Diabetes Wellness Summer 2016 by Diabetes New Zealand

wellness

SUMMER 2016

DIABETES

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

TAKE CONTROL • MEAL MAKEOVERS • GESTATIONAL DIABETES • LOVE THOSE BONES • TRAVEL WITH T1 SUMMER SALADS • HOW FIT AM I? • REVERSE T2 STUDY • 5 CHRISTMAS CROPS

RUGBY STAR MALAKAI FEKITOA “GIVING UP SUGAR CHANGED MY LIFE”

WIN

SEE INSIDE FOR $2,000+ OF READER GIVEAWAYS

Dexcom G5 Mobile is here ®

Dexcom G5® Mobile gives you glucose readings every 5 minutes1 so you can see your highs, lows and how fast you’re getting there. Better yet, customisable alerts and alarms help you respond quickly to, or avoid potentially dangerous hypoglycaemic events2.

ASK ABOUT

HypoPak Fast acting glucose

Alerts and Alarms help keep you safe Respond quickly to potentially dangerous hyperor hypoglycaemic events2 with automatic alerts and alarms that let you know when your glucose levels are too high or too low.

Make treatment decisions without confirmatory fingerpricks* Save up to 2920† fingerpricks a year.

Share™ View your CGM results directly on your compatible smart device^ and ShareTM your glucose data with up to 5 followers, even when they’re far away.

For more information or to order contact us between 9am-5pm, Mon - Fri on 0508 634 103 W www.nzmsdiabetes.co.nz

E nzms@nzms.co.nz

1. Dexcom G5 Mobile Continuous Glucose Monitoring System, User’s Guide, 2015. 2. Pettus J, Price DA, Edelman SV. How Patients with Type 1 Diabetes Translate Continuous Glucose Monitoring Data into Diabetes Management Decisions. Endocr Pract. 2015;21(6):613-620. *If your glucose alerts and readings do not match your symptoms or expectations, you should obtain a fingerprick. A minimum of two fingerpricks a day is required for calibration. † Based on testing 10 time per day. ^To view a list of compatible devices, visit www.dexcom.com/ compatibility. Dexcom G5® Mobile is not currently indicated for children under 2 years of age. Not compatible with Animas® Vibe® insulin pump. Always read the manufacturer’s instructions and use strictly as directed. ©2016 Dexcom Inc. All rights reserved. NZG5APR1602V3

Contents SUMMER 2016 VOLUME 28 | NO 4

4 Editorial

23 FAMILY: Sweat, step, sleep and sit – new guidelines for your child

6 Upfront 8 COVER: The Malakai Fekitoa Interview

24 GESTATIONAL DIABETES: Jacqui van Blerk's shock news and what happened next

COVER PHOTOGRAPY: KENT BLECHYNDEN WWW.KENTBLECHYNDENPHOTOGRAPHY.CO.NZ

12 DIABETES ACTION MONTH: Join the MoveMeant!

26 RECIPES: Delicious summer salads

14 LIFE: Take Control Toolkit + Jasmin's story

16 LIFE: Bridging the gap 17 WIN: Exclusive reader competition. Be in to win! 18 YOUTH: Emily Watson's epic trip for diabetes 20 EAT: Helen Gibbs answers the big question – What's for dinner? 22 RESEARCH: Wellington scientists hope protein + exercise can help people with type 2 diabetes

28 CARE: The ins and outs of osteoporosis and top tips for bone health 31 PREDIABETES: Can probioitics and intermittent fasting help reverse prediabetes? 32 EAT: The good old Kiwi BBQ gets a healthy makeover

34 MOVE: Craig Wise on how to test your fitness 35 MOVE: Move those muscles (especially if you have T1) 36 GROW: Rachel Knight tells us about five fastgrowing crops to plant for Christmas 37 TRAVEL: Where in the world is Katie Doyle? Updates from our favourite T1 travel blogger 38 REFLECT: Ruby McGill on the mental health challenges of having diabetes

33 YOUTH: Nicole Chan, the 2016 winner of the John McLaren Youth Award

Be in to win! Check out the READER COMPETITION on page 17, and NEW MEMBER promotion on page 13

SHOP

DONATE

JOIN

Shop online at diabetesauckland. org.nz/shop/ – members receive 10% discount

We'd love to hear your personal stories about living with diabetes – contact editor@ diabetes.org.nz

Join us on Facebook, Instagram and Twitter for the latest news and events

Want to find out more info about how to live well with diabetes? Go to our website diabetes.org.nz

Help make a difference to those living with diabetes – donate now on diabetes.org.nz

Get access to this mag, regular e-news and support from your local branch – join online at diabetes.org.nz

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

DIABETES WELLNESS | Summer 2016

Editorial

Kia ora koutou. Welcome to our new-look Diabetes Wellness magazine! It contains the same great content created specifically for Diabetes New Zealand members but presented in a different package. You’ll notice a new shape, a fresh design and four extra pages of diabetes news and features. We’d love to hear your feedback – tell us what you think. Why did we add wellness to the title? Wellness is the quality or state of being healthy in body and mind, especially as the result of deliberate effort. This is what Diabetes NZ and our magazine have always been about – helping New Zealanders with all kinds of diabetes live well with a (sometimes infuriating) long-term condition. I know from my own experience that if we can take responsibility for our own health, we can improve our wellbeing on a daily basis. This year’s Diabetes Action Month focuses on the need for people to take control of their diabetes, while reminding all Kiwis that everyone is at risk of developing type 2. During November, we will be unveiling a new ‘Take Control Toolkit’ campaign, which will support all our members to manage their diabetes through improved nutrition, physical activity and a positive mindset. We will also be ramping up our ongoing membership drive. You can read all about Diabetes Action Month later in this issue. Please get involved in a local event or activity near you. And don’t forget to enter our exclusive reader competition to win one of two wellness prize packs worth more than $580 each. There are now more than 260,000 people with diabetes in New Zealand and the number is growing daily. In response our Board will be rolling out Diabetes New Zealand 2020 at our AGM/Conference on 26 November 2016. This new strategy will ensure our organisation continues to be the voice of all people affected by diabetes. Next year we are looking at developing a programme called Know the difference. That is, the difference between type 1 and type 2. Watch this space! Stay safe and well this summer. Ka kite ano. STEVE CREW

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

DIABETES NEW ZEALAND Patrons Lady Beattie and Sir Eion Edgar President Deb Connor Chief executive Steve Crew Diabetes New Zealand Inc. National Office Level 7, 15 Murphy Street Thorndon, Wellington 6144 Postal address PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Fax 04 499 7146 Email admin@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Twitter twitter.com/diabetes_nz

DIABETES WELLNESS MAGAZINE Editor Caroline Wood editor@diabetes.org.nz Publisher Diabetes New Zealand Production & distribution Rose Miller, Kraftwork Magazine delivery address changes Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email admin@diabetes.org.nz Back issues issuu.com/diabetesnewzealand ISSN 1176-4406

ADVERTISING & SPONSORSHIP Advertising John Emmanuel john@affinityads.com or 09 473 9947 Business development manager Sue Brewster sue@diabetes.org.nz or 09 810 7047

Chief Executive, Diabetes New Zealand Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes Wellness does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

DIABETES WELLNESS | Summer 2016

FreeStyle Optium Neo

As easy or as useful as you want it to be! 1

Tests both blood glucose & blood ketones1,2 Highlights when your blood glucose patterns need attention Lets you log insulin doses you have taken

Clear, sharp screen is easy to use & read1

Blood Glucose and Ketone Monitoring System

Ask your Healthcare Professional about FreeStyle Optium Neo or go to myfreestyle.com.au to find out more! Please contact medi’Ray for more information: 0800 106 100 I info@mediray.co.nz I www.mediray.co.nz

FreeStyle Optium range of products are used in the testing or monitoring of blood glucose and blood ketone levels for people diagnosed with diabetes. People with diabetes with elevated blood ketone levels should seek medical advice. Reference 1. Evaluation of the FreeStyle Optium Neo Blood Glucose and Ketone Monitoring System, sponsored by Abbott Diabetes Care, 2013. Data on file. 2. Clinical Evaluation of a Faster, Smaller Sample Volume Blood ß-Ketone Test Strip, sponsored by Abbott Diabetes Care, 2006. Data on file. For more information call Abbott Diabetes Care Customer Service 1800 801 478 or visit www.myfreestyle.com.au. FreeStyle and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. Information contained herein is for distribution outside of the USA only. Abbott Diabetes Care, 666 Doncaster Road, Doncaster, Victoria 3108, Australia. www.myfreestyle.com.au. Always read the label and follow the manufacturer’s instructions. ABN 95 000 180 389 MSE140506114551

TAPS NA7904

Upfront

Pump inequalities There are significant demographic and regional disparities in the use of insulin pumps in New Zealand, according to University of Otago research. Pumps have been funded by PHARMAC since September 2012 for patients who meet certain clinical criteria. However, the Otago researchers found that Māori, Pacific, and Asian people with type 1 diabetes were significantly less likely to be using a pump than New Zealand Europeans. The most socio-economically disadvantaged, male, and older patients were also less likely to be using a pump. There were significant differences in use across district health board regions. Study co-lead author Dr Lianne Parkin said: “International research suggests that insulin pumps may have several advantages compared with multiple daily injections, including improved quality of life and fewer diabetes-related complications.” The study is newly published in the international diabetes journal, Acta Diabetologica.

BATHTIME BONUS

GESTATIONAL DIABETES

Soaking in a hot bath could help control type 2 diabetes, according to the surprise results of a new study. A UK research team found that taking a bath can reduce peak blood sugar levels by 10 percent. They also found energy expenditure levels can be increased by 80 percent, burning 126 calories per hour. Dr Steve Faulkner, from Loughborough University, who led the study, said: “We discovered the participants who bathed had, on average, 10 percent lower peak glucose levels in comparison to those who exercised, which was completely unexpected.”

How much weight gain is healthy in pregnancy? A New Zealand study has shown that many mums-to-be don’t know the answer to this. Nor do they know that putting on too much weight during pregnancy can raise their risk of developing gestational diabetes, which puts mum and baby at risk.

www.lboro.ac.uk/news-events/ news/2016/april/hot-bath-study.html

DIABETES WELLNESS | Summer 2016

As gestational diabetes rates are on the increase in New Zealand, this New Zealand study recommends that strategies to improve the knowledge around healthy weight gain during pregnancy are urgently required. *Jacqui van Blerk never expected to develop gestational diabetes. See our story on p24. Reference: NZ Med J 2016; 129 (1439): 37–45

CONFERENCE TIME Diabetes New Zealand’s one-day conference and AGM promises to be a rewarding experience for everyone who attends. Speakers include Diabetes NZ President Deb Connor, who will talk about an important new strategy document Diabetes New Zealand 2020 that lays the foundation for the future of our organisation. Dr Tom Mullholland will be the keynote speaker. His proactive grass roots work through his Dr Tom on a Mission project has featured in the media this year and we look forward to hearing what insights he has to share from his work with communities around New Zealand. Date 26 November 2016 Venue West Plaza Hotel, 110 Wakefield St, Wellington Conference 9am–4.30pm A Special General Meeting for Diabetes Youth NZ will be held at 10am on the same day, at the same venue. For more information and registration details please check out our website www.diabetes.org.nz

NEW DRUG HOPE The global market for diabetes and obesity treatments is set to rise from $70.8 billion in 2015 to $163.2 billion by 2022, at a strong compound annual growth rate of 12.7%, according to business intelligence firm GBI Research. The growth is largely attributable to a big increase in the incidence of type 2 diabetes and obesity. As a result a number of new diabetes medications are expected to come onto the market in the next six years, with some even expected to reach ‘blockbuster’ status.

A bottle of energy drink

A bottle of sports drink

A can of fizzy drink

ON YER BIKE Middle-aged Scandinavian men and women who bike to work even at relatively modest levels are at lower risk of developing type 2 diabetes. Time to get biking? Electric bikes are becoming more affordable and are great fun even on hills!

Sugar science A Royal Society of New Zealand review of the science of sugar and its effects says it’s difficult for people to know how much extra sugar they’re consuming. Royal Society president Emeritus Professor Richard Bedford said the review sought to provide clarity on the issue of sugar, given the confusion abounding in the community and media. Between sugar-sweetened beverages and a wide range of food products with added sugar, Professor Bedford said it was likely Kiwis were exceeding recommended guidelines ‘regularly, if not every day’. It is particularly difficult to follow recommendations as food labels in New Zealand do not indicate the amount of added sugars in a product. The health effects of excess sugar consumption include a higher risk of type 2 diabetes, obesity, heart disease and gout.

VIVA MEXICO

BANISH SAT-FAT

Mexico has one of the highest rates of obesity worldwide and was one of the first countries to introduce a tax on energy-dense foods and sugar-sweetened beverages. A new study reports on the effect of this after 12 months of implementation and shows there is a very clear reduction in the purchasing of these food items. The effect was greatest in those with lower socioeconomic status. Time for some sugar tax action here in New Zealand?

An American study has found that if a person replaces just five percent of their energy intake from saturated fats with monounsaturated and polyunsaturated fatty acids, they could reduce their risk of mortality by 27 percent. Pass the olive oil please! And check out our new meal makeovers column on p32 for other healthy food swaps.

Reference: PLoS Med 2016;13(7):e1002057

Reference: JAMA Intern Med 2016; 176(8): 1134–4

STRANGER THAN FICTION A James Dyson award-winning team has designed smart contact lenses that monitor the blood sugar levels of diabetes patients and transmit data to their phones in real time. The invention, developed by engineers from the University of Waterloo, Canada, is said to be a potential game-changer in the field of blood sugar monitoring. The lens is minimally invasive and works by analysing tear fluid. It is linked to a clip wearable on the collar or behind the ear, which is connected to a small device that transmits the data to the person's smartphone. The lens doesn't affect a person's vision in any way and isn't contraindicated by other diabetes prescriptions. But don’t get excited just yet, the technology is still at an experimental stage and it has yet to go through human testing, due to start in April 2017.

DIABETES WELLNESS | Summer 2016

Cover

THE MALAKAI FE Rugby superstar Malakai Fekitoa shares why he wants to help people with diabetes live healthy active lives. BY CAROLINE WOOD PHOTOGRAPHY BY KENT BLECHYNDEN

t took steely determination, talent and a radical change in diet for Malakai Fekitoa to reach the top of his physical game. Like many young Pacific Islanders he says as a teenager he favoured sugar (lots of it) and takeaways in his diet. But experience has taught him that what he puts into his body makes a big difference to how he looks, feels and performs on the rugby field. In fact, giving up sugar and takeaways was a turning point in his rugby career, the softlyspoken Malakai, 24, explains, on the eve of the All Blacks game against the Wallabies in the battle for the Bledisloe Cup in August. “Coming from the islands, I used to love sugar in everything, like Raro – everything had to be fizzy. At school, I didn’t know anything – I drank fizzy drinks and ate takeaways – but I got away with it because I trained a lot.” At 19, Malakai was semiprofessional and his body fat was tested. The results were a bit of

DIABETES WELLNESS | Summer 2016

EKITOA INTERVIEW a shock. They told him he had to change his eating habits to reduce his body fat. This would help his precision and performance on the pitch. So the teenager cut out sugary stuff, fizzy drinks, caffeine and takeaways. He reduced his carbs, going from eating half a loaf of bread to one or two pieces of toast, and he stopped eating his favourite banana bread. “After two to three weeks I notice a big difference. I have more energy, when I play I feel lighter and stronger and I feel

heavy and less likely to develop type 2 diabetes. Earlier this year he became a FABruary ambassador helping highlight the dangers of obesity and encouraging people to take small steps towards being healthy. He says diabetes was a bit of a taboo subject in the small Tongan village where he grew up. Malakai comes from a large traditional family and is one of 14 siblings. Even now he doesn’t want to ask family members if they have diabetes because they might feel ‘put down’.

I’m worried about my family, that’s where I want to start. I want to help them first and set a good example for others to follow.

good about myself, I look better, I can tell the difference, every day I can see the change. “They tested again and my body fat had gone down. Even my flatmate, he followed what I did. Although he didn’t cut down everything like me, he stopped the little things. I told him not to eat unhealthy fast foods. He’s a professional rugby player too, a prop, and he went down [in body fat] too. Just the little things, they made a difference.” Malakai wants to share his story in the hope it may help people, especially young Pacific Islanders, become a little healthier, less

“I didn’t know much about diabetes, I didn’t know what it meant until Sue [Brewster] from Diabetes NZ approached me. We talked about it and she explained everything. That’s when I decided I wanted to put my hand up and help out. “In my culture, most Islanders and my family, some of my brothers and sisters, are not into training, or don’t know much about what to eat and what not to eat, and I want to help them first. “I think people are ashamed about it [diabetes]. Islanders are very secret about their health.

DIABETES WELLNESS | Summer 2016

Cover

GAME DAY

Malakai shares his typical match day routine ahead of an evening All Blacks fixture. BREAKFAST • Porridge and banana, a little bit of almond milk, no sugar • Half a small glass of orange or apple juice – Malakai wouldn’t normally drink fruit juice but on a game day he needs the extra energy. His usual drink would be (a lot of) water. And sometimes green tea. • One piece of wholegrain toast and avocado with three poached eggs • Fruit eg a small piece of banana or watermelon. After a breakfast of kings Malakai will take it easy, relax, maybe even go back to bed to sleep. MORNING TEA 11am Sometimes a coffee, and maybe a treat like a muffin or scone [but only on game day though!] LUNCH Something light like a chicken and vege wrap and a large glass of water. TEAM TALK AND GAME PREP There’s no training on game day but the team will do a walk through of the match and prep for the game at their team hotel. Malakai says some people go to the gym, but he prefers swimming during match day to wake him up and stretch. SUPPER 4–5pm Malakai will fill up with a big meal before the match. Perhaps chicken, mashed potatoes, veges, one poached egg, half a spoon of baked beans or spaghetti and water. A nutritionist travels with the team and briefs their hotel about the right kind of food to serve. There’s plenty of choice and it’s up to individual players what they eat. Some people don’t eat or just have toast, says Malakai. JUST BEFORE THE GAME A scone and jam – Malakai says he needs the sugar to pep up his body for the game. Other than game days his diet is almost sugar free. Pack bags, shower and get ready to head to stadium for 7.30pm kick off.

TRAINING DAYS The team will have a pre-training meeting in the morning, then from 10am–12 noon it’s training on the field with lots of cardio-busting activities. Malakai might go to the pool and spa afterwards. Then it’s off to the gym for strength training in the afternoon. He stretches morning and night.

DIABETES WELLNESS | Summer 2016

When I go home they say to me ‘Why don’t you eat, why you lose weight?’ They think it’s normal to be big. Obviously I know a little bit better from footy and from what I’ve learned throughout the years, I know the difference. “I see many people struggle, they don’t stop eating. I’m worried about my family, that’s where I want to start, I want to help them first and set a good example for others to follow.” Malakai supports Diabetes NZ’s key message that everyone, no matter what age or stage, can take small steps to a healthier lifestyle. His advice is to make a start, set some goals, try to achieve them and set some more. This is how he has lived his life and it’s worked for him. The rugby star, who has access to some of the best nutrition and exercise advice in the country, is happy to share some of the lessons he has learned along the way (see Malakai’s top tips panel, right). And he has one key message for those of us who are finding it tough. “Remember what you are going through is worth it. You’re going to see a result in your body and health, and when you do, it will be worth it.”

MALAKAI’S small STEPS TO SUCCESS

1 2

Work out why you want to change in the first place to find your motivation. Start with little steps. Do it gradually, and notice the changes in your body and health. Look at what you eat and eat a little less. Eat lots of veges and fruit, snack on fruit, nuts and crackers. Make sure you eat at the right time, around 6-7pm not 10pm. Drink a lot of water – why do you need sugar or fizzy every day?

4 5

Set small goals, try to achieve them, then set some more. This applies to everything in life. For example, just have one slice of toast, not four, because you don’t have to cut out everything in one go. Remember what you are going through is worth it. You’re going to see a result in your body and health, and when you do, it will be worth it.

Start with just 10-20 mins of exercise – try walking and build up slowly. You don’t have to go crazy about running, training and stuff. Asking a mate or family member to come with you to help keep you motivated.

DIABETES WELLNESS | Summer 2016

Diabetes Action Month

Join us during our second annual Diabetes Action Month campaign, when we challenge New Zealanders to face up to the tsunami of diabetes in our communities. During November, Diabetes NZ and our supporters will challenge New Zealanders to Join the MoveMeant and show support for the 260,000+ Kiwis living with diabetes – and those at risk of developing it.

Diabetes Action Month takes place from 1-30 November 2016. Keep up with news and events via our Facebook page.

WHAT'S HAPPENING?

This year we have more fantastic resources to share, motivational challenges, and a brand new campaign to highlight the impact of diabetes on New Zealanders and their families. Business development manager Sue Brewster explains: “Last year’s inaugural Diabetes Action Month focused on the theme of ‘Know your risk’. “This year we will focus on the next stage of awareness, which is ‘Know how to manage your diabetes’, while also letting Kiwis of all ages know that everyone is at risk. “To support this we will be launching a Take Control Toolkit to help people with diabetes and prediabetes (and their families) manage their condition and understand how different factors can influence a person's control of both type 1 and type 2 diabetes.”

TAKE CONTROL TOOLKIT

A new wellness initiative from Diabetes NZ forms the heart of this year’s Diabetes Action Month. A group of 12 people with diabetes have been using a series of information and support tools over a 12-week period to help them “take control” of their diabetes (see overleaf). The information, resources and support videos developed as part of the 12-week initiative will be compiled into Diabetes NZ’s Take Control Toolkit and promoted during Diabetes Action Month. The toolkit will be released exclusively to members in November 2016 (see p14) and made available to the general public in early 2017 via www.diabetes.org.nz.

Left: Highlights from last year's inaugural Diabetes Action Month

DIABETES WELLNESS | Summer 2016

WHAT'S COMING UP

Week 1 will begin with a national launch of the campaign and we will again be calling on New Zealanders to Join the MoveMeant! Week 2 will celebrate the kick-off (or should that be stepoff?) of the Fitbit MoveMeant Challenge with our first pool of challengers stepping out on Monday 7 November. During Week 3 our social media activity and local activity will focus on the IDF Eyes on Diabetes material in the lead up to World Diabetes Day on Monday 14 November. In Week 4 and 5 we will wrap up the campaign with the finals of the Diabetes NZ Fitbit MoveMeant Challenge and the Diabetes New Zealand AGM in Wellington featuring some fantastic keynote speakers. Throughout Diabetes Action Month, there will also be local branch events taking place across the country. See www.diabetes.org.nz for details.

Fitbit MoveMeant CHALLENGE PHOTO OF ANDREA HEWITT: MARTIN PUTZ/WIKIPEDIA

The Diabetes New Zealand Fitbit MoveMeant Challenge returns. Who will take the most steps during the challenge, which runs from 7 November for a month? Last year’s winner Andrew Barnes, Founder of Perpetual Guardian, will return to defend his 2015 title (156,000 steps – can they beat him?!) Other challengers confirmed to date are our own superstepper Chief Executive Steve Crew, Health Minister Dr Jonathan Coleman, Minister of Pacific Peoples Peseta Sam Lotu-Iiga MP, MP Jacinda Ardern, MP Louisa Wall, celebrity chef Brett McGregor, Pita Pit director Duane Dalton, Black Sticks’ Gemma Flynn and rugby star DJ Forbes. They will have their work cut out as they will be up against some pretty tough competition, including triathlete Andrea Hewitt. Clockwise, from top left: Brett McGregor, Gemma Flynn, Louisa Wall, Dr Jonathan Coleman, Peseta Sam Lotu-Iiga, Andrea Hewitt, Andrew Barnes, Jacinda Ardern, and centre, Steve Crew.

JOIN TODAY AND BE IN TO WIN Do you know a friend or family member affected by diabetes? Please encourage them to join up with Diabetes NZ during November and they will go into a draw to win a New Member Star Prize Pack worth $700. The pack includes a signed Pulse Energy Highlanders rugby jersey (pictured far right), 1x Fitbit Blaze, 1x Bio-Organics Glycemix Product Pack (see right), 2x $50 Shoe Clinic vouchers ($50 off New Balance shoes or a New Balance t-shirt up to the value of $50), 1x $40 voucher for Thorlos Padds socks and 2x Pita Pit salad vouchers (valued at $13.50 each).

The New Member Star Prize Pack includes a Pulse Energy Highlanders rugby jersey signed by the 2016 team. Prize courtesy of Pulse Energy, principal sponsor of the Highlanders. Also included in the star prize pack is a Fitbit Blaze (RRP $369.95). This smart fitness watch is designed to help you maximise every workout with revolutionary features like PurePulse heart rate, Connected GPS, on-screen workouts and smartphone notifications. RUNNER UP PRIZES The four runners up will each receive a Bio-Organics Glycemix Product Prize Pack (RRP $169.95). The range is designed to help people who want nutritional support for their body and lifestyle. Each prize pack contains: 1 x Metabolic Multi, 1 x Vision Defence, 1 x CoQ10 + Alpha Lipoic Acid, 1 x Foot & Heel Balm, 1 x Neuropad (two foot-test patches per pack), 1 x Glucose Rapid or 1 x Wound Gel.

Join Diabetes NZ during November and be in to win. Go to www.diabetes.org.nz and click on JOIN US TODAY. Usual competition terms and conditions apply, see www.diabetes.org.nz/site-info/terms_and_conditions

DIABETES WELLNESS | Summer 2016

Life

TAKE CONTROL TOOLKIT

iabetes NZ has a silver medal it gives to members who have been on insulin for more than 50 years and we have featured many of their positive stories in this magazine. We know that people can live a long healthy life with type 1 or type 2 diabetes if their diabetes is ‘controlled’ and their blood sugar levels are within normal range. But life isn’t always that simple and sometimes managing the big D is, well, d… hard. Some people with type 2 diabetes may be in denial, others may experience diabetes ‘burnout’ and give up trying. And for many of us it’s hard to know where to start. This is why Diabetes NZ is launching an initiative this month aimed at helping New Zealanders with diabetes to better manage their condition. It has developed a Take Control Toolkit featuring a range of information

Diabetes NZ is launching a wellness initiative to help anyone with type 1, type 2 or prediabetes take control of their condition. Caroline Wood finds out more.

and support tools in three key areas: health & wellbeing, food & nutrition and physical activity. To help illustrate how the tools can be used, Diabetes NZ invited a small group of people to ‘test’ the tools over a 12-week period running up to Diabetes Action Month. Ten of the participants have type 2 diabetes, one has prediabetes, and one has type 1. The participants range in age from 30 to 78 years. Some have had diabetes for more than a decade, others only for a few months. The group met regularly over 12 weeks to discuss their diabetes goals. Diabetes self-management advisor Dr Richard Cooper, who has previously made significant changes in his own life to control his type 2 diabetes, supported the participants on their journey. They also shared their diabetes stories with each other and their health, diabetes and fitness were monitored at the start, middle and end of the 12 weeks.

The full suite of Take Control Toolkit resources will be shared with Diabetes NZ members from November 2016 onwards and made available publicly as an online resource in February 2017. Diabetes NZ’s Sue Brewster, who has been leading the project, said: “The aim is to develop a suite of information for people with diabetes and prediabetes to help them take control. We want to provide current and reliable information because we know it can make a difference. It will also be useful for families and friends who want to help support a loved one towards a healthier life.” Diabetes NZ members will be sent an email link to the Take Control Toolkit. If we don't have your email, or you have changed emails, please contact us on admin@ diabetes.org.nz or call 0800 342 238 so we can update your details on our database.

HOW CAN I CONTROL MY DIABETES? • Take your medication as prescribed • Eat healthily • Take regular physical activity • Have a positive mindset. Lowering your blood sugar levels and keeping them within a normal range reduces the risk of long-term diabetes-related complications like heart disease, stroke, nerve, eye, foot and kidney damage.

DIABETES WELLNESS | Summer 2016

MY STORY

WE JUST WANT TO HAVE A BABY Jasmin has a really big motivation to take control of her diabetes. She and husband Clinton desperately want a baby.

arlier this year, Jasmin and Clinton Hewett were told they couldn’t start fertility treatment because of Jasmin’s uncontrolled type 2 diabetes and high blood pressure. Jasmin, 37, had been diagnosed with diabetes in August 2015 but wasn’t taking the treatments she’d been prescribed. She explains: “At that point I wasn’t taking care of myself. I wasn’t taking my diabetes or blood pressure medication. I thought I would try and do it naturally [reduce her blood sugar levels] but I wasn’t really motivated to do it. “A year after my diagnosis my husband and I wanted to have children, but we were told I couldn’t because of my diabetes. I wasn’t able to do the fertility treatment. We’d previously lost a baby due to an ectopic pregnancy and IVF was my only hope. I was devastated.” Two months later, when Jasmin was approached to try Diabetes NZ’s Take Control Toolkit, she decided to take part in the 12week programme.

“I just felt like this is the right thing to do, what have I got to lose?” she said. Jasmin, who used to be part of a Cook Islands dance group, says she gave up dancing and other sport when she became too busy with work, family and church. Since starting to use the toolkit five weeks ago, Jasmin and her husband Clinton have been taking daily walks and are already noticing the benefits. “So far this programme is really helping. I’m more active and so is my husband. “I’ve noticed a difference. I’m more alert and have more energy, especially at work,” she says. The couple, who live in South Auckland, eat pretty healthily already but they’ve reduced their portion sizes, are buying more veges and experimenting with new healthy recipes like stir fries. Jasmin doesn’t need to lose a lot of weight – she says she’s about average for a Pacific Islander – but her endocrinologist Brendan OrrWalker has challenged her to lose 5kg to see if it makes a difference

to her diabetes. “He said how about you try it and see what happens? Everyone has different genes and chemical composition.” Diabetes runs in Jasmin’s family. Four of her brothers and one sister have type 2 , as did her mum. Her mum managed her type 2 diabetes well but some of her siblings don’t. “I’m not even sure if they go to see a doctor,” says Jasmin. “I suspected I would get it because my siblings had it but I didn’t think I would get it in my 30s. I didn’t believe them when they told me.” But the good news is that Jasmin is feeling more positive about her diabetes and her blood sugar levels have come down since she started using the toolkit. It’s early days yet, but Jasmin is hopeful that these small steps will put her back in the driving seat with her diabetes and that she and Clinton are on the way to fulfilling their dream of having a baby.

DIABETES WELLNESS | Summer 2016

Life

When Carla Adlington was asked to join the Take Control Toolkit initiative, she jumped at the chance to learn more about all kinds of diabetes.

MY STORY

BRIDGING THE GAP

arla, 30, is a volunteer camp manager for Diabetes Youth NZ and some of the teens who attend residential camps in the Auckland region have type 2 diabetes. She says she wants to be able to help them in the same way she supports those with type 1. “I know the basics about T2 but I thought this was a good opportunity to bridge the gap,” she said. It was also a chance to reflect on her own health and learn something new. One early lesson was trying out a Fitbit activity tracker and realising how sedentary her office job is. She is now trying to increase her daily step rate. Carla says she has pretty good control of her type 1 diabetes already, although she has some tough days. When I spoke to her,

DIABETES WELLNESS | Summer 2016

she was nearly mid-way through the 12-week initiative. “I’ve really enjoyed it. It’s an opportunity to focus and think about diabetes and the differences between T1 and T2. Everyone has different stories to tell. One T2 told us that she has blood sugar levels in the 20s. If I’m in the 20s I’ll feel quite nauseous and ill. It was a shock to hear that she didn't feel the same.” Carla spent 17 years living in the United States, returning to live in New Zealand when she was 24. She attended her first diabetes camp in America when she was eight. It was a revelation because there were hundreds of kids there all with diabetes and she loved the experience. “I could try out lots of different types of technologies at the camps there. It was very educational,

supportive and motivational. Having diabetes in America was very different. The technology available for T1s is years ahead of New Zealand.” Carla has a continuous glucose monitor attached wirelessly to a smart watch. Her family can see her blood sugar stats and check up on her if they haven’t heard from her for a while. She can see trends and it makes her diabetes control very good, she says. One of the biggest benefits is that she no longer needs to do regular finger pricks. Carla hopes she can share what it is like living with type 1 with others trialling the toolkit. “It’s an opportunity to learn about the differences [between type 1 and 2] and embrace them,” she says.

Reader competition

Be in to win!

To celebrate Diabetes Action Month and our new-look Diabetes WELLNESS magazine, we have put together two fantastic prize packs (worth over $580 each) in an exclusive reader competition. As well as the two prize packs, we have a host of runner up prizes. During November, Diabetes NZ invites you to Join the MoveMeant and take control of your diabetes.

WIN PRIZES WORTH MORE THAN

$1,400

WELLNESS PRIZE PACKS We have two fabulous wellness prize packs comprising: 1x Fitbit Surge (RRP $469.95), a Shoe Clinic voucher for $50 off a pair of New Balance shoes or a New Balance T-shirt, a $40 voucher for a pair of Thorlos Padds socks (RRP $40) and two Pita Pit salad vouchers (RRP $27). Our seven runner up prizes include: 3x Shoe Clinic vouchers for $50 off a pair of New Balance shoes or a New Balance T-shirt; 2x $40 vouchers for Thorlos Padds socks and 2x $27 Pita Pit salad vouchers (each prize contains two $13.50 vouchers). See below for descriptions of all the prizes. To be in to win, email draw@diabetes.org.nz with the keywords TAKE CONTROL by 11 December 2016. Please include your name and address. We will post your prize by Christmas. Usual competition terms and conditions apply, see www.diabetes.org.nz/site-info/terms_and_conditions

Pita Pit: Salad vouchers â&#x20AC;&#x201C; two $13.50 vouchers Pita Pit make good food irresistible. They love healthy, natural, fresh ingredients and funnily enough, so does your body. When it comes to the body, controlling what you put in makes it easier to lead a full and active life. A fresh, healthy, tasty Pita Pit salad is a great way to do your body a favour. Fitbit Surge RRP $469.95 The only GPS fitness super watch designed for all-day wear, Surge helps you maximise your performance with stats like distance, pace, and elevation climbed. Stay on track by seeing routes and review your workout summaries. Itâ&#x20AC;&#x2122;s a sleek, comfortable watch perfect for work, workouts and all day.

Shoe Clinic: $50 off one pair of New Balance shoes or a New Balance t-shirt up to the value of $50 Shoe Clinic are experts in assessing and providing the right shoe for you, no matter the age, stage or condition of your feet. All shoes come with a 30-day money back guarantee. Most stores offer free podiatry appointments. Together with New Balance, we can fit you with a shoe that will meet all your physical activity needs.

Thorlos: A $40 voucher for a pair of Thorlos Padds socks Thorlos Padds clinically tested padded socks are proven to benefit those with diabetes who are not at risk of ulcers and also those with arthritis, to reduce pain and aid mobility through physical exercise in comfort. Your feet will feel better or your money back!

DIABETES WELLNESS | Summer 2016

Youth

HOW IS EMILY PLANNING TO MARK WORLD DIABETES DAY ON 14 NOVEMBER? World Diabetes Day is just around the corner and you will find Emily paddling the circumference of Lake Wanaka to mark the day amongst other local festivities. “Got to love adventures like these, a synonym for living life with diabetes really, you have to be resourceful, adaptable and positive to thrive,” she says.

TOUR OF NEW ZEALAND IDF Young Leader for New Zealand Emily Wilson is planning an epic trip to promote diabetes awareness among school children.

t has been almost a year since I organised my last diabetes event on World Diabetes Day 2015. A couple of support group meetings, blogs and mentor sessions are all I have managed in between travelling, work, racing and dealing with family health concerns over the last few months. In the meantime, I have been trucking along with my own diabetes management,

DIABETES WELLNESS | Summer 2016

experimenting with my diet to try and achieve better control with less intervention. I am making progress and learning lots which is great. Recently I have found myself with some breathing room to formalise a dream I have had for some time now. I have always believed that knowledge is power. If we want to change the outcome of the situation we find ourselves in, we must first educate people so they can begin to help themselves and seek better alternatives. Change has to start with our young people and for me, I want to stick to what excites me, what I know and what I am good at ie talking, working with kids and adventuring in the outdoors. So with this in mind I am

planning a multisport tour of New Zealand, visiting as many schools as I can, as I bike, kayak and run the length of the country in late summer/autumn 2017. The aim is simple, to educate our youth on what diabetes is (the different types), how it affects the body, what the signs and symptoms are and how we can live well with it or prevent it. To inspire our kids to believe that anything is possible with chronic illness – that we are not bound by our perceived circumstances. I am very aware of the mammoth effort it will take to execute my mission. The route, sponsorship, the timing of school visits, finding drivers/support people and generating media coverage are only some of the things that need to be considered. I know I can do it. It is not only the anticipation and thrill of the unknown that leave a tingle in my belly but the excitement of sinking my teeth into a challenge that gives my life more meaning and purpose. It’s going to be a true adventure and an awesome tour of the beautiful place we are lucky enough to call home! I will be encouraging people to come out and give me a shout, wave or come along with me for different stages. Emily is a sports instructor and extreme sports competitor. She lives in Wanaka. You can connect with Emily via emilyw_is@live.com

The Fitbit family of trackers helps motivate you to get active which can help manage type 1 diabetes and prevent or delay type 2 diabetes. They also track every part of your day including activity, exercise, food, weight and sleep â&#x20AC;&#x201C; to help you find your fit and stay healthy.

fitbit.com

Eat

WHAT’S FOR DINNER? You may have recently been diagnosed with diabetes or perhaps you want to make some dietary changes but don’t know where to start. Nutrition expert Helen Gibbs says making small changes can have a big impact.

DIABETES WELLNESS | Summer 2016

elcome to your diabetes journey. Being diagnosed with type 2 diabetes, whatever your age and stage, leaves most people reeling in shock – there is so much to learn about and remember. While working for nearly 20 years as a dietitian, alongside doctors and nurses in General Practice, I have often asked these health professionals: “What is the single most important thing for the patient to know when they are leaving the consultation room after a diagnosis of diabetes?” The responses have been varied – they might talk about HbA1c values or how diabetes medications work. But what they hardly ever say is “What is for dinner?” But you and I know it’s common to worry about the things that we do in daily life – and eating and drinking is going to be top of most people’s list. The good news is that you don’t need to eat differently from any other members of your family. That means you don’t need to cook separate meals.

The recommended eating pattern for people with type 2 diabetes is ‘healthy eating’ and that is going to be suitable for everyone in the family. Here are some broad rules of thumb for the kinds of changes that many people need to make when they are eating to manage their diabetes – that means eating to reduce blood sugar levels and in some cases to lose weight. I suggest you work on the changes one at a time, so you can improve your chances of the changes sticking: • Eat less overall • Eat less fat, especially saturated fat • Eat more veges • When selecting starchy foods, choose wholegrain and high fibre options • Eat slowly and enjoy your food because it takes time for your brain to register that your stomach is full. If you can make even just one of the changes suggested here, you will be taking a positive step that will help you control your diabetes.

Hang 10 for health How big is your plate size? The food area of your dinner plate should be no wider than your hand when you “hang 10” (see pic) over the plate. Typically for a woman this is 22cm and for a man 25cm. If you’ve got a bigger plate than this, chances are you will be filling it up with food. For many people reducing plate size = eating less food.

FIX 1

FIX 2

FIX 3

Balance your plate About half of your plate should be full of non-starchy vegetables – put them on first. A quarter of your plate should have a fist of starchy food (either a vegetable or cerealbased food) and the remaining quarter of your plate should have a palm of protein food. Limit the fat Choose leaner cuts of meat or “trim, skin or skim” your meat portion to reduce the fat. Try measuring your cooking oil – 1 tsp per person per meal. Use low fat dressings and sauces, trim milk and limit cheese to no more than 30g per person per meal.

LOW

EVOLUTION NOT REVOLUTION You may have planned to have a meal of pork chops with mashed potato and frozen mixed vegetables before the news of your diabetes diagnosis. You can still stick with the plan, with just a few fixes.

FIX 4

FIX 5

CALORIE SWEETENER Measures spoon-for- spoon like sugar

Trim at least ½ the fat off the chop and plan to grill it rather than fry it –once trimmed your meat (minus the bone) should weigh around 150–200g before cooking.

Perfect to use in your favourite food or drink recipes. Add a delicious, sweet taste with fewer calories.

Wash but don’t peel your potatoes, cook them in the skin. Aim for a fist-sized serving of potato for each person. You could mash the potatoes with the skin, and use trim milk and 1 tsp of margarine in the mash – or preferably leave them whole. As well as cooking up your mixed vegetables, cook up a second vegetable such as spinach or carrots. You need to cook enough vegetables for ½ a plate per person. Don’t forget to serve on a smaller plate – and make sure you serve your vegetables first.

STARTING POINT Here are some practical, quick ways to improve just about any meal.

FOR MORE INFORMATION ABOUT HEALTHY EATING, SEE DIABETES NZ’S HEALTHY EATING PAMPHLET ON DIABETES.ORG.NZ OR ORDER FROM US ON 0800 342 238.

For delicious recipes, visit

club

.co.nz

Research

PROTEIN POWER Researchers from Wellington’s Massey University are studying whether a protein powder + exercise combo can help people with type 2 diabetes.

ew Zealand scientists are excited about a new protein powder extract developed by researchers at the University of Otago. They hope it will prove to enhance the benefits of exercise in people with type 2 diabetes, including lowering blood sugar levels. The Wellington-based study involves people with diabetes embarking on an exercise programme five days a week and taking the protein powder twice a day, once after exercise and again in the evening. As well as taking the protein supplement (or placebo), all study participants have to do

DIABETES WELLNESS | Summer 2016

45 minutes of exercise five days a week. This includes a mix of endurance and strength training – cycling, weights, rowing and circuit training. The protein powder is thought to have an impact on muscle protein following exercise, improving blood flow and the metabolism of glucose. Dr Martin Gram, from Massey University (pictured top right with one of the study participants) says the beneficial effects might be caused by the unique amino acid and mineral composition of the protein, which may protect the body’s tissues through antioxidant mechanisms. “Ingestion of the protein may help people with type 2 diabetes lower their blood glucose levels. Consequently, the study will provide an opportunity to assess this promising practical, natural and non-drug intervention for diabetic therapy.” Final results from the study won’t be known until the end of next year.

The study is a collaboration between the Department of Anatomy and the Free Radical Research Group at the University of Otago and Massey University’s College of Health. It is funded by a $1 million Smart Ideas grant from the Ministry of Business, Innovation and Employment.

STUDY PARTICIPANTS NEEDED The research team is looking for participants in Wellington or Palmerston North who are sedentary, aged between 35–65 years and have been diagnosed with type 2 diabetes but are not on insulin treatment. The study is 17 weeks long and includes 14 weeks of exercise supervised by clinical specialists. Health tests are done to evaluate the effects of the training and protein intervention. Contact Dr Martin Gram on 022 169 2343 or m.gram@massey.ac.nz to find out more.

Family

IS YOUR child

MOVING ENOUGH? My children love screens, do yours?! Mine have a seemingly never-ending desire to sit and play Minecraft or watch YouTube videos. It could be on a tablet, phone or computer, they don’t really mind but left to their own devices (excuse the pun) I’m pretty sure they would be happy being on a screen (and sedentary) for several hours at a time, possibly even the whole day.

A HEALTHY 24 HOURS INCLUDES:

Bedtimes are also interesting in our household. We have one son who goes to sleep like a light at (about) the right time. And another who...doesn’t. We worry about how much sleep they should be getting. But help is at hand from the world’s first 24-hour movement guide for children and teenagers. The Canadian guidelines include evidencebased advice on how much your young person should sweat, play on screens and sleep per day. The Canadian 24-Hour Movement Guidelines for Children and Youth were developed by the Canadian Society for Exercise Physiology, the Conference Board of Canada, HALO-CHEO, ParticipACTION and the Public Health Agency of Canada. See www.csep.ca/en/ guidelines/24- hourmovementBy Caroline Wood

MODERATE TO VIGOROUS PHYSICAL ACTIVITY An accumulation of at least 60 minutes per day of moderate to vigorous physical activity involving a variety of aerobic activities. Vigorous physical activities, and muscle and bone strengthening activities should each be incorporated at least 3 days per week;

LIGHT PHYSICAL ACTIVITY

SEDENTARY BEHAVIOUR

Several hours of a variety of structured and unstructured light physical activities;

No more than 2 hours per day of recreational screen time; Limited sitting for extended periods.

SLEEP Uninterrupted 9 to 11 hours of sleep per night for those aged 5–13 years and 8 to 10 hours per night for those aged 14–17 years, with consistent bed and wake-up times;

DIABETES WELLNESS | Summer 2016

Gestational diabetes

WHAT ARE THE ODDS?

L Jacqui van Blerk has a T1 daughter but doesn’t have diabetes herself, or at least she didn’t until...

DIABETES WELLNESS | Summer 2016

ast summer was a particularly good one – late evening barbeques with friends, sharing a glass or two of our favourite reds and discussing our upcoming plans for a six-week holiday in Europe to celebrate some milestone birthdays in the family. With our six-year old T1 spending New Year with her aunt at Pakiri, sending her Libre readings to our Nightscout website so we had a constant fix on her numbers, Hubby and I thought we’d finally reached that magic point in diabetes care where everything settles into an easily-managed routine, with no more hitches or surprises… A pregnancy test at the end of January added a new twist to our routine! Determined to give our surprise new arrival the best possible start, I was faced with the challenges of identifying the 1,001 foods and activities to be avoided during pregnancy. The bottles of wine were consigned to a dusty cupboard and I resolutely walked past the sushi shop next to my workplace, consoling myself that nine months can pass in the flicker of an eye… I thought I’d done fairly well managing dietary restrictions and limiting weight gain when I took a routine glucose test at the sixmonth mark. But the results came

back and I was shocked to hear I needed to take an additional polycose test for gestational diabetes. Slightly shaken, I popped on my daughter’s Libre glucose sensor and started monitoring my glucose levels in preparation for the test. Fluctuating between 3.8 fasting and mid-6s after meals, I figured the first test must have been a fluke, until I met a friend for lunch and ordered pancakes with maple syrup…and realised my glucose levels didn’t come back down for the next three hours. My standard, low-GI diet had been masking the problem my system had processing high glycaemic foods! It was therefore not a huge surprise when I failed the two-hour polycose test which confirmed the gestational diabetes diagnosis. To my T1 daughter’s delight, I was now her ‘sensor buddy’, with both of us scanning numbers before meals, and carb counting every morsel we ate. I was put in touch with the team at the North Shore Hospital to monitor my condition, and its impact on the baby, which involved weekly logs of pre-and post-prandial blood sugar levels, as well as multiple scans to confirm the baby’s growth rates. Suddenly my biggest concern

was no longer whether we’d get the nursery painted in time for Bub’s arrival (still on the to-do list!) but whether he’d be affected by the complications of gestational diabetes. I was left feeling extremely vulnerable and frustrated that despite being in much better condition than I’d been six years earlier, my body had failed me. Seeking answers, I was surprised to find that gestational diabetes is fairly

The thought of consciously inflicting any of this on my unborn child reined in any resentment I felt at having my eating habits so closely scrutinised by strangers, and I was incredibly grateful to have access to my Freestyle Libre glucose monitoring system, helping me keep my BSLs [blood sugar levels] within range as much as possible. I made some interesting discoveries on the way, including

Our family will need to continue to focus on healthier food options and activities to help prevent diabetes becoming a more permanent part of my personal health. common, affecting up to 10% of pregnancies, and that one of the risk factors is advanced maternal age. That put me firmly in my place! The ante-natal team warned me that babies born to women with gestational diabetes tend to be much larger at birth, and therefore more likely to be delivered by C-section. They also highlighted that the babies tended to experience hypoglycaemia after the birth, as their bodies were conditioned to produce higher levels of insulin to cope with the mother’s high glucose levels, and were at risk of respiratory distress.

the impact of stress on BSLs, highlighted on a particularly bad afternoon at work when my levels shot above nine, and the 2-3 unit increase caused by an unsweetened cup of tea. I also learned to be more patient and tolerant of my daughter’s volatile levels, realising that we couldn’t control each of the potential factors resulting in highs or lows. I was one of the lucky ones – my BSLs were managed with small changes to diet, without the need for insulin or additional medication. Bub was delivered at a slightly small 2.98 kg, and apart from a small dextrose supplement when he

hadn’t fed well overnight and his BSL dropped slightly below threshold, has come through the experience unscathed. For now, the pokes, prods and scrutinising of diet have been replaced with post-natal midwife visits and reminders to keep up the fluids as Bub and I face the challenges of sleep deprivation and 2-3 hourly feeds. I’m not off the hook though – my risk of developing type 2 diabetes later in life has increased, and I will need to track my HbA1c annually to ensure it stays within range. Our family will need to continue to focus on healthier food options and activities to help prevent diabetes becoming a more permanent part of my personal health.

Jacqui van Blerk is President of Diabetes Youth NZ. Her son Sam arrived safe and sound on 22 September 2016.

DIABETES WELLNESS | Summer 2016

Recipes

SUMMER SALADS RAINBOW SALAD I encourage my patients to eat not only more, but also different coloured vegetables. As well as making food look more enticing,the different colours represent different phytochemicals, substances which plants produce to protect themselves against bacteria, viruses, and so on, and which are also good for our health. This beautiful rainbow salad should help give you the variety you need. SERVES 2

2 large handfuls of watercress 1 carrot, grated 1 pickled beetroot, diced 1 yellow capsicum, deseeded and cut into strips 8 cherry tomatoes, halved 4 radishes, finely sliced Handful of blueberries Put all the salad ingredients in a large bowl and toss them in French vinaigrette (see below). CALORIES 120 | PROTEIN 3G | FAT 1G | FIBRE 4G | CARBS 11G

FRENCH VINAIGRETTE MAKES 4 PORTIONS

4 tbsp olive oil 2 tbsp lemon juice 1 tsp English, Dijon or wholegrain mustard Âź garlic clove, crushed (optional) Beat all the ingredients together and adjust the seasoning. CALORIES 100 | PROTEIN 0G | FAT 11G | FIBRE 0G | CARBS 2G

Recipes courtesy of The 8-week Blood Sugar Diet Recipe Book by Dr Clare Bailey with Dr Sarah Schenker, foreword by Dr Michael Mosley, published by Simon & Schuster Australia. Paperback $39.99. This is the companion book to the best-selling 8-week Blood Sugar Diet by Dr Michael Mosley. It features 150 low calorie, low carb recipes designed to promote weight loss in people with type 2 diabetes. People with type 1 diabetes are not recommended to follow a low-carb diet but can still enjoy these healthy salad recipes.

*Caution: Discuss your diet plans with your doctor if you are on insulin or a diabetes medication other than metformin; are taking blood pressure tablets or warfarin, have retinopathy, or a significant medical condition.

DIABETES WELLNESS | Summer 2016

TIP

Deseed the cucumber by cutting it in half lengthwise and scooping out the watery seeds with a teaspoon.

MOROCCAN SPICED CHICKPEA SALAD We use quinoa here instead of couscous as it is higher in protein and fibre and significantly lower in starchy carbohydrates. SERVES 4

200g quinoa (mixture of dark and pale if available) 350ml vegetable stock 400g tin chickpeas, drained and rinsed 1 tbsp olive oil Juice of 1 lemon 1 tsp ras el hanout (or harissa paste or paprika) 8 cherry tomatoes, halved Âź cucumber, deseeded and diced 4 spring onions, finely chopped 100g pomegranate seeds (or raisins) Handful of mint or coriander leaves, torn 2 tbsp flaked almonds, toasted

Place the quinoa in a saucepan with the stock, bring it to the boil, then reduce the heat and simmer for 10-15 minutes or until all the stock has been absorbed. Remove it from the heat, cover it and leave it to stand for 5 more minutes. Put the chickpeas into a wide bowl and add the oil, lemon and spice. Mix well to coat the chickpeas. Add the quinoa and all the other ingredients to the chickpeas and gently toss them together. Season with salt and freshly ground black pepper.

Care

Love those BONES

Bone health may be compromised by having diabetes, as Paul Mitchell, from Osteoporosis NZ, explains.

e don’t tend to think about our skeleton very much. But without a healthy skeleton, we can be in big trouble. Osteoporosis causes bones to become weak and fragile, so that they break easily, even as a result of a minor fall or a bump. Fractures caused by osteoporosis can be lifethreatening and a major cause of pain and long-term disability. You only have to ask yourself if have you known someone who has broken their hip. If so, you know just how devastating osteoporosis can be. The good news is that osteoporosis can be diagnosed, prevented and treated. Last month a global campaign was launched by the International Osteoporosis Foundation to raise awareness that specific groups of people are at increased risk of suffering osteoporotic fractures, also known as fragility fractures. These include: • People over 50 who have sustained a fracture as a result of a minor fall or injury • People taking certain types of medicines, including some diabetes medications • People who are living with diabetes and other medical conditions. While the science of the relationship between diabetes and

DIABETES WELLNESS | Summer 2016

The most common fractures caused by osteoporosis are hip, spine, wrist and shoulder (humerus) fractures. Currently, the annual cost of treating these fractures is estimated to be $400 million. As New Zealand's one million baby boomers age, the burden of osteoporosis is set to increase rapidly.

NORMAL HEALTHY BONE

OSTEOPOROTIC BONE

osteoporosis is not completely understood, research has shown that bone health is compromised by diabetes. The link between the two diseases is underpinned by a complex interaction between insulin and bone. Further, some anti-diabetic drugs have been associated with increased risk of fractures. Individuals with both type 1 and type 2 diabetes are at increased risk of suffering hip fractures. However, this is more pronounced in type 1 diabetes. Significant progress has been made in New Zealand in recent years. In 2012, Osteoporosis NZ published BoneCare 2020, which called for a national effort to develop a systematic approach to hip fracture care and prevention. Implementation of this strategy is now well underway, with systems to prevent fragility fractures being implemented across the country and establishment of a New Zealand Hip Fracture Registry. In July, ACC announced a major investment aimed at reducing the number of falls and fractures older people suffer. You can read more about this campaign at www.osteoporosis. org.nz and learn how to keep your bones healthy throughout life. Paul Mitchell is Chairman of the Board of Osteoporosis NZ

AM I AT RISK OF OSTEOPOROSIS?

Yes, your risk is higher if you have type 1 or type 2 diabetes Mary Carter, 72, from Auckland, has had type 2 diabetes for over 25 years. In 2013 she developed cracks in her sacrum, probably by lifting a heavy vacuum cleaner. And last year she developed a crack in her pelvis. Both her injuries took over a year to heal. Her doctors say Mary has early signs of osteoporosis and she recently had an Aclasta infusion to strengthen her bones. She said: “It’s bad at the moment. I can walk for about 10-15 minutes before the pain gets so severe I have to sit down. And standing up is worse. I didn’t know that I was at higher risk of broken bones and osteoporosis because of my diabetes. I wish I had known as I would have asked for help earlier.” Although more research is needed to clarify the complex relationship between these two diseases, researchers have shown that bone health is compromised by diabetes. The interplay between bone and insulin is a key link between osteoporosis and diabetes and the use of some antidiabetic drugs has also been associated with an increased risk of fractures. The risk also increases with the development of diabetes complications.

HERE ARE SOME FACTS: • People with type 1 diabetes have lower bone mineral density (BMD) and a higher risk of fractures. Evidence is accumulating that people with type 2 diabetes who have complications, particularly microvascular disease (such as diabetic eye disease or kidney disease), are also at increased risk of certain types of osteoporotic fractures despite having a higher BMD when compared to people with type 1 diabetes. • The longer average life expectancy of people with diabetes that has accompanied improvements in medical care has increased the significance of osteoporosis. In addition to the usual causes of osteoporosis associated with ageing, bone health is also compromised by diabetes. • Women with type 1 and 2 diabetes also have an increased fracture risk because vision problems and nerve damage associated with the disease have been linked to an increased risk of falls. Hypoglycaemia, or low blood sugar reactions, may also contribute to falls and fractures. • Sedentary lifestyle habits common in many people with type 2 diabetes may also interfere with bone health. Source: International Diabetes Federation/International Osteoporosis Foundation

Did you know men can develop weak bones too? Almost a quarter of all people with osteoporosis are men.

DIABETES WELLNESS | Summer 2016

Care

TOP TIPS

FOR BONE HEALTH (TO PREVENT AND TREAT OSTEOPOROSIS)

1. A HEALTHY DIET RICH IN CALCIUM AND VITAMIN D

Calcium is contained in various foods, and especially in dairy products. Although guidelines vary worldwide and according to age, adequate intake of 500–1000 mg/day is often advised. Vitamin D is produced in the skin upon exposure to sunlight. Although many people are able to obtain enough vitamin D naturally via sunlight, older people are often deficient in this vitamin due, in part, to limited time spent outdoors. The International Osteoporosis Foundation recommends vitamin D supplementation for men and women over 60 years. 2. R EGULAR BONE STRENGTHENING EXERCISE

DIABETES WELLNESS | Summer 2016

Regular weight-bearing and musclestrengthening exercise can also help prevent bone loss and, by enhancing balance and flexibility, reduce the likelihood of falling and breaking a bone. Exercise is especially important for people with diabetes since exercise helps insulin lower blood glucose levels.

3. H EALTHY LIFESTYLE

Avoiding smoking and excessive alcohol intake, while maintaining a healthy body weight, not only helps with the management of diabetes, it is also important for bone health. 4. MEDICATION

Drug treatments approved for the prevention and treatment of osteoporosis in postmenopausal women and men are commonly prescribed, although more research is needed to determine how effective these treatments are in older patients with diabetes. 5. M INIMISING THE RISK OF FALLING

Two main steps to avoiding falls are wearing slip-proof shoes and fall-proofing the home. The latter may include installing hand rails on stairs and in bathrooms as well as ensuring that walkways are free of hazards (such as loose rugs).

TAKE ACTION >> • Take this test and see if you are at risk: osteoporosis.org.nz/wp-content/uploads/2016-Ripsheet-WEB.pdf. • Talk to your doctor and ask whether you need a bone density test. • Download Osteoporosis NZ’s free leaflet osteoporosis.org.nz/resources/brochure-all-about-osteoporosis. • More information about diabetes and bone health can be found here: worldosteoporosisday.org/resources/2016/fact-sheets.

Prediabetes

PROFAST TRIAL Could taking probiotics combined with intermittent fasting help people reverse their prediabetes and lose excess weight? We talk to lead investigator Dr Rinki Murphy about a new study.

e all know New Zealanders are getting heavier and developing a range of obesity-related health problems, such as type 2 diabetes and heart disease. The good news is that by losing weight, people with prediabetes can reduce their risk of developing type 2 diabetes and improve their general health. Many bugs live in our gut and these can influence our health. Probiotics (the good bugs) may change the environment in the gut to improve how our body breaks down food. New research shows they can also help prevent diabetes and maintain healthy weight. Auckland diabetes specialist Dr Rinki Murphy is leading a new study that hopes to improve the health of overweight people with prediabetes – those with borderline high levels of blood glucose that signify high risk for developing type 2 diabetes over time.

The Probiotics and Intermittent Fasting for Prediabetes (PROFAST) trial will look at the impact of intermittent fasting with and without probiotic supplementation. Participants will receive dietary advice on calorie counting and advice on how to restrict calories severely for two days every week – to 600kcal per day for women or 650kcal per day for men (roughly a quarter of usual intake). The study will also look at whether this dietary approach in combination with taking probiotic capsules reduces blood sugar levels and the chance of developing diabetes.

The main trial will involve more than 500 participants but first researchers are looking for 50 volunteers, who live in Auckland, to take part in a feasibility study. This will help them design the larger study. Dr Rinki Murphy said: “We will be looking to see the combined effect of taking probiotics and intermittent fasting. We want to see if we can reduce progression to type 2 diabetes in overweight adults of different ethnicities. “There is some evidence that a particular probiotic – Lactobacillus rhamnosus in high doses – reduces the development of gestational diabetes. We want to see if this probiotic is useful in prediabetes, and which dose is best.” Volunteers will find out more about how their body handles sugar and their body fat distribution from detailed testing and will be given expert help on reducing their calories on fasting days. “It’s a chance for people to give some time and energy into a clinical study that may potentially help them and many more people at risk of type 2 diabetes,” Dr Murphy added. To find out more or volunteer to take part, contact Wafa Elasheg on 0210621736 or Elise Penning on 0284158953 or email profast. bcu@gmail.com

FASTING IF YOU ALREADY HAVE DIABETES People with type 1 or type 2 diabetes should check with their doctor or diabetes nurse before trying any diet that involves fasting. Dr Rinki says intermittent fasting for people with type 2 diabetes may work for some people but it’s not a mainstream weight loss strategy. She said: “It needs to be discussed with your doctor or diabetes nurse before trying it, particularly if you are taking diabetes and/or blood pressure medication.”

DIABETES WELLNESS | Summer 2016

Eat

MEAL MAKEOVERS Welcome to our new meal makeovers column where our dietitian Helen Gibbs suggests some healthy alternatives for... the Kiwi summer BBQ. How can we make a BBQ better for people with diabetes, especially if your family likes a traditional meat-heavy affair? Here are some great tips and tricks to turn an unhealthy meal on the barbie into something delicious and healthy.

TWELVE BBQ MAKEOVER TIPS

Fill your plate once and remember the golden rule: ½ plate vegetables, ¼ starchy food and ¼ meat.

Serve large jugs of iced water flavoured with mint, lemon or fruit teas, to encourage thirsty people to drink water rather than alcohol.

Offering pre-dinner nibbles? Choose vegetable sticks and dips such as hummus, salsa or cucumber raita made with low fat yoghurt.

leaner meats to grill 4 Choose or BBQ and offer smaller

Swap out meat for colourful veges on the grill and up your 5+ a day

portions – aim for around 200g per person. Leaner meats such as chicken breast can be wrapped in foil to prevent them drying out.

lots of colourful veges 6 Cook on the BBQ – try capsicums,

courgettes, eggplant, asparagus and onions.

Limit the amount of oil added to the vegetables by cooking them on tin-foil with a spray of oil.

pre-butter your bread, 8 Don’t have margarine on the side. of garlic bread 9 Instead consider having bruschetta – brush on the oil, don’t pour.

wholemeal and 10 Offer wholegrain breads. dressing on the side 11 Leave when you make a salad. this reduced fat dressing 12 Try for coleslaw and potato

Serving sausages? They should contain less than 15g fat per 100g.

salads: ½ cup low fat yogurt and ½ cup reduced fat mayonnaise. Add dressing at 1 tablespoon per person.

MEAL MAKEOVER CALCULATOR Traditional Kiwi BBQ

kJ(kcal) Fat (g) Carbohydrate (g) Fibre (g)

DIABETES WELLNESS | Summer 2016

BEFORE

AFTER

2 sausages, 1 large lamb chop, 2 slices white bread with margarine, 2 rounds of garlic bread, ½ cup coleslaw, ½ cup potato salad

1 chicken breast without skin baked in foil with 2 tablespoons of salsa, 2 slices of wholegrain bread with 1 teaspoon reduced fat margarine, 1 cup green salad with 1 tablespoon lite dressing, 1 corn on cob with 1 teaspoon reduced fat margarine

7414 (1774)

3399 (813)

120

Youth

Diabetes Youth New Zealand (DYNZ) was established specifically for young people with diabetes up to the age of 25. We offer support and education for the whole family/ whānau. JOIN TODAY at www.diabetesyouth.org.nz

MY DIABETES DREAM Nicole Chan, 17, is the 2016 winner of the John McLaren Youth Award.

“

was diagnosed with type 1 diabetes two years ago in 2014. Initially it was hard to adjust to a life with this condition (as I’m sure anyone with diabetes will understand). But I was fortunate to have immense support from my family, friends, staff and students at my school and my wonderful team at Wellington Hospital – Kirsty, Ann, Tim and also my dean Anne Field. Receiving the John McLaren Youth Award for 2016 is an absolute honour and privilege. I’m currently a Year 13 student attending Samuel Marsden Collegiate in Karori, Wellington. In my spare time, you can find me creating and whipping up new recipes in the kitchen, working on my lifestyle health blog, curled up reading a book, exercising, having laughs with my friends and family, and helping my local community through service, including baking for a soup kitchen (the Suzanne Aubert Compassion Centre). The award opens up many opportunities for me. I plan to use the funds to help finance my tertiary education studying Law and Commerce at Victoria

University. With these degrees, I hope to gain an understanding of law and business which will assist in my plans to establish an organisation in the future. What kind of organisation – business or not-for-profit? My organisation will aim to educate and promote good health with a strong focus on diabetes and other risks associated with diabetes due to possible lack of knowledge and poor management. I am passionate about nutrition and wellbeing especially ideas centred around diabetes. The award will provide a wonderful opportunity for me to bring together my passion, diabetes and my dream of working in the business and entrepreneurial sector. Diabetes NZ and Diabetes Youth NZ are two very important organisations relating to diabetes in New Zealand. These two organisations support and bring people who have diabetes and their supporters together through events and educate through information on their website, magazine and notices. Both organisations have been steadfast moral supporters for

WHAT ARE THE JOHN MCLAREN AWARDS? John McLaren bequeathed a sum of money from his estate to be used by young New Zealanders with diabetes. The awards are given annually and recognise the pursuit of excellence across cultural, academic and sporting fields by young people with diabetes.

me. They understand what I’m going through, encourage me and uplift me to see that diabetes is not a hassle or a burden. Having diabetes has helped me to live my life even more to the fullest and persevere through hard times. I encourage you to apply for the John Youth McLaren Award in 2017 if you’re eligible, because the opportunities it provides you to reach your dreams and passions are too good to be true. I look forward to catching up with you soon with updates as to what I’m up to! You can see Nicole’s blog at thelifestylerunner.wordpress.com

DIABETES WELLNESS | Summer 2016

Move

HOW FIT ARE YOU?

I Craig Wise offers three simple ways to test your fitness and measure progress.

t’s that time of the year when everyone begins to think about either getting fit for summer or pondering on the soon-to-be enacted New Year’s resolution – you know the one that starts: “This year I’m going to get fit by...” But before you can get fit, you have to know how fit you are – are you a beginner? Intermediate? Athlete? As part of a well-planned path to being fit (or fitter), it’s good to know where you are starting from. This lets you gauge your progress – just watching the scales isn’t the way to do it. Big doesn’t necessarily mean unfit and skinny doesn’t equate to being healthy. Fitness covers three areas: strength, cardiovascular fitness and flexibility. You can visit a sports performance testing laboratory, which can be expensive, to find out how fit you are. Or you can do some basic tests for yourself at home (with little or no equipment). The simple fitness tests below can help you gauge where you are at and you can repeat them every six to eight weeks to see how you are progressing. Make a note of your results each time so you can see any changes.

DIABETES WELLNESS | Summer 2016

THE PRESS-UP TEST – STRENGTH TESTING This extremely simple test has been around for a while and is a staple in the fitness testing regime. Strength and endurance in the muscles of the upper body, specifically the chest, shoulders, triceps and core, are a good indication of overall fitness. This simple exercise engages muscles throughout the entire body – from head to toe – in order to maintain good form throughout the exercise. • Begin in a press up position on hands and toes with hands shoulder-width apart and elbows fully extended. • While keeping a straight line from the toes to hips, and to the shoulders, lower your upper body so your elbows bend to 90 degrees. • Push back up to the start position. • That is one rep. • Repeat for a minute, counting the number of press ups completed. MODIFICATIONS:

1. If you find that you’re able to complete a minute easily then change the test slightly and count the number of press ups until you can do no more. 2. If you are unable to do a full press up, then change the exercise slightly and place your knees on the floor.

KEEP WORKING THOSE MUSCLES

HUFFY PUFFY FITNESS – CARDIOVASCULAR TESTING Heart health is an important aspect of any fitness testing. It is easy to see how strong you are or aren’t but what is happening inside is just as important. This simple test will get your heart pumping and also will let you know how quickly your body returns to its pre-exercise state – a good indication of cardiovascular fitness. • Find a step to use for the exercise. • Take your resting pulse rate for ten seconds. • Step up and down on the step for 3 minutes non stop. • Take your pulse rate at the end of the three minutes and then every 30 seconds until it has returned to the starting rate (or a beat or two away).

HOW BENDY ARE YOU? – FLEXIBILITY TESTING The sit-and-reach test is a good simple way to measure the general flexibility of the backs of your legs, your hips and your lower back. Having good flexibilty is great for injury prevention and muscle stiffness. • Sit on the floor with your legs straight and feet a little wider than shoulder width apart. • Holding a piece of chalk in your hand, slowly reach forward as far as you can, holding the position briefly. • Mark with the chalk where you have reached to. • Repeat twice more, measure from your seated position to your furthest mark and record the best of the three reaches. These tests are not scientific or exact but unless you are a top athlete they should be enough to give you guidance. The tests are designed for general use. If you have injuries or medical conditions then check with your medical advisor before performing the tests. They may suggest alternatives or modifications which would better suit your specific needs.

Researchers think focusing on improving the strength and health of muscles in those with type 1 diabetes could produce better health outcomes. Loss of physical strength due to muscle deterioration is a complication for people living with type 1 diabetes that’s often overlooked. New research from Canada’s McMaster University shows it shouldn’t be. Two recent studies published in Diabetes and Scientific Reports highlight the loss of muscle stem cells early on in the disease; a likely key to the muscle deterioration which happens later on. The loss of skeletal muscle, which is the largest insulin-sensitive organ, impacts the body’s ability to regulate blood sugar and respond to insulin over time. “Through research with both mice and humans, we’ve shown that type 1 diabetes negatively impacts muscle, and by improving muscle health we can reduce blood sugar levels and improve the response to insulin,” says Thomas Hawke, senior author of both studies. His research team discovered one means to prevent the loss of skeletal muscle in diabetes is to reduce myostatin, a natural secreted hormone that represses muscle growth. A number of pharmaceutical companies are in late stage clinical trials of new inhibitor drugs that have been shown to be “highly effective” in inhibiting myostatin with fewer adverse side effects, says Hawke. “While my advice would be to exercise, our work may provide therapeutic options for those who may be unable to, or unable to at intensities needed to see therapeutic benefit,” he added. Reference: https://fhs.mcmaster.ca/main/news/ news_2016/Diabetes_Studies.html

DIABETES WELLNESS | Summer 2016

Grow Life

FIVE CHRISTMAS CROPS Rachel Knight is an enthusiastic gardener, teacher, writer and cook. See her blog at www.thekitchengarden.co.nz

ate spring is a great time to get growing as the temperatures rise, the days are long but there’s still plenty of moisture in the soil. Even if our crops aren’t quite ready by Christmas, we’ll have plenty to feast on early in the New Year. We all benefit from spending time in our gardens in the busy run up to the festive season. We can get a head start if we buy seedlings or plants from the garden centre, but we need to grow root vegetables from seed (beetroot, carrots, radishes). The big seedlings always look

tempting, but if we choose the smallest plants on display it’s like choosing the milk in the supermarket with the longest ‘best before’ date. The bigger ones have been on the shelves the longest, the smaller ones will have been delivered more recently. We give our seedlings an easy transition if we get an area ready to plant before buying them, so we can transplant them as soon as we get home. If temperatures are consistently over about 15 degrees at night and we use fresh, good quality seeds, we’ll

get great germination at this time of year sowing directly into the soil. We still need to remember to water the seed bed, but we cut out the job of transplanting. Often direct sown seeds do very well as they can spread their roots quickly and don’t get the disturbance that pot-sown seeds get when planted out. Enjoy some long summer evenings in the garden winding down from your day and watching the marvellous growth in your edible garden. Watch, water and wait to taste your first harvest.

RECOMMENDED VARIETIES

LETTUCE Little Gem An upright mini cos type lettuce. Sow seeds direct thinning to 15cm apart in both directions. One month from sowing for ‘baby leaves’, two months for compact lettuces. Afternoon shade.

RADISH French Breakfast Sow 16 seeds in a 30cm square (4 x 4), cover lightly with soil about the depth of the seed’s diameter. Four to six weeks from sowing to harvest. Evening shade.

DIABETES WELLNESS | Summer 2016

ZUCCHINI Cocozelle Choose a healthy seedling for a head start or sow seeds for a greater choice of varieties. Eight weeks from transplanting seedlings (about 10 weeks from sowing). Full sun.

DWARF BEANS Purple Tee Pee Purple, stringless French bean growing on 45cm high plants. Easy to spot when picking. Six to eight weeks from sowing to first harvest. Full sun.

STRAWBERRIES Choose plants in large pots for early fruiting and check their roots are well established. Three to six weeks from well grown flowering plants. Full sun.

Travel

What Katie did next What’s our thrill-seeking American columnist Katie Doyle been up to since she left New Zealand?

s the end of my 12-month New Zealand working holiday drew closer last September, it was hard to believe that soon I’d be embarking on new travels away from a place I had grown to love. Here are the best diabetes-related stories that have happened since you last heard from me: 1. EPIC ROAD TRIP I spent my last two weeks in New Zealand road tripping up to Auckland from Queenstown. My friends and I hiked and camped in national parks, took the ferry across the Cook Strait, and worked our way up to the Bay of Islands and Cape Reinga, gladly taking on any outdoor challenge we encountered. How many people can say that they managed to ski, swim in hot springs, and go canyoning down a river over a span of just a few days? It was so much fun to have great friends around to cheer me up amid annoying low blood sugars while we were hiking. I now have friends from all corners of the globe who will go on such adventures with me… 2. DEAD SEA FLOATING …which brings me to Jordan. I took the “long way” back to the United States, stopping in the desert to visit my sister. We took our reunion down to Aqaba, Jordan’s port on the Red Sea. My mom met us a few days later and we went to Madaba, Petra, Wadi Musa, and the Dead Sea. I strongly recommend checking out this phenomenal place, where floatation devices aren’t needed and you can serenely read your book without worrying about any of the pages getting wet. I even checked my blood sugar while floating!

Katie Doyle is an American writer and producer with type 1 diabetes who has been travelling and blogging her way around the world. To find out more, visit www.kadoyle.com.

3. WORLD DIABETES CONGRESS In December, the 2015 International Diabetes Federation Young Leaders in Diabetes (YLD) Programme was held in Vancouver, Canada, for one week before the World Diabetes Congress. There, I met Emily Wilson, Diabetes NZ’s Young Leader from Wanaka, near where I used to live. And it was no surprise that we discovered we had mutual friends! I also met Carrie Hetherington, Diabetes NZ’s 2014 Young Leader, who recently published a children’s book, Little Lisette: The Diabetic Deep Sea Diver. Over two weeks in Vancouver, we developed an incredible network of advocates for changing diabetes around the world, discussing ways to get diabetes supplies to those who need them the most, listening to inspiring speakers, and sharing our thoughts on healthcare policy and diabetes advocacy. 4. IRELAND I went on a two-week holiday to Ireland in March and celebrated my 13th dia-versary (the anniversary of my diagnosis) in Dublin. As I wrote in a previous column, it’s hard to be sad about having diabetes when you’re doing something out of the ordinary. This year, great friends and Guinness made it a special day. 5. CAPE COD Most recently, I spent the Northern Hemisphere summer as a swim instructor on Cape Cod, Massachusetts. Much to the fascination of my students, I wore my pink waterproof insulin pump and continuous glucose monitor in the water every day. By answering inevitable questions about my ‘fashion’ accessories, I try to help make it easier for other people with diabetes as we embrace our zest for life.

Pictured, Left: Golden Bay near Takaka. Photo Katie Doyle. Centre: Katie (right) celebrating Diaversary #13 in Dublin, Ireland, with friend. Right: Katie checking her blood sugar, Dead Sea, Jordan. Photo Anne Doyle.

DIABETES WELLNESS | Summer 2016

Reflect

Join Ruby McGill as she charts her journey to ‘master’ type 1 diabetes. Surely it’s possible...

FIVE WAYS TO MENTAL WELLBEING

y journey to master diabetes and grow Baby No. 2 has been draining, mentally draining. Yet it probably shouldn’t come as a surprise as I internally review every blood sugar result, asking myself: “What did I do wrong? Surely I knew that would happen? Did I really think I could eat that without any consequences?” If you want to live a normal life, you need to get this right... It’s pretty clear, to master diabetes I need to be physically fit and mentally strong. In fact, this isn’t restricted to diabetics – we all need to be mentally strong. Life can be tough. Many of us choose healthy food options and exercise to build a strong body, but how many fuel our minds to improve mental health? My little family has been trying to incorporate the Mental Health Foundation’s Five Ways to Wellbeing in our daily lives. These simple strategies help build a strong, healthy, resilient mind. Here are a few ways we use the five ways to wellbeing.

GIVE – your time, your words, your presence I share my diabetes journey, ‘my words’ through my blog. I initially hoped my diabetes journey would help others, unaware that the process was also helping me.

CONNECT – Talk and listen, be there, feel connected We are notorious multi-taskers, and while we get things done, what are we missing? We recently introduced Sunday family day. No multitasking, no work, no study – just reconnecting with each other, my little family of three, soon to be four. I am always amazed how recharged and energised I feel after catching up with my girlfriends. We laugh, we cry, we share our frustrations, tips, tricks, food and wine (but not while I was pregnant!). I am surrounded by an unwavering network of support.

TAKE NOTICE – Remember the simple things that give you joy This is quite possibly the simplest wellbeing strategy, but in reality, for many, the hardest to implement. Earlier in the year we began sharing ‘three good things’ from our day around the dinner table. The aim isn’t to sugar-coat what’s happened, but to take time to reflect and be grateful for the little things.

KEEP LEARNING – Embrace new experiences, see opportunities, surprise yourself As an instructional designer and life-long learner I’m always looking for fun, new experiences and opportunities to fuel my mind. I’ve enrolled in lessons, scoured the internet and soaked up the expertise of my friends, family and colleagues. I’ve learnt how to paddleboard, use hashtags, create a website, understand employment law and how to surf.

BE ACTIVE – Do what you can, enjoy what you do, move your mood It’s all about increasing your heart rate and shifting your mood. Exercise is good for your waistline but, most importantly, it makes you feel good! We create impromptu dance floors in the lounge, potter in the garden or get stuck into renovating our home.

How do you improve your mental health? As I continue my diabetes journey and welcome the newest addition to our whānau, I will share how I’m using the five ways to wellbeing on Instagram. Come and join me @mastering_ diabetes. #masteringdiabetes #fivewaystowellbeing

Ruby welcomed Felix McKechnie McGill into the world on Friday 30 September – 8lb 3oz (3.71kg).

DIABETES WELLNESS | Summer 2016

GlucaGen® HypoKit

Glucagon (rys) hydrochloride

Make sure it’s there when they need it* GlucaGen® HypoKit is used to treat severe hypoglycaemia in people using insulin or taking tablets to control diabetes, who have become unconscious. Available from pharmacy with or without a prescription.

Patient support available The HypoHelp website and app are an important resource for patients at risk of hypoglycaemia and includes a free expiry date reminder service for patients with a GlucaGen® HypoKit. Download the app for free at www.hypohelp.co.nz Also available at Google Play or iTunes.

*Refer to full indications below

GlucaGen® HypoKit is a Pharmacist Only Medicine that is funded through the PHARMAC with a prescription, or available for purchase without a prescription (normal pharmacy charges apply). Ask your Healthcare Professional if GlucaGen® HypoKit is right for you.

Before prescribing, please review full Data Sheet available at www.medsafe.govt.nz GlucaGen® HypoKit. (glucagon [rys] hydrochloride). Presentation: Each pack consists of a vial containing lyophilised glucagon 1 mg (1 IU) as hydrochloride and a glass syringe pre-filled with 1 mL water for injections. Indications: Therapeutic: Treatment of severe hypoglycaemic reactions in persons with diabetes mellitus treated with insulin or oral hypoglycaemic agents. To prevent secondary hypoglycaemia, oral carbohydrate should be given to restore hepatic glycogen following response to treatment. The treatment of sulfonylurea-induced hypoglycaemia differs from severe insulin-induced hypoglycaemia due to the possibility of secondary hypoglycaemia - it is preferable to use intravenous glucose (see full Product Information/ Data Sheet). Medical consultation is required for all patients with severe hypoglycaemia. Contraindications: Hypersensitivity to glucagon or lactose, phaeocromocytoma, insulinoma or glucagonoma. Precautions: Glucagon will have little or no effect when the patient is fasting or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia. When used in endoscopy or radiography, caution should be observed in diabetic patients, or elderly patients with known cardiac disease. Glucagon is instable in solution, it should be used immediately after reconstitution and must not be administered by intravenous infusion. May cause allergic reactions in latex sensitive individuals. * Interactions: Glucagon is an insulin antagonist. When given in large doses, glucagon may potentiate the anticoagulant activity of warfarin. Glucagon can reverse cardiovascular depression of profound ß-blockade (see full Product Information/Data Sheet).* With indomethacin, glucagon may lose its hyperglycaemic effect or even produce hypoglycaemia. Adverse Effects: Nausea; vomiting. Dosage and Administration: The glucagon solution should be prepared immediately before use. Dissolve powder in accompanying solvent and administer by subcutaneous or intramuscular injection. Therapeutic: Adults and children above 25 kg - administer 1 mg; Children below 25 kg - administer 0.5 mg. (Jan 2015).

Novo Nordisk Pharmaceuticals Ltd., G.S.T. 53 960 898. PO Box 51268 Pakuranga, Auckland, New Zealand. NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS(DA) 1545RB McK341063/Diabetes NZ 09/16.

GlucaGen® HypoKit Glucagon (rys) hydrochloride

Want to know more about

Type 2 Diabetes? Medical jargon can be confusing, but Type 2 Diabetes Xplained takes away that confusion through storytelling. Follow a New Zealand patientâ&#x20AC;&#x2122;s journey and learn more about Type 2 Diabetes in an engaging, informative and entertaining story. It is written by doctors for patients. Be sure to download your copy today.

VISIT WWW.TYPE2DIABETESXPLAINED.CO.NZ OR DOWNLOAD YOUR FREE APP

CREATED BY

KINDLY SPONSORED BY

SCAN ME TO DOWNLOAD