from a type 1 diabetes patient with hydrogel until a 3D tissue is created. “It is essentially a layer-by-layer technique where we overlap different 2D layers of material (cells) until you have a 3D product,” Hays said.
construct is moved to cell culture tools where it grows and differentiates into its final form. There can be technical challenges with the architecture of the AP, with what relates to construction of tissues that will maintain blood flow, for example. Without a builtin vascular system, cell death would occur as the tissues expand in size. As with any transplant, there is also the risk of organ rejection once inserted into a patient’s body. But, Hays, Reeser and Freeman found a workaround this issue: using harvested cells from a patient’s own body.
Once that process of creating a continuous piece of tissue is done, the early tissue
Insulin use for gestational diabetes associated with postpartum diabetes
study has found that women who required insulin for gestational diabetes mellitus (GDM) had an elevated risk for post-partum diabetes versus those with GDM who did not require insulin. The retrospective study was presented at the recent 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress in Texas. According to the Centres for Disease Control and Prevention (CDC), up to 9.2 per cent of pregnant women develop GDM. These patients have an increased risk for subsequent type 2 diabetes, underscoring the need for follow-up glucose testing in this population. Using data collected within six to 12 weeks of delivery, the researchers analysed associations among patient age, body mass index (BMI), parity, treatment approach, and postpartum screening results.
Only 40 per cent of the sample had postpartum glucose testing at six to 12 weeks. Of these patients, 7.05 per cent were diagnosed with diabetes mellitus, and an additional 15.3 per cent had impaired glucose tolerance. A higher risk for postpartum diabetes was found in patients with GDM who had required insulin during pregnancy. In line with earlier findings, the investigators wrote that the present results showed that the “majority of women with GDM did not have postpartum screening as recommended,” despite the high risk for type 2 diabetes in these patients. “Women with GDM should have a long term management plan from pregnancy period to prevent being lost during follow up.”
Source: Endocrinology Advisor 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.
Study into Type 1 Vascular Complications Published and DRWA Launch a New Blog by Diabetes Research WA Executive Director, Sherl Westlund
ne of our funded researchers, Telethon Kids Institute PhD student Matthew Cooper, has had a new phase of his type 1 diabetes project published and we’re thrilled to share the findings with you. We’ve also launched a new online blog discussing our thoughts on issues such as depression and diabetes, parental guilt and diabetes and – as outlined here – the need for WA workplaces to help restrict the sale of sugary drinks. We hope you enjoy this update.
Vascular Complications in Type 1
Diabetes Research WA New Blog
Supervised by Princess Margaret Hospital Children’s Diabetes Centre co-director Professor Elizabeth Davis, PhD student Matthew Cooper’s latest study has highlighted the need to do more to prevent chronic vascular complications stemming from type 1 diabetes.
Our new blog is a way to share thoughts on issues that we are passionate about. One of those is the idea that WA companies can help play a part in reducing rising rates of obesity and type 2 diabetes by following in the footsteps of the World Health Organisation, removing the sale of sugary drinks from workplaces and committing to not serving them at official functions.
The findings, published in The Journal of Diabetes and Its Complications, reveal that despite advances in diabetes management, micro and macrovascular complications like stroke, diabetic eye disease, and kidney damage remain a reality. “By looking at the health records of more than 1300 Western Australians diagnosed with type 1 diabetes in childhood, we discovered that by early adulthood, 32 of these patients had been hospitalised and treated for a vascular complication, mostly eye disease, which can obviously have a huge impact on a person’s quality of life,” Mr Cooper explained. “We also found rates of end stage kidney disease and stroke were significantly elevated compared to the general population.” Professor Davis said poor blood sugar control during childhood and adolescence was associated with an increased risk of complications in early adulthood: “On top of this, women, those with low socioeconomic status, and type 1 patients who’d experienced severe hypoglycaemia were at increased risk for developing these complications.”
We realise no one strategy will be a “cure all” but it’s also true that helping people make better choices is a great step; reducing supply reduces impulse buying and can help educate people about what constitutes a healthier choice. Research has repeatedly shown regular consumption of sugar sweetened beverages is linked to a greater risk of developing type 2 diabetes. These drinks are also associated with a higher risk of other health issues including heart disease, gout, tooth decay, bone erosion, and more. But it’s not good enough to fund research; the whole community needs to act on the findings if we are to change the future.
This type of research is powerful because by knowing who’s most at risk from complications, and when and why those issues show up, we can help change the future by allowing doctors and caregivers to intervene earlier to help bring down that risk.
To read more of our blog posts or news, to find out about our 2017 National Diabetes Week events, or to help fund crucial WA research please visit diabetesresearchwa.com.au or call (08) 9224 1006.
Launch of CGM subsidy initiative
lthough it can be difficult to predict the impact of an emerging technology, there are several exciting developments on the horizon that may soon significantly change how people with diabetes receive medical care or manage the condition on their own. At least one relatively new innovation, the Continuous Glucose Monitor (CGM), is already changing the daily routine for some. In an initiative that has been praised as a ‘life-changer’ by diabetes organisations around the country, young people with type 1 diabetes will have access to free glucose monitoring devices under a Federal Government program.
Diabetes educator Rebecca Flavel, who runs the start-up sessions, said the main motive most parents are giving as their reason for using the CGM is the peace of mind at night that the device provides.
On April 1, the Federal Government officially launched the $54 million CGM subsidy initiative. Subsidised access to CGMs is open to children and young people aged under 21 years, living with type 1 diabetes, who face significant challenges in managing their blood glucose levels.
“One of the hardest things about having a child with type 1 diabetes is the concern that their blood glucose levels will dramatically drop in the middle of the night,” she said. “Having constant monitoring and an alarm with the CGM alleviates these worries, so parents can finally sleep through the night without worrying about their child having a low without them knowing.”
CGMs not only reduce the number of finger pricks to test blood sugar, they also can provide an alarm system to prevent a dangerous night-time hypoglycaemic episode. They also promise great improvements in daily life for people living with diabetes and their carer, and an improvement in the management of blood sugar levels may lead to a reduction in hospital admissions and the development of diabetes complications.
If you are interested in finding out more about the initiative, the management of your child’s diabetes with CGM will still be through your endocrinologist and treating team at PMH. If you wish to start using CGM please speak to your team at PMH or visit the NDSS website www.ndss.com.au/cgm.
“As of March this year, there are almost 14,000 young people under the age of 21 living with type 1 diabetes in Australia,” Diabetes WA CEO Andrew Wagstaff said. “More than 1400 of these are living in WA and anything that can make their lives, and the lives of their carers, easier is a good thing.” The program will save people who take up the offer up to $4000 a year by giving them access to continuous glucose monitoring devices for free through the National Diabetes Services Scheme (NDSS). “This will help to reduce stress and anxiety for everyone involved, Federal Health Minister Greg Hunt said in a statement.” To assist those who wanted to learn more, Diabetes Australia, as managers of the NDSS ran a series of free webinars throughout April and May that provided information about the benefits of CGM and the new subsidy for a range of CGM products which can be accessed through the NDSS. We are also working with Princess Margaret Hospital (PMH) to help young people new to CGM that are taking up the opportunity of the government subsidy. The Diabetes WA Diabetes Education Team have been running free start-up sessions with families and will be assisting more than 300 families over the next six months and beyond.
Photo Credit: AMSL Diabetes
I’ve been using a CGM and love it!
icole, 28, Supply and Support Services Officer at Diabetes WA has recently started using a CGM for the first time. Here she tells us about her experience. I was diagnosed with type 1 diabetes when I was 9½ years old. I was transitioning to an insulin pump at the start of this year, so my educator recommended the CGM at the same time. I’ve been using the CGM for just over three months now and I find it has been life changing! I love it! The assistance with extra control, flexibility and reassurance it offers is amazing.
My Pros: The obvious positive for me is less finger pricks, which can be an inconvenience in itself when you have a busy routine. It is very easy to use and quite effortless in the way that it gives continuous results and you don’t need to do much to get these. Accuracy and continuity of blood sugar levels is another big positive, as you can monitor trends closer and see what is happening with your blood sugar levels on a continuous basis. This assists with managing and controlling swings in blood sugars as you can see exactly how a particular food affects your levels in what time frame and to what extent. It also offers being able to see which direction your sugar levels are heading as opposed to finger pricks which take a snap shot of now, but we all know this can swing up or down very quickly. Seeing this means that we can correct an insulin dose more accurately and not eat unnecessarily or correct unnecessarily depending on the direction of the trending arrow.
I find it really offers more flexibility in day to day life – with work or school, dinner plans, sporting activities, anything really that can be unpredictable. My fear of lows has also decreased with the combination of the insulin pump and the CGM that are linked. This is extremely reassuring when sleeping, as I feel most vulnerable at this time.
My Cons: I personally don’t see too many negatives as, for me, it has been so beneficial that any small con is outweighed by all that it has to offer. If I had to be picky, I would say it is quite costly but, again, I feel as though it is well worth the cost. It is such a great initiative that eligible young kids can have these costs covered by the government now. You can sometimes see the CGM under clothes but this doesn’t worry me anymore – though I can see how it may affect some. The results are also very in your face, as they are continuous, so can be confronting at times, but I feel this just helps you improve things as you are aware more.
Recommendation? I would absolutely recommend a CGM to anyone who is considering it. It truly makes everyday life that bit easier! I can’t believe I went without it for so long.
CGMs offered to rock stars at DWA PMH Kids Camp Point Walter Recreation Centre was filled with rock stars for a special four days in April at our rock-star themed Kids Camp, run in conjunction with Princess Margaret Hospital (PMH) and Sports Challenge Australia. Thirty-six kids aged between 11 and 12 years old with type 1 diabetes attended the camp where they enjoyed sleepovers, endless fun activities and even a special visit from a Westpac Rescue Helicopter, all while being supported by Diabetes WA and PMH clinical staff and learning about managing their diabetes.
While having a heavy focus on fun, the objective of the camp is to provide children with type 1 diabetes with a setting in which they can learn more about their condition, gain confidence in managing it, and explore their independence.
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continued from previous page In a camp first, in light of the new government funding of CGMs for under 21s, every child was offered the opportunity to use a CGM for the duration of the camp. This saw an unprecedented number of applications to attend the camp, demonstrating the diabetes community’s enthusiasm for trying out the device. Clinical Professor Liz Davis, Head of Diabetes and Obesity Services and Deputy Head of the Department of Endocrinology and Diabetes at PMH, attended the camp and was pleased to see the kids embracing the opportunity to use a CGM. “It is really exciting that our young patients with type 1 diabetes in Australia now have the opportunity to access the latest technology for monitoring their blood glucose levels,” Professor Davis says. “‘Knowledge is power’, and continuous readouts of blood glucose levels provide patients with so much extra information to use in making decisions about their diabetes care.” “Both the kids and the staff on the camp thought it was fabulous having the opportunity to trial the devices. It was a great chance for everyone to become more familiar with the CGM, and they provided an extra level of reassurance to the
camp leaders managing the blood glucose levels overnight. The leaders were able to use CGM to monitor blood glucose levels and reduce finger prick tests day and night, leaving the kids free to join in all the great activities, and sleep with less interruption overnight.” Diabetes educator Rebecca Flavel, agrees that the camp was a great opportunity for the kids to try out the CGM for the first time. “Enabling the kids to try out the CGMs at the camp gave them the opportunity to have full support from qualified staff throughout their trial period. This is extremely reassuring for both the kids and their parents as they don’t have to navigate this new technology alone,” she says.
DESMOND in the Pilbara
orking in collaboration with WA Primary Health Alliance (WAPHA), Diabetes WA is venturing into the Pilbara with the development of a Pilbara Diabetes Management Strategy, which will include the training and qualification of health professionals in the region as accredited DESMOND and Walking Away facilitators. The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) program is an interactive workshop designed to support people living with type 2 diabetes. The six-hour group education program focuses on providing a welcoming and non-judgemental space where participants can plan how they would like to manage their diabetes. Walking Away from Diabetes is a free interactive group education program for people who are at risk of developing type 2 diabetes and are interested in trying to prevent it. Facilitated by two trained educators, this three-hour program helps people to explore and understand their risk of developing type 2 diabetes in the future, and identify simple changes and strategies to put in place to help lower that risk. Working in collaboration with WAPHA, the aim of the Pilbara Diabetes Management Strategy is to support local providers to receive training,
mentoring and become accredited to deliver DESMOND and Walking Away throughout the region as required. Diabetes WA will support providers, relying on their local expertise, and manage program administrative-related tasks to free up that time for an already under-capacity workforce. “The aim of the pilot project is to enhance the self-management skills of those with, or at risk of, diabetes, as well as increase capacity within the Pilbara region to cope with wait lists for diabetes education,” says Pilbara
Diabetes Management Strategy coordinator, Jennifer Sweeting. “It also aims to increase links to telehealth options to further support the management of diabetes in the Pilbara, with engagement around local service provision and needs.” In a positive first step towards addressing the tsunami of diabetes in the Pilbara region, and to build the capacity of local providers to deliver local services, Diabetes WA and WAPHA are working with resident organisations to engage individuals interested in training. While gathering local knowledge and feedback about how to promote programs in the region, the team is hoping to ensure that diabetes is seen as a community priority. “Our programs focus on helping people to make informed choices about their own diabetes management,” Jennifer said. “This is important to ensure that people are capable of sustainable change that fits within their existing lifestyle.”
New resources for older people
ith increasing age, the number of people with diabetes also increases. Approximately 50% of all Australians with diabetes are aged 65 years or older.
Managing Diabetes as You Age
The National Diabetes Services Scheme (NDSS) has developed a series of booklets that give some good general tips about living with diabetes as you age.
Diabetes care is generally the same no matter how old you are. However, there are some specific changes that happen with age and these might affect your diabetes.
Healthy Eating for Older People
You can download these booklets as e-books or PDFs at ndss.com.au/older-people or contact Diabetes WA on 1300 001 880 to receive free hard copies.
This booklet provides information about healthy eating and food choices for older people living with diabetes.
You and Your Health Care Team This booklet is designed to help you understand the health system and make it easier for you to manage your diabetes. It is not always easy to find your way around the health system and as you get older you may have more health issues to deal with, which can add extra challenges.
My twelve-year-old son was diagnosed with type 1 diabetes three months ago and he is worried about playing junior footy this year while managing his condition. Are you able to give us some advice to reassure him? Jeff, father of a child with type 1 diabetes
DWA exercise physiologist and diabetes educator Marian Brennan says...
As I am getting older I am becoming more forgetful. What should I do if I forget to take my morning medication? I am taking metformin and Diamicron. Glenda, type 2 diabetes
DWA dietitian and diabetes educator Sheryl Moore says… If you forget to take your morning diabetes medication, it’s best to leave that dose and just take the next dose as planned. You may notice that your blood glucose levels rise slightly but that should not be a problem if it’s only occasionally. If you are forgetting regularly, you may like to chat to your doctor to develop strategies to help you remember.
My levels keep fluctuating and I can’t seem to get them right. I feel like I eat well and exercise but I have a young baby and am up throughout the night, so am pretty exhausted. Could the lack of sleep be affecting my blood glucose levels? Clare, type 2 diabetes
Food and exercise are not the only things that can affect blood glucose levels (BGLs). Your change in routine, sleep patterns, hormones and stress levels to name a few issues, can change the way your body needs and uses glucose. Doing a bit more monitoring may help identify some patterns in your BGLs and troubleshooting in those areas first may help stabilise your levels sooner. If you’re still unsure, contact your diabetes educator or nurse.
Being diagnosed with type 1 diabetes can be an overwhelming and scary time but it doesn’t mean you have to stop the things you enjoy. People with type 1 diabetes can and do safely participate in all sports. It may require a bit of trial and error; a bit more monitoring and/or adjustments to insulin and carbohydrate, but there is no reason why people with type 1 diabetes cannot enjoy and succeed in sport. In fact, there are a number of professional AFL players who have type 1 diabetes – Jack Fitzpatrick (Hawthorn), Jamie Cripps (St Kilda and West Coast), Paddy McCartin (St Kilda) and Sam Reid (Greater Western Sydney) just to name a few!
If you have a diabetes-related question that you would like answered, email it to email@example.com. If you can’t wait until the next quarterly issue of Diabetes Matters to get your answer, you can speak to a member of the Diabetes WA education team. Call the Diabetes Information and Advice Line (DIAL) between 8.30am and 4.30pm weekdays on 1300 001 880.
Matt’s Powerful Community
ttending the AMSL Diabetes Sport weekend–an event that brings together people living with type 1 diabetes with an interest in sports and exercise–last year was a transformative experience for Matt Pontel. Diagnosed with type 1 diabetes at age 10, Matt had always hidden his condition from those around him and never sought out a community. “Being in a room with 60 or so other type 1s was life changing. As someone who had never sought out a community, to then be surrounded by other type 1s discussing their condition and their achievements and how they managed to reach such heights, was inspiring,” Matt said. Always a sportsman, the conference changed the way Matt prepared for physical activity and it changed the way he saw the diabetes community. “I had never thought to adjust my insulin or pre-carb properly but asking questions of other type 1 athletes changed my perspective. “There are so many amazing athletes living with type 1 diabetes that have inspired me and proved to me that anything is possible. So I set myself a challenge to run the half-marathon in the HBF Run for a Reason. It wasn’t easy but that’s what makes the victory even more empowering.” “At the start of my run, I was doing it for me and my family – for all the blood, sweat, tears and insulin over the last 16 years. And when I crossed the finish line it was for all of the people with type 1 diabetes who have been told you shouldn’t do this because you have diabetes.”
Matt being interviewed for a Channel Nine documentary on his participation in the HBF Run for a Reason. Matt loved participating in the physical challenge of the event. “Doing the HBF Run was the first time I’ve felt like an athlete first and a person with diabetes second. ‘Hold my beer diabetes, we are doing a half-marathon!’” “I was checking my CGM every 4km water station, instead of checking my blood with a lancet – a new concept to me but it has proven itself to be amazingly accurate so I trusted it! Given it was my first half-marathon and considering the
Matt on Technology – In his own words The possibilities of how we can manage this condition in spite of a cure are endless. Technology has had such an impact on the way we live and the communities we build. Just think of the last 10 years – insulin is getting quicker and smarter. My glucose meter talks to my pump; it is smaller, requires less blood, gives me results quickly, and has better accuracy. The pump itself allows me to configure more parameters, pull out more data, and be very precise with my control. CGM has turned into something that is accurate, empowering, and integrates with pumps, wearables, and smart-phones. Imagine where technology will be in 2020. If there was ever a good time to have type 1 diabetes, it’s now.
Matt and fellow runner, Jake O’Brien after completing the HBF Run. nerves, my sugars behaved as perfectly as they could. I literally burst into tears when I saw my trend line for the race, it was so spot on!” After completing the half-marathon, Matt said he now wants to build on the community he experienced at the AMSL Diabetes conference in his own unique way. “I’d like to offer support and insight into what can be a challenging condition. With the help of technology, I can communicate with a much bigger audience. Social media, peer groups, meet-ups, exercise clubs and blogs all allow the type 1 community to get together in support, share wisdom and invite others on their journey. “It’s a powerful community.”
App Innovation – Diabetes
esigned to help people manage their type 2 diabetes, emojifit Diabetes is a new smartphone app that uses principles from the award-winning DESMOND diabetes self-management program, offered by Diabetes WA.
Based on decision science and evidence-based practice, and researched by a team of experts over 20 years, the app recognises the importance of someone’s emotions and values and the personal choices they make in relation to their condition. emojifit Diabetes is a self-tailored program allowing individuals to make choices based on what fits around other important aspects of their lives and to focus on their biggest concerns. Registered psychologist Professor Timothy Skinner of Charles Darwin University heads the development team for the app. His doctoral work on diabetes inspired him to develop the DESMOND diabetes program for people with type 2 diabetes. This award-winning program delivered by diabetes organisations around the world has helped over 200,000 people to take control of their diabetes.
The app allows the user to build one plan, working on one thing at a time, aiming to develop confidence in managing: • • • • •
weight loss; blood glucose control; increasing physical activity; changing food consumption and cooking techniques; and remembering to take medication.
As the user gains confidence, they can move to developing up to four plans with the more advanced app, emojifitXtra. Developed by Australian company Decision Support Analytics, the emojifit Diabetes app is supported by Diabetes WA and can be used in conjunction with our self-management workshops. To find out more, visit the Diabetes WA website or www.emojifit.com.au. To download the app search ‘emojifit’ in the iTunes App Store.
Let’s Get Technical
here is a certain magic to the kitchen, an alchemy like no other when it comes to orchestrating ingredients into the perfect meal. An enchanted combination of components, vital with life that all come together under the hand of the skilled cook to create the meals that nourish us to health and wellbeing… but what if those skills aren’t quite up to scratch? Have you ever heard of sautéing a cake or steaming a leg of lamb? Simmering cookies? If these techniques sound a little odd to you, it’s because there are certain cooking methods that coordinate with specific foods. So in line with our technology theme for this issue – let’s get technical with our food. Cooking methods can be broken down into three sub-categories: dry heat, moist heat, and a combination of the two. The dry-heat method, which is a relatively quick process, adds crispness and flavour, but doesn’t tenderize. Ingredients cooked this way are small, thin, and already tender – think sautéing ground meat and roasting vegetables. The moist-heat cooking method involves cooking with water or stock, like poaching fish and steaming broccoli. The third category is a combination of the two and often uses long, slow-cooking periods to tenderise and break down tough cuts of meat, like braising pork shoulder.
Choosing the correct cooking method not only impacts the final product, but also affects the texture, appearance and flavour of the dish. To ensure you get the most delicious outcome from your cooking, we have provided a description of basic cooking techniques so you can choose the best one for your ingredients.
Technique 1: Slow Roast This hands-off method (the oven does the work) gets the most flavour out of vegetables and ensures an even, fork-tender finish on a large cut of meat. Fast, high heat can dry out the edges before the centre is cooked. You’ll need time, but slow roasting can transform tough ingredients. Take tomatoes: even not-so-great ones become irresistible as the low heat slowly removes water and concentrates their flavour. They’re excellent in a simple pasta salad or served with ricotta on crusty bread or toasted baguette slices.
Technique 2: Poach
Technique 7: Deep Fry
Not to be confused with boiling, poaching is the art of cooking in a flavoured liquid kept at a low simmer. The result is a well-seasoned, supremely moist dish. Poaching allows for more wiggle room to cook a recipe just right, making it a go-to technique for a plump chicken breast or fish fillets that can easily overcook, or cook unevenly, at high heat. The broth slowly flavours the dish as it cooks, so don’t skimp on seasoning. Green onions, whole spices, and fresh herbs are great additions.
Deep-frying is essentially submerging food in oil or fat and cooking it rapidly at a high temperature. The science behind deep-frying is quite simple: when the oil is hot enough, the surface of the food will cook instantly, forming a seal. At the same time, the moisture inside the food is converted to steam, which cooks the food from the surface inwards. Be aware – deep frying is one of the unhealthiest methods of cooking as the food generally absorbs a large amount of fat and the frying process robs the vegetables or meat of their natural nutritional value.
Technique 3: Sear A crisp, golden brown exterior on meat or fish signals deep, savoury flavour. Start by patting down the meat or fish with a paper towel. Moisture creates steam, which hinders browning. Next, preheat the pan over high heat, then add the oil. When the oil is shimmering and hot, add the meat and let it cook untouched. It’s ready to flip when a corner lifts easily from the pan. If it sticks or tugs, give it a minute or so more. Head chef at Sydney’s acclaimed restaurant O Bar Michael Moore, who has type 2 diabetes, says: “Many of our signature dishes are flash-seared to deliver precise, clean flavours. It’s a technique that allows vegetables to caramelise and soften, meats to crisp and char, and it brings out the pure, sweet taste of seafood.”
Technique 8: Emulsify If you find it almost impossible to stop dunking chips, vegetables, or your fingers into homemade aioli or dressing, then you’re enjoying the magic of emulsification. It’s the process of combining two liquids that don’t normally mix (like oil and vinegar) into a creamy, unified concoction. Start adding the oil to the vinegar a drop at a time while whisking constantly. Work up to a slow, steady drizzle, whisking all the time.
Technique 4: Sauté Sautéed foods are cooked in a thin layer of fat over mediumhigh heat, usually in a frying pan on the stovetop. The word comes from the French word “sauter,” which means “to jump.” Similar to stir-frying, traditionally when sautéing the cook shakes the pan, making the food jump, to keep the food from sticking and ensure it cooks on all sides. This can also be done by stirring. Foods are just cooked until tender.
Technique 5: Braise Braising is a combination cooking method that first involves sautéing or searing an item, then simmering it in liquid for a long cooking period until tender. Foods that are braised are often larger proteins like pot roasts and poultry legs.
Technique 6: Blanch and Shock The best way to preserve the colour and the nutrients of vegetables is to boil them briefly in water (blanch), then cool them quickly with a dunk in an ice bath (shock). This technique also helps firm the flesh of a fruit while loosening the skin, which makes peeling, peaches or tomatoes for example, easier. And it works for herbs too. The process will help the herbs maintain their vibrant colour and resist the tendency to turn black while mellowing the flavour.
Poached snapper with spring onion and ginger Light and fresh, this method of cooking keeps the snapper beautifully moist and allows the flavours of the ginger and onion to delicately season the flesh.
Nutritional Information per serve (including rice)
Energy 1758 kJ Protein 39 g Total Fat 11 g Saturated Fat 1 g
Carbohydrate 40g Sugar 1g Dietary Fibre 1 g Sodium 417 mg
• 8 spring onions, chopped
1. Bring 4 of the spring onions, sliced ginger, ¼ teaspoon of the chilli flakes, 1 tablespoon salt and 3 cups water to a low simmer in a medium skillet. (The water should bubble only slightly around the edges.)
• 2-3cm piece ginger, sliced, plus 1 teaspoon grated ginger • ½ teaspoon red chilli flakes • sea salt • 4 x 170g boneless, skinless pieces snapper or similar white fish • 2 tablespoons canola oil • ¼ teaspoon sesame oil • 2 teaspoons reduced-salt soy sauce • 1 tablespoon red wine vinegar • fresh coriander leaves and halved snap peas, for serving • 1 cup (200g) basmati rice, for serving
2. Season the fish with ½ teaspoon salt and add to the skillet. Cook until the fish is opaque throughout, 10 to 12 minutes. 3. Meanwhile, combine the canola oil, sesame oil, soy sauce, vinegar, the grated ginger, the remaining 4 spring onions and the remaining ¼ teaspoon of chilli flakes in a medium bowl. 4. Serve the fish on top of the coriander and snap peas, drizzled with the relish. Serve with the cooked rice, and why not throw in some extra winter vegetables or salad.
Slow-roasted caramel-pear pudding Caramel befriends pears in this lighter version of a slow-cooked pudding. It uses low-fat milk and flaxseeds – chewy little nutrient powerhouses packed with fibre and essential omega-3s.
Nutritional Information Per Serve
Energy 759 kJ Protein 3g Total Fat 6g Saturated Fat 2 g Carbohydrate 27 g Sugar 15 g Dietary Fibre 3 g Sodium 160 mg
• 2 cups wholemeal plain flour
1. Lightly coat the inside of a 3.5 litre slow cooker with cooking spray and set aside.
• ¹⁄³ cup granulated sugar • 2 tablespoons flaxseed meal
2. In a medium bowl stir together flour, sugar, flaxseed meal, baking powder, cinnamon, and salt. Add milk and oil; stir just until combined. Stir in dried pears. Spoon batter evenly into the prepared cooker.
• 2 teaspoons baking powder • 1 teaspoon ground cinnamon • ½ teaspoon salt
3. In a medium saucepan combine the water, pear nectar, brown sugar, and butter. Bring to boiling, stirring to dissolve brown sugar. Reduce heat. Boil gently, uncovered, for 2 minutes. Carefully pour over batter in cooker.
• 1 cup low-fat milk • ¼ cup canola oil • ½ cup snipped dried pears or dried apples • 1 cup water • 1 cup pear nectar
4. Cover and cook on low-heat setting for 3 to 3½ hours. Turn off cooker. Let stand, uncovered, for 45 minutes to cool slightly. (Do not invert onto a platter if serving warm as liquid will be very hot.) 5. To serve, spoon pudding cake into dessert dishes. If desired, top with fat-free greek yogurt.
• ½ cup packed brown sugar • 30g butter
Classic Pesto – with blanched basil
Blanching, and then shocking, the basil before using it in this pesto ensures it stays bright green, even after it’s been tossed with hot pasta or stored for several days.
Makes: 3 cups
Nutritional Information Per Serve
Energy 761 kJ Protein 4g Total Fat 18 g Saturated Fat 3 g Carbohydrate 2 g Sugar 0g Dietary Fibre 1 g Sodium 164 mg
• 3 to 4 bunches basil, leaves only (8 tightly packed cups)
1. Bring a large pot of salted water to a boil. Fill a large bowl with ice and water and set aside nearby. Cook the basil in the boiling water until bright green, about 10 seconds. Transfer to the prepared ice bath using a slotted spoon. Let the basil cool, then drain and squeeze dry.
2. Pulse the pine nuts and garlic in a blender until finely chopped, scraping down the sides as needed. Add the pecorino, parmesan, basil, and ½ cup water and process until a puree forms, scraping down the sides as needed.
cup toasted pine nuts
• 2 cloves garlic • 30g pecorino, grated (¼ cup) • 60g parmesan, grated (½ cup) • sea salt • ¾ cup olive oil
3. With the machine running, slowly add the oil and process until very smooth. Add ¼ teaspoon salt and pulse twice to combine. 4. Refrigerate in an airtight container for up to 5 days. NB: remember you will need to serve the pesto with something – it is most commonly served on pasta but is also delicious on chicken or vegetables – so make sure you factor in your carbohydrate, salt and fat count considering this as a complete meal.
Maintain Your Fitness Mojo This Winter I
t’s getting colder and we are losing the light. You may be tempted to hang up your exercise gear and hibernate. But if you’re tempted to hit the snooze button in the morning, remember this – staying motivated this winter requires a change to only one thing: your mindset. Though winters in WA aren’t quite snow, sleet and ice, the darker mornings and brisk earlier sunsets of those winter months can still make it hard to avoid the couch and to keep up the fitness regime that was established when motivation levels were higher.
Regular exercise will make you feel more energetic, which should make it a little easier to get out of your warm bed on cold, dark mornings.
Here are some tips to inspire you to keep moving Stay inside, workout at home – Cold weather outside does not mean you can’t exercise, even if you don’t have a gym membership. You can easily workout in your very own home with just your own bodyweight. Free workouts can be found on YouTube that need no equipment and workout DVDs are also readily available to rent and buy. Clean the house – While you’re being creative with your at-home workouts, consider cleaning your home. As silly as it may seem, sweeping, dusting, scrubbing and even cooking burns calories and gets your blood pumping. Plus, you have the added benefit of a clean house! Include friends – Getting a group of friends together provides accountability and makes things more fun. Joining a group class, sports club, or walking the shopping centres are all ideas for groups to try together. Embrace the weather – Why not layer up and take a walk? Instead of avoiding the cold, embrace it. If there is brutal lightning and thunder, perhaps change your plan, but getting outside for some fresh air and open space will be good for your mind as well as your body. Just make sure you wear warm clothes and remember that, even in winter, the sun can still burn. Set a goal – Setting out a plan to achieve your goals is a great way to stay motivated. Diabetes WA exercise physiologist, Marian Brennan says, “Make a plan and map out your goals, write them down and then when it comes to the doing aspect of your plan, try not to overthink it… minimise opportunities where you might start weighing up whether you should go for that walk or stay inside where it’s warm.” “Make it easier for yourself,” she says. “Bring exercise clothes to work so you don’t arrive home and get tempted by distractions. If exercising in the morning, get your gear ready the night before and put it right next to the bed.
Winter colds – Colds are more common in winter, but you don’t necessarily have to stop exercising if you’re feeling under the weather. Marian says use common sense and listen to your body. “The general guidelines are, if your symptoms are ‘above the shoulders’, such as a runny nose or a typical sore throat, light to moderate exercise should be ok,” she says. “If your symptoms have gone to your chest or you are experiencing muscle aches and pains with a fever, you are probably better off getting some rest.” If you have asthma, take extra care when exercising in winter as cold air can trigger symptoms. Use your inhaler before you exercise and have it with you during your activity. Including a warm up consisting of light intensity exercise for 10-15 minutes can help. Focus on the benefits – When you are struggling to extract yourself from your doona, you need to remind yourself of the benefits exercise brings you. Write it down so you remember that you want to manage your stress levels, keep your blood glucose levels (BGLs) in check, have an abundance of energy and feel good about yourself rather than falling asleep at your desk, feeling overwhelmed and overweight. Keep in mind – While exercise in all seasons is very beneficial for people living with diabetes, there are some specific considerations for wet weather workouts that you should keep in mind; • Be careful of exercising in the rain if this means your feet are going to get wet, as soggy feet will increase your risk of developing blisters. Regularly checking your feet before and after exercise is important. • If having to check your BGLS during exercise, it might be difficult to get a blood sample if your hands are cold. Consider wearing gloves or warming up your hands before pricking your finger. • Cooler weather may mask how hard you are working. Take note of an increased heart rate or heavy breathing, rather than sweating. Your rate of exertion may impact on how your BGLs respond to the exercise.
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WIN a copy of the Good Carbs Cookbook!
Thanks to the generosity of Murdoch Books, we have two copies of this family-friendly cookbook by Dr. Alan Barclay, Kate McGhie and Phillippa Sandall to give away. Good carbs are essential. They supply the feel-good, taste-good fuel to keep you strong, boost your energy and help you stay healthy. The Good Carbs Cookbook helps you choose the best fruits, vegetables, beans, peas, lentils, seeds, nuts and grains and explains how to use them in 100 refreshingly nourishing recipes to enjoy every day – for breakfast, brunch, lunch, dinner and dessert. This family-friendly cookbook has a nutritional analysis for each recipe with tips and helpful hints for the novice, nervous, curious or time-starved cook. This book will equip you with the basics about good carbs and their chums, good fats and lean proteins. Publisher: Murdoch Books RRP: $39.99 To enter, complete the competition slip and mail to:
Diabetes Matters – Members’ Competition PO Box 1699, Subiaco, WA, 6904 or email the below details to
Good Luck! Name: Diabetes WA membership number: Address: Contact number: Email address: Entries close 1 September 2017.
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Diabetes WA members receive a 10% discount on First Aid training and products at Royal Life Saving Society WA this year*!
USE THE WAD15NU DISCOUNT CODE TO RECEIVE UP TO 45% OFF
*Register on our website to claim this offer.
BOOK ONLINE at lifesavingwa.com.au and enter the code DIABETESWA or for corporate or group booking enquiries call our bookings team on (08) 9383 8200 *10% discount applies to all available First Aid and Resuscitation courses run by RLSSWA, as well as products purchased through RLSSWA’s online shop using the discount code. Offer valid through 30/06/2017.
Royal Life Saving Society WA is a Registered Training Organisation (code #0854)
www.tanitaaustralia.com | freecall 1800 656 444
ON SALE NOW! Get your copy of the 2017/18 Entertainment Book from Diabetes WA to receive $200 of bonus offers!
The Entertainment Book offers hundreds of discounts and 2-for-1 deals at Perth’s best restaurants, cafés, hotels and more. Bali once again is included and the number of discounts have even increased on last year’s offerings. Available as a traditional hard-copy book or as a digital app for your Apple or Android device, your membership gives
you over $20,000 worth of valuable offers valid through to 1 June 2018. For each book sold, Diabetes WA will receive 20 per cent of the proceeds which will go towards supporting those living with, affected by and at risk of diabetes. Entertainment Books cost $70.00 and are available now.
To order your copy today email firstname.lastname@example.org or call (08) 9436 6242. 34
June - August Diabetes WA Raffle 23
Its raffle time once again! Buy a raffle ticket for your chance to win $10,000 and support Diabetes WA and the work we do in the community. Tickets are only $2 and can be purchased by calling 1300 001 880 or emailing email@example.com. Winners will be drawn 31st August.
July 2-9 NAIDOC Week
The importance, resilience and richness of Aboriginal and Torres Strait Islander languages will be the focus of national celebrations marking NAIDOC Week 2017 . Visit www.naidoc.org.au for details.
July 9-15 etes WeekWeek, National Dievenab t of the year, National Diabetes
The biggest diabetes awareness focus on mental health and is running 9 - 15 July. This year’s theme will aspect of diabetes management. helping to raise awareness of this critical reness raising activity during If you would like to host your own awa Diabetes WA team for an National Diabetes Week, contact the wa.com.au or call 1300 001 880. information pack at media@diabetes on our website. be Further information can also found
July 9-15 Kellion Victory Awards
Every year, during National Diabetes Wee k, Diabetes WA awards the Kellion Victory Medal to those who have lived with insulin dependent diabetes for 50 years or more. The Kellion Carer Award is also presented, which recognises many years of love, dedication and support to a spouse, family member or close friend supporting the person living with diabetes. To find out more about the Kellion Awa rds or to nominate someone, call 1300 001 880 or email firstname.lastname@example.org.
Diabetes WA nch 2017 Corporate Lu is taking place at Frasers Our annual corporate lunch in your Restaurant, so make sure you mark the date s and Eagle t Coas t diary. Inaugural coach of the Wes n ralia Aust tern Wes the of current director general r ande Alex Ron n eatio Recr and t Spor Department of will feature as our guest speaker. ities For information, sponsorship opportun or to book a table of 10, contact email@example.com.
Real Solutions Real Support Obesity Surgery WA offers a multidisciplinary team approach to people with obesity. It is well known that obesity is a high risk factor for developing type 2 diabetes. The good news is that losing weight can improve your type 2 diabetes, help stabilise blood sugar and decrease medication requirements to make your life healthier. Don’t leave it until it’s too late, while your diabetes is poorly controlled it is doing slow and irreversible damage to your organs. The less time you have elevated blood glucose levels, the better. Harsha Chandraratna Surgeon
Janet Barry Obesity Assessment Clinician
Angela Houston Dietitian
Jo Climo Nurse
Come in and have a discussion with one of our doctors to learn more about how Obesity Surgery WA could help you. We offer real solutions with real support.
Practical Surgery Options Sleeve Gastrectomy Gastric Banding
Call 9332 0066 to make a healthier life. Subiaco • Murdoch • Mandurah
Roux-en-Y Gastric Bypass
Omega Loop Gastric Bypass
Help us continue to meet the growing need for services and support for people affected by diabetes in Western Australia. A gift in your will is a valuable way of supporting Diabetes WA. We receive large and small bequests and each is welcome and greatly appreciated. If you are writing your first will, or updating your current one, please remember Diabetes WA and the difference you can make to the lives of countless Western Australians, perhaps even someone you know. If you would like to know more please call 1300 001 880 or visit www.diabeteswa.com.au.
Diabetes Matters is a quarterly, 36 page glossy magazine published by Diabetes WA, containing a quality mix of topical health and lifestyle...
Published on Jun 15, 2017
Diabetes Matters is a quarterly, 36 page glossy magazine published by Diabetes WA, containing a quality mix of topical health and lifestyle...