Diabetes Summer 2012

Diabetes Summer 2012

DIABETES PREVENTION TRIAL Can you help?

One in four:

Shock new prediabetes figures

Living well with diabetes

Elaine’s story:

“I won’t let blindness and diabetes get me down”

Technology: Diabetes Plan website

Kids & diabetes:

Get the whole family involved

Summer living: Grow beautiful beans + festive diabetes baking

STOP BRUSHING WITH

ORDINARY TOOTHPASTE

START REDUCING UP TO 90% OF PLAQUE GERMS1

ORDINARY TOOTHPASTE

SUPERIOR* PROTECTION F O R A H E A LT H Y M O U T H

Colgate Total, with regular brushing fights gingivitis, cavities, plaque and protects gums. Always read the label and use as directed. If symptoms persist see your Dentist. Colgate-Palmolive Ltd Lower Hutt. TAPS PP2488. *vs. regular fluoride toothpaste. †Dramatisation of plaque bacteria 12 hours after brushing. 1) Fine, et al. (2006).

Journal of the American Dental Association, 137: 1406-1413; funded by Colgate-Palmolive Co, New York.

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L AND

DE NTAL AS S O CI A TI O N

N Z DA

APPROVED

Diabetes: the national magazine of Diabetes New Zealand | Vol 24 no 4 Summer 2012

INSIDE summer 2012 4 5

From the President From the Chief Executive

Upfront

6

News, views and research

Physical Activity

8

Have an active summer holiday

28

Treatment

12 Lifestyle changes prevent T2 diabetes

Living with diabetes

14 Elaine’s story: Diabetes made me a better person

Research

Focus

16 T1 diabetes prevention trial

10 Special Report: Prediabetes

Gardening

18 Grow beautiful beans

27 New food and exercise guidelines

28 Leaving home: Helping your teenager fly the nest

Technology

Care and prevention

19 Diabetes Plan website:

30 Summer survival kit for feet 31 NZ obesity conference

Diabetes Awareness Week

Community

Track your diabetes goals

20 Pregnancy and diabetes Food

18

Families and children

22 Festive food ideas 24 Sure to rise: Ann Gregory's healthy baking tips

26 Recipes: Summer dips

32 World Diabetes Day:

Blue monument challenge

33 Unification update The last word

32 Insulin for Life:

Help save a life today

EDITOR: Caroline Wood email: editor@diabetes.org.nz DESIGN AND PRINTING: Kraftwork, Wellington MAGAZINE DELIVERY ADDRESS CHANGES: Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 369 636 Email: membership@diabetes.org.nz ISSN: 1176-4406 Disclaimer: Every effort is made to ensure accuracy, but Diabetes New Zealand Inc. accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. If in doubt, check with your own doctor, nurse, dietitian, or health care professional. Editorial and advertising material does not necessarily reflect the views of the Editor or Diabetes New Zealand Inc. Advertising in Diabetes does not constitute endorsement of any product, and no advertiser may use publication of an advertisement in the magazine to support the marketing of any product. Copyright of all editorial is held by Diabetes New Zealand Inc. No article, in whole or in part, should be reprinted without permission of the Editor.

Not yet a member of Diabetes New Zealand?

Call 0800 369 636 now to join or visit www.diabetes.org.nz Membership includes a free subscription to Diabetes magazine

FRO M TH E PRES I DENT

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A momentous year Dear fellow readers and especially members of Diabetes New Zealand.

Well, what a year 2012 has been!!

Momentous doesn’t begin to cover it. I have this quote pinned above my desk: “Coming together is a beginning; keeping together is progress; working together is success.” –Henry Ford. My belief in it has been affirmed by sure knowledge that we are well into the progress and success part of the journey. The journey, of course, has no ending and will always require a great deal of work to maintain both the vision and its reality.

But that’s OK because we have proven we can come together to achieve hard stuff and make things happen. And I am extremely proud

to be able to stand among such people. Thank you all for sharing the vision and for putting in the hard yards to make it happen.

And it has been hard – more so at times than others, but together we got there. By continuing to debate and discuss, refine and modify, we have got to a place few others have. Lots are astonished by what we have achieved because so many have dreamed of it but so few have actually got there.

There is no magic formula or secret because at the end of the day we had vision and commitment, which was liberally dosed with lots of good will and plenty of hard work.

October 1 was the day that assets were transferred and the new united Diabetes New Zealand came to life.

Of course it is not the end point and the work and need for commitment will always be there but let’s not overlook the significance of this day and what it symbolises.

When I didn’t feel much different on October 2, I brought myself up with a round turn. It is easy to get carried away doing all that needs to be done but it is also only fitting that we take time to recognise our monumental achievement and celebrate it. We deserve to feel proud and excited and elated about our future. And it is very important to acknowledge the contributions of everyone to this end. I simply say ‘Thank you.’

So apart from the usual good wishes at this time of year for a Christmas filled with bonhomie and a wellearned summer break, I invite your reflection on the amazing milestones we have achieved together through 2012. Well done to us all.

Seasons greetings

Chris Baty National President

Welcome to Diabetes magazine Our mission is to help you live well with diabetes.

Every issue of Diabetes includes: • Trusted expert advice • Latest research and treatment options • Inspiring personal stories • Delicious diabetes-friendly recipes • Lifestyle advice on food, exercise, travel • Spotlight on children and diabetes

SUBSCRIBE today and have four issues of Diabetes delivered straight to your door for just $18 per annum.

Diabetes is published by Diabetes New Zealand.

Join today for just $35 waged (or $27.50 unwaged) and receive a free subscription to the magazine.

Email: admin@diabetes.org.nz or call 0800 369 636 to find out more.

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DIABETES | Spring 2012

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FROM THE CHIEF EXECUTIVE

Work begins on diabetes knowledge platform We know people with diabetes can live active and healthy lives with the right information and support.

To this end Diabetes New Zealand has started work on an incredibly exciting project to develop an interactive online resource. It will offer a wide range of support for people with diabetes, our branch volunteers and clinical staff.

The web-based resource, currently known as the Diabetes Knowledge Platform, will be the first of its kind in New Zealand. We hope it will become the 'go to' place for information about diabetes.

It will offer access to education and training resources and lots of interactive features such as videos, online forums and e-mail conversations.

People with diabetes will be able to access the latest information on how to manage their condition, live healthier lifestyles and engage with other people who have diabetes. And

our volunteers, who deliver crucial support services in the community, will be able to access the resources, advice and information they need for their work. At the same time diabetes health professionals will be able to find education and training resources as well as new developments in research and treatment options.

Long-term conditions such as diabetes are not easy to manage. However there is a strong and growing body of evidence that shows the right kind of support is effective in equipping people with the skills they need to self-manage their condition.

This is one of the main aims of the new online resource. It will give people with diabetes the knowledge and skills they need to effectively self-manage their condition.

All the medical information about diabetes will be overseen by the New Zealand Society for the Study of Diabetes (NZSSD). It will not only provide a trusted online information and support base but will also be able to link conversations between an individual and the team of people who are helping them to manage their diabetes.

So where are we now? We have started development work on a prototype of the resource. This prototype will allow us to test the web platform with small groups of people and where needed make changes to make it better.

The platform is being built in partnership with NZSSD and the Refract Group, which specialises in building web-based resources of this kind. Additionally, two district health boards have committed support to building some of the prototype's modules.

Crucially this resource is being built from the bottom up. People with diabetes, and those that support them have come together to create something that will be the place to go for information and advice on how to live well with diabetes.

Watch this space, there are exciting times ahead!

Joe Asghar Chief Executive

See our website for advice, tips and ideas on how to live well with diabetes: www.diabetes.org.nz

Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: Joe Asghar COMMUNICATIONS MANAGER: Lisa Woods DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 7, Classic House 15 Murphy Street Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145; Fax 04 499 7146 Email: admin@diabetes.org.nz

Diabetes New Zealand is a national organisation that acts for people affected by diabetes. We work to raise awareness, educate and inform people about diabetes, its treatment, management and control.

We offer local support to individuals with diabetes through a network of diabetes branches across the country. We also support research into the treatment, prevention and cure of diabetes.

Call now to make an instant $20 donation:

0900 DIABETES (0900 86369)

Spring 2012 | DIABETES

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UP FRO NT

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NEWS, VIEWS AND RESEARCH

Poor risk understanding

Diabetes triples in China

An Australian study has found patients under-estimated the complications of diabetes and were not up to date with the latest evidence-based research on how to manage their diabetes. This disadvantaged them in being able to make informed decisions. Health professionals were the most frequently identified source of information, with little value placed on research evidence. The study, by Tammy C Hoffmann and Chris B Del Mar, was published in The Journal of Internal Medicine.

The number of people in China with Type 2 diabetes has tripled over the past decade, with 90 million people living with the disease. The massive increase has fuelled a 20 per cent increase in diabetes drug sales, putting enormous strain on local health services.

Source: www.dovepress.com

An average of $194 a year is spent treating each diabetes patient in China, versus more than $5,000 in developed countries, such as the US, according to the International Diabetes Federation.

Screening no help Screening middle-aged adults for Type 2 diabetes has no overall effect on the number who die over the next 10 years, concludes a study by the UK Medical Research Council. The research, which was conducted in the east of England, contradicts earlier studies that indicated screening for diabetes every five years would reduce deaths by as much as 40 per cent.

Reference: BMJ 2012;345:e6687

$1m diabetes grant The government has given $1 million in funding to Canterbury Scientific and the University of Canterbury’s Biomolecular Interaction Centre. It will be used for research into tests for the secondary complications of diabetes. The Diagnostic Markers for Diabetic Complications project is expected to lead to the development of new commercial tests to identify patients at high risk of diabetic complications such as heart disease, visual impairment, diabetic neuropathy and kidney disease.

It is estimated that fewer than two out of five people have their blood sugar under control, according to the Chinese Diabetes Society. Metformin, the most common treatment, is free in China but doctors want to be able to give newer drugs that help stabilise blood sugar.

Source: Bloomberg

Let’s get active Researchers looked at the link between physical activity and mortality in 5,859 patients with diabetes from the EPIC study. Moderate activity significantly reduced the risks of total and cardiovascular-related deaths, compared with those who were inactive. The total mortality risk was reduced with leisure-time physical activity, while cardiovascular-related mortality was reduced with walking.

Source: NZ Diabetes & Obesity Research Review

Real life hypos Researchers looked at how well insulin-treated patients used recommended hypoglycaemic treatment (quick-acting carbohydrate followed by a long-acting carbohydrate). Initial treatment with recommended foods was reported by 78 per cent of respondents but only 41 per cent of these were quickacting carbohydrates, and only 55 per cent reported consumption of follow-up food.

Breast cancer link

“This study confirms my suspicion. Few patients were actually managing their ‘hypos’ well, with common issues being the wrong type of carbohydrate and overtreating the hypo. I agree with the authors that better and standardised education is required,” said Dr Jeremy Krebs.

Post-menopausal women with Type 2 diabetes appear to have a 27 per cent higher risk of getting breast cancer, according to an international team writing in the British Journal of Cancer. Being obese or overweight is linked to both conditions. But cancer experts say there may be a link between diabetes and breast cancer. There was no link for pre-menopausal women or those with Type 1 diabetes. The study involved 56,000 women with breast cancer.

Source: NZ Diabetes & Obesity Research Review

Source: BBC NEWS

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DIABETES | Winter 2012

An important date for New Zealanders with diabetes.

Dec

1

Saturday From 1st December 2012, CareSens will be the only fully funded brand of blood glucose meters for New Zealanders with diabetes. Then from 1st March 2013, CareSens will be the only fully funded option for both meters and test strips.

There are three funded CareSens meters to choose from, all with different features. To find out which one is right for you, ask your health professional, visit www.caresens.co.nz or phone our toll-free helpline on 0800 GLUCOSE (0800 458 267). We’re here to help.

Which means you have just over three months to switch to CareSens meters and test strips in order to continue being fully funded. Switching is easy: if you’re taking medicines such as glibenclamide, glipizide, gliclazide or insulin, your pharmacist can help you change to a free CareSens meter (no patient co-payment).

If you’re using diet and exercise to control your diabetes (or taking metformin alone), you are not eligible for a funded meter: however Pharmaco is offering you a free CareSens II meter through your medical or health centre.

Please discuss this with your doctor or diabetes nurse at your next visit.

Blood Glucose Meters

Pharmaco (NZ) Ltd, PO Box 4079, Auckland, New Zealand Toll-Free Phone: 0508 CARESENS (0508 227373) Email: custserv@caresens.co.nz, Fax: 09 307 1307

Before using CareSens, please read the instructions in the Owner’s Manuals, Quick Guides and Package Inserts. Always read the pack insert/user manual, and follow the manufacturer’s instructions and the advice provided by your health professional/diabetes nurse.

TAPS: DA2512AY

25 October 2012

P HYS I CA L A CTI VITY

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GET OUTD OORS

Have an active summer holiday A holiday in the great outdoors can be a wonderful retreat from the pressures of everyday life. But there are a few things to consider before you go.

Summer is just around the corner and many of you will already be planning your camping, tramping, cycling or kayaking trip. You can go anywhere and do anything with diabetes – but wherever you go, your diabetes comes too. The key to a successful and safe trip is to plan ahead and ensure you are looking after yourself before and during the trip.

First steps Try to avoid going camping or hiking alone: if you get into trouble it is much better to have a travelling companion to help. If you choose to go alone, don’t forget to tell someone where you will be and when you expect to return so you can be found if there is an emergency. Buy travel insurance if you are going overseas. Consider getting a medical alert bracelet if you don’t already have one. Doctors

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DIABETES | Summer 2012

will know instantly that you have diabetes and will be able to access your medical history, including the medication you are on. Prepare a travel folder with your medications, doctor’s contact information and insurance policy.

Physical preparations Depending on the nature of your trip and how physical it is going to be, a check up with your diabetes doctor may be in order. Activities such as tramping, cycling or kayaking nearly always mean you are being more physically active than usual. If you are on sulphonylurea tablets or insulin you may find your blood sugar levels begin to go low. If this happens it is best to reduce the dose of these medications while you are doing the extra activity. Ask your diabetes team to help you plan for a dose reduction if need be.

Test your blood sugar Test your blood glucose frequently while you are on holiday. Your whole routine of activity and food is likely to be very different. The type of food you eat may also change. Keep a daily record of insulin doses and test results. This will help you identify

any trends and assist any medical advisors you may need to see.

If you are having problems with your blood glucose, follow the guidelines you worked out with your team before you went away. If necessary contact a hospital or diabetes doctor in the area for advice.

Stay safe Be aware of safety and try to avoid sunburn, injuries and contaminated food or water. Eat and drink enough to meet your needs. Take extra food, water and medication. If you are on medications that can cause your blood glucose to go low take supplies of simple carbohydrate, for example glucose or sugar.

Look after your feet Wear comfortable shoes and never go barefoot. Check your feet every day, look for blisters, cuts, redness, swelling, and scratches. Make sure your footwear is sturdy and also fits you well. Don’t use brand new shoes – try them out before the trip.

Get medical care at the first sign of infection or inflammation.

You can find lots more travel tips on Diabetes New Zealand’s website: www.diabetes.org.nz

Still the world’s #1 blood glucose monitoring brand* Strips still fully funded until 1st March 2013** Strips still available to purchase after 1st March 2013

It has been our privilege to serve and support New Zealanders with diabetes for the last 30 years. The recent PHARMAC decision about future funding has confirmed that Accu-Chek Performa strips will remain fully funded until 1st March 2013.

After this date, you can still use the Accu-Chek Performa system by purchasing the test strips. Please call the Accu-Chek Enquiry Line on 0800 802 299 for more details. www.accu-chek.co.nz Roche Diagnostics, 15 Rakino Way, PO Box 62089, Sylvia Park, Auckland 1644, New Zealand.

Accu-Chek Enquiry Line: 0800 802 299. Always read the label and follow the manufacturer’s instructions. TAPS NA 5922

*

Based on worldwide sales data reported by Abbott Diabetes Care, Bayer Medical Care, Johnson & Johnson Diabetes Care and Roche Diabetes Care full year 2011.

** Accu-Chek Performa test strips. Usual dispensing fees apply.

RDTN/6236

FO CU S

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SPECIARLT REPO

PRE D IABETES

On the brink: New Zealand’s prediabetes problem More than one in four Pacific Islanders and one in five Māori aged between 31 and 50 have prediabetes, according to new figures. Without intervention, half of them will go on to develop Type 2 diabetes at great cost to society. Caroline Wood reports.

Fifty people a day are currently being diagnosed with diabetes in New Zealand. We have one of the highest rates of diabetes in the developed world with about 208,000 Kiwis living with the disease.

These sobering statistics may only be the start of a national epidemic with some doctors warning it is about to get a whole lot worse.

A ‘scary’ proportion of middleaged adults have prediabetes, according to new figures obtained

by Diabetes. Half of them will go on to develop diabetes putting more pressure on already stretched health services.

Prediabetes means you have blood glucose levels that are higher than normal but not high enough to be called diabetes. About 50 per cent of people with prediabetes go on to develop Type 2 diabetes – but the risk can be reduced by lifestyle changes.

Unfortunately, people with prediabetes can start to experience complications associated with Type 2 diabetes even though they don’t actually have the condition. This includes long-term damage to the eyes, heart and circulatory system.

Prevalence of diabetes and prediabetes by ethnic group Diabetes

Prediabetes (age 31-50)

Pacific men

13%

30%

Pacific women

18%

25%

Ma¯ori men

9%

22%

Ma¯ori women

8%

23%

Pakeha men

4%

13%

Pakeha women

3%

10%

Source: Kirsten Coppell, Sheila Williams & New Zealand Adult Nutrition Survey

This is devastating for the patient and costly for the healthcare system.

Healthcare for people with diabetes is predicted to cost New Zealand more than $1 billion in less than a decade.

The cost is mainly due to the rise in obesity-related Type 2 diabetes.

Healthcare for people with diabetes is predicted to cost New Zealand more than $1 billion in less than a decade.

The cost is mainly due to the rise in obesity-related Type 2 diabetes.

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DIABETES | Summer 2012

PREDI A BETES

diabetes, with an increased risk of cardiovascular disease whether they get the disease or not.”

The good news is that it is possible to delay or even reverse prediabetes with a combination of weight loss and exercise.

Doctors are calling for consistent national screening and an aggressive lifestyle approach that will help patients reverse the symptoms and prevent them developing Type 2 diabetes.

“I think the prediabetes figures are incredibly scary. If I was the Minister of Health, I would be horrified.”

— PROF JIM MANN

Just over one in 10 Pakeha aged 31 to 50 years have prediabetes, according to soon-to-be-published data collected by the New Zealand Adult Nutrition Survey 2008/09, the most recent source of reliable national data on prediabetes.

The risk is up to three times higher for Pasifika and Māori. The survey shows 30 per cent of middle aged Pacific men and 25 per cent of Pacific women have prediabetes; while more than 20 per cent of Māori men and women have the condition (see the table on page 10).

Professor Jim Mann, Director of University of Otago’s National Centre for Diabetes and Obesity Research, said: “I think the prediabetes figures are incredibly scary. If I was the Minister of Health, I would be horrified.

“We know that diabetes in this country is already at epidemic proportions. Now we have got a lot more people on the brink of

But does New Zealand’s public health system have the capacity to help everyone who comes through the door with prediabetes?

National guidelines say GPs should be offering every man over 45 years and every woman over 55 an HbA1c test for diabetes. This simple test will pick up anyone who has prediabetes. People should be offered the test earlier if they have a family history of diabetes or they are Pasifika or Māori.

Anecdotal evidence suggests the tests are not being offered consistently across the country.

And people are being offered different levels of intervention once diagnosed. Research is currently being undertaken by the University of Otago to find out whether this really is the case.

“The problem for me is what happens when people are diagnosed with prediabetes,” Professor Mann added.

“We are doing a survey now to find out what happens. I’m not sure the majority are getting the kind of lifestyle interventions they need.”

The Government does not keep statistics on how many people have prediabetes. It has set a health target of 90 percent of the eligible population being given a cardiovascular risk assessment, including blood tests for diabetes, by 1 July 2014.

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FOCUS

Prediabetes: A silent killer • There are typically no signs or symptoms.

• National guidelines recommend an HbA1c test for every man over 45 years and every woman over 55 years. Ask for a test now if you are in a high risk group, or you have a family history of diabetes.

• Prediabetes is diagnosed if two HbA1c readings come back higher than normal. The gold standard test is an HbA1c blood test. A normal result is 40 mmol/mol or less. An HbA1c ≥50 mmol/mol is diagnostic of diabetes.

• For patients with ‘prediabetes’ – an initial HbA1c result of 41–49 mmol/mol, cardiovascular risk assessment and lifestyle interventions are recommended with repeat HbA1c screening in 6–12 months.

• Prediabetes can cause long-term damage to a person’s body with an increased risk of developing Type 2 diabetes, heart attack and stroke.

• There is a 50 per cent risk over 10 years of progressing to overt diabetes. A recent study showed the average time for progression was less than three years.

• Losing weight – at least five to 10 per cent of your starting weight – can usually reverse prediabetes or prevent Type 2 diabetes developing.

• Eating more healthily and being physically active at least 30 minutes a day will help the body’s insulin work better.

• Doctors may also prescribe medicine to prediabetes patients to help control the amount of glucose in the blood.

Summer 2012 | DIABETES

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TREATM ENT

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PRED IABETES

Lifestyle changes prevent T2 diabetes Two studies have found it is possible to stop people with prediabetes going on to get the disease. Both involved early intervention to encourage people to change their lifestyles.

Study 1: Aggressive intervention Patients with prediabetes should have ‘early and aggressive’ treatment to stop them developing Type 2 diabetes, according to researchers from the University of Colorado.

They found that patients who managed to bring their blood sugar level back to normal, even briefly, were less likely to develop Type 2 diabetes.

The study followed nearly 2,000 people with prediabetes. Some were taking medication, some were undertaking lifestyle changes and

others were doing nothing.

Those people who reduced their blood sugar level to normal were 56 per cent less likely to develop Type 2 diabetes during the six years of the study, which was published in The Lancet in July.

Lead author Dr Leigh Perreault, from the University of Columbia, said: “This analysis draws attention to the significant long-term reduction in diabetes risk when someone with prediabetes returns to normal glucose regulation, supporting a shift in the standard of care to early and aggressive glucose-lowering treatment in patients at highest risk.”

Study 2: Lifestyle changes The Finnish Diabetes Prevention Study was the first randomised controlled trial to examine the effect of lifestyle changes in preventing Type 2 diabetes. Each patient

received individual counselling that focused on four areas: Achieving a healthy body weight; reducing fat intake; increasing fibre; and more physical activity.

At the two-year follow-up, the incidence of Type 2 diabetes in the intervention group was less than half that observed within the control group.

Researchers say each component of the lifestyle intervention contributed to the risk reduction: • weight loss • increase in physical activity • reduction of total and saturated fat intake • increase in dietary fibre.

More recently, the study’s researchers reported the positive impact of lifestyle changes was maintained for at least four years after the intensive intervention finished.

Source: International Diabetes Federation

Diabetes makes The Maggies final Diabetes has been shortlisted for the finals of The Maggies, a national competition to celebrate and award the best magazine covers of 2012.

There were over 80 entries (25 going through to the finals), with the judges remarking on how impressed they were with the high quality of entries.

Our magazine was one of five finalists in the Specialist category of the competition, which is supported by the Magazine Publishers Association.

The shortlisted entries were put to the public vote during November at www.themaggies.co.nz. At the time of going to press the winners had not been announced.

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DIABETES | Summer 2012

As well as promoting great magazine design, the competition has raised over $3,500 for the New Zealand Breast Cancer Foundation.

Diabetes Living well with diabetes

Autumn 2012

Diabetes was redesigned in early 2012 to give it a fresh new look and make it more reader-friendly. We entered the relaunch cover (right).

The cover story “We are golden” celebrated 50 years of Diabetes New Zealand but also looked to the future, which is represented by our children.

We loved the golden glow of the image and the fact it represented hope for the future.

We’d like to thank all our readers and everyone at Diabetes New Zealand for your support over the past year.

We are golden: Celebrating 50 years of Diabetes New Zealand

diabetes youth Watch out for the little guys

Gardening and diabetes the emotional rollercoaster of diagnosis

“i lost 30kg and no longer take medication” one woman’s remarkable story

Caroline Wood Editor Rose Miller, Kraftwork Designer

ANIMAS VIBE INSULIN PUMP NOW FULLY FUNDED FOR ELIGIBLE PATIENTS Funding for eligible patients is now available for: • Animas Vibe insulin pumps and cartridges • A wide range of infusion sets • ADR cartridges suitable for use in your Minimed Paradigm pump Ask your doctor if you meet the criteria.

• • • • • •

CGM enabled using latest Dexcom G4TM technology Smart features on the pump - no need to rely on a separate device Fully waterproof Full colour screen Fully customisable food database Compatible with web based Diasend software

W www.nzms.co.nz P 09 259 4062 E nzms@nzms.co.nz Dexcom G4TM is not currently indicated for children under 18 years of age.

Please note CGM consumables are not currently funded.

Always read the manufacturer’s instructions and use strictly as directed. NZMS, Auckland. TAPS NA6067

LIV ING W ITH D I A B E TE S

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EL AINE’ S STO RY

Diabetes made me a better person Elaine Maiai’s life fell apart when she lost her sight and then developed Type 1 diabetes. Over the past four years, she has turned her life around and forged a new career as an artist. Elaine, 40, from West Auckland, tells her inspiring story in the hope that it may help others.

I was diagnosed with the autoimmune condition Graves’ disease in 2008. Within six weeks I had lost most of my vision. I had a very aggressive form of Graves’ disease, which causes an overactive thyroid. It ravaged my body. I couldn’t see, I couldn’t get out of the house; I didn’t have any help. It was a terrible time. After a year and a half my husband left me, he couldn’t cope with it.

Two years later I was diagnosed with Type 1 diabetes, a week after my

I’m actually grateful for the process I have been through.

Losing my eyesight, getting diabetes, I’m a much better person for it.

nana in Scotland was diagnosed with the same condition. She was 75 years old. I was 38.

It’s taken me until this year to accept my disability. I’m actually grateful for the process I have been through.

Losing my eyesight, getting diabetes, I’m a much better person for it. I hope my story might help someone else to look at their life and their diabetes differently.

Before getting sick I was very healthy, there was nothing wrong with me. I had a fantastic job as a make up artist for companies like Lancôme and L’Oréal. I was selfconfident, I had a fantastic career, my marriage was great, I had wonderful children, everything was going along normally and then – bang.

My eye condition is very rare complication of Graves’ disease. I had to have surgery for nine hours.

They had to break my nose to relieve the fluid in my eyes, it relieved the pressure but the damage was done, it was irreversible. I am now legally blind. I have about 30 per cent vision.

I was so ill, I was that sick and desperate, I couldn’t absorb the fact I was now blind. I can honestly say it’s only been this year that I have been able to go back over that period in my life, examine it and accept it.

My vision is like a broken mirror, it’s like looking through a kaleidoscope.

I can see light and dark and colours.

I rely heavily on my memory and guess work.

I use a cane and people stare and I get lots of comments. I don’t care what people say, my self-confidence has come back, it’s plentiful at the moment, it’s beautiful.

Then I was diagnosed with Type 1 diabetes, I couldn’t believe it, I kept thinking: ‘What’s next?’ At first I

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DIABETES | Summer 2012

EL A I NE' S STO RY

didn’t take it seriously, I thought it was part and parcel of Graves’.

One of the best things I did was accept diabetes was a separate issue and that I needed to get on top of it.

Diabetes affects everything, there are no shortcuts, I have to manage my diabetes every day.

For me, it’s something I have to work on and work on every single day. I didn’t realise how involved it would be. I can’t read food labels, so preparing meals was a chore. Now we eat the same meal on the same night of the week to make it easier for me to cook.

Problem solving gave me control.

To have control over what I ate was really empowering, I would never have done that if I didn’t get diabetes.

I was 70kg then went up to 100kg because of the steroids. Now I am down to 74kg. I thank my diabetes for that. I had to take care of myself because of diabetes. I feel really good now. I just take each day as a new day and concentrate on that.

I have to be extremely careful when I take my insulin because of my vision. I try to do it when there is someone around to check how much I have put in the pen.

My diabetes doctor Catherine McNamara was wonderful. She talked to me about accepting everything, she planted the seed:

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LI V I NG WITH DI ABE TES

‘You are in control here, don’t let diabetes control you’. So now I think: ‘So what if I have diabetes? I’m not going to let it define me.’

I have a 16-year-old daughter and a 19-year-old son. The kids find it very tough. They have experienced and been through things that some adults wouldn’t have coped with. My children saw their mum going from being strong, independent and on top of the world to a broken woman, struggling to get her clothes on.

They have had to grow up in a hurry and learn to become independent.

They are supportive, delightful, mature young adults now. They keep me going. They are fantastic.

Art saved me. I started playing with paint and eyeshadow and nail polish when I was very ill with Grave’s.

For my 40th birthday my sister took me out for a pampering session at a beauty spa. While I was gone my parents and children emptied my studio and set up my parents’ home as an art gallery. They invited my friends and an art gallery owner.

I arrived to find lots of people in their driveway. They said: ‘Here’s the exhibition you’ve always wanted.’

The feedback was amazing. The major works sold that day and the rest over Christmas. The gallery owner also took some pieces. That’s proved to me I can do anything I like.

Elaine with children Jimmie and KDee who have been her rock during her illness.

I go to the gym three times a week if I can, and I walk every day. I am lucky to have a supportive family – my mum and dad and brother, sister and cousin. The hardest part is asking for help and being dependent on people.

I did Round the Bays Auckland last year, which was a huge achievement.

I want to go on the next blind Outward Bound course to help build my confidence.

I am Scottish. Our family arrived in New Zealand from Scotland in 1982.

I lived 11 years in Scotland and have very strong memories of it. But I’ve not been back for 20 years.

My goal is to sell my art so I can go to Scotland. I am going on my own – that is a deliberate decision. I want to go over and let everyone know I am all right.

As told to Caroline Wood

Learning to paint helped Elaine come to terms with losing her sight and gave her a new focus in life.

Summer 2012 | DIABETES

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RES EA RCH

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D IABETES PREVENTION TRI A L

Volunteers needed for T1 diabetes prevention trial Kiwis are being urged to take part in a global trial to develop a vaccine to prevent Type 1 diabetes. Some Diabetes readers have already signed up for a blood test to see if they are eligible. Caroline Wood reports.

“Get involved today and write yourself into the medical history books!” It’s a pretty big claim and one that is intended to encourage people to take part in a possibly game-changing diabetes prevention trial.

The Type 1 Diabetes Prevention Trial, also known as the Intranasal Insulin Trial (INIT II), is part of a coordinated global research project to develop a vaccine for Type 1 diabetes.

Kiwis are being asked to take a simple blood test to see if they are at risk of developing Type 1 diabetes.

Further testing will check if they are eligible to take part in the second

phase of the trial, when the vaccine will be tested on human volunteers.

Only two per cent of relatives tested will be considered high risk.

The remaining 98 per cent can be reassured their risk is low.

The vaccine being tested is insulin, administered via a nasal spray.

Nasal insulin works like a vaccine to stimulate a protective type of immune response to insulin.

Doctors believe this will prevent the onset of Type 1 diabetes and could eventually lead to a cure.

The stakes are high but the potential is there, says principal' New Zealand investigator Dr Craig Jefferies, Clinical Director of the Paediatric Endocrinology Service at Starship Hospital.

“We think there is a chance that we can delay the onset of Type 1 diabetes and maybe even prevent it forever. It would be a very simple and cost-effective way to treat people.

“It’s a free test and one that is not normally routinely available. Most

Get involved today and write yourself into the medical history books!

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DIABETES | Summer 2012

people who take the test will be reassured that they are not going to get diabetes. And for parents it means they are not going to worry their child has diabetes every time they are unwell.

“I recommend anyone thinking about it goes to get tested. Most will be negative but if you are positive you will get support and help. It will be one of the best things you can do for yourself or your child because you will get excellent support and education and a better prognosis going forward.”

The trial began in 2006 and is jointly funded by Australia’s National Health and Medical Research Council and the Juvenile Diabetes Research Foundation.

Over the past five years researchers have screened over 7,500 people in Australia and New Zealand to assess their eligibility. So far 71 participants have been enrolled.

Researchers are planning to test 12,000 people in total, resulting in 240 going forward to the human testing phase.

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RE SEARCH

HOW TO TAKE PART Anyone aged between four and 30 years who has a first-degree (mother, father, brother, sister, son, daughter) or second-degree (aunt, uncle, grandmother, grandfather, half-brother, half-sister) relative with Type 1 diabetes can participate.

The first step is to have a free blood test for antibodies that indicate the risk of getting Type 1 diabetes.

Before someone is diagnosed with diabetes, there is a period of time, often many years, when there are no symptoms, but the body’s immune system has already begun attacking the insulinproducing cells in the pancreas.

The blood test measures three different antibodies that show if the immune system has started attacking the beta cells in the pancreas.

Only two per cent (1 in 50 people) will be deemed high risk and therefore potentially eligible to take part in the human testing phase of the trial.

You will be offered further free testing to measure your ability to produce insulin. If the glucose tests are normal you would be eligible to participate in the human testing part of the trial.

Q&A ON THE HUMAN TESTING PHASE How long is the treatment?

Participants will self-administer an insulin nasal spray each morning for one week and then once a week for 12 months. They will return for a check-up every three months during the treatment year, then every six months for a further four years.

Has nasal insulin been tested before?

Yes, nasal insulin has been tested in an earlier clinical trial, in which it was shown to be safe and to induce immune effects. Insulin inhaled through the nose does not enter the blood stream so it does not cause hypoglycaemia.

Was the treatment initially tested on animals?

Yes. It was shown to be safe and to stimulate a protective immune response to insulin, which suppressed the development of diabetes in mice prone to Type 1 diabetes.

What are the possible risks of the trial to me?

If you have the screening blood test and are one of the minority with a positive test this can cause you anxiety.

In our experience this anxiety is temporary. As with all medications, there is a small possibility that you may have side effects, but with the nasal spray these are usually very minor and transient.

Summer 2012 | DIABETES

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GARD EN I N G

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SUMMER BEANS

Grow beautiful beans Anyone can grow beans and they look wonderful in a home garden, as gardening expert Rachel Knight explains. Why not give it a go this summer?

I love growing my own beans in summer as they come in so many shapes, sizes and colours and are easy to grow. Beans are expensive to buy and often wilting by the time you get them home. They taste so much better freshly picked.

Even if you don’t have a large garden you can grow dwarf beans in large pots or planter boxes. Tall bean varieties make a magnificent display and can form an attractive vertical feature in your garden. Bean flowers come in shades of white, pink and red and don’t need to be confined to your vegetable garden.

Which bean for you?

Most climbing bean varieties can grow over two metres high whereas other beans are dwarf or ‘bush’ beans and less than half a metre high. Pods can be flat, such as the traditional ‘Scarlet Runner’ or round, in the case of French beans.

Most beans are green but some are purple, yellow or mottled. Yellow beans keep their colour when cooked, but sadly purple beans turn green once heated.

Tall beans will need some sort of support – they’ll twine around a bamboo cane or wire mesh fence very happily without your needing to tie them up. Just make sure it’s sturdy enough to resist the wind when laden with bean plants. I use two lines of bamboo canes about 30cm apart tied together at the top with cable ties with another bamboo cane across the top horizontally. I plant a single bean at the bottom of each cane.

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Later can be better for beans Sowing beans in late spring or summer will make germination easier as beans need even temperatures before they start growing. Beans need temperatures steadily above 15 ° C to germinate well. If you want to give them an early start, sowing them indoors in pots makes sense. Once things have warmed up outside, beans grow very happily from seeds sown in the soil. Either way, sow them about the width of the bean seed below the surface.

Bean plants benefit from plenty of compost around their roots for a good source of nutrients and, more importantly, water. They particularly appreciate this once they’re flowering and fruiting. In dry summers beans need a generous watering once a week at their most productive stage.

When to eat your beans My favourite time to eat beans is when they’re young and tender, before the seeds are fully developed. The best way to keep your beans producing is to keep picking the beans, possibly daily. I have a five-year-old friend who rejects most vegetables but will eat with relish beans he picks himself, fresh from his garden.

You can also wait for the seeds to mature and shell them as you would peas. Alternatively you can allow the beans to dry and store them for the winter to use in soups and stews.

Don’t worry if you grow too many beans for you and your family to eat.

You can freeze the rest or give them away to friends and neighbours.

They’ll look lovely in your garden, taste delicious and might make you a new friend or two in the process.

See Rachel's gardening blog on www.thekitchengarden.co.nz

Five best beans Here are five varieties I’ve enjoyed growing and eating: White Emergo Runner – a white-flowered, climbing bean with tasty long, flat, green pods.

Purple Tee Pee – delicious and prolific, dwarf French bean.

Albenga – attractive Italian dwarf bean with mottled green and purple pods.

Roquefort – dwarf bean with well-flavoured slender goldenyellow pods with black seeds.

King of the blues – glossy deep purple beans on tall vigorous plants.

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TECH NOLOGY

Go online to track your diabetes goals Do you want to know how much fibre is in a beef madras or how much fat is in a banana cake? A Kiwi-designed website will tell you that and so much more, as Caroline Wood reports Diabetes Plan is a new website designed by and for New Zealanders to give people an extra technological tool to live well with diabetes. The aim is to put users back in the driving seat and feeling as if they are in control of their food and diabetes management.

You can go online, search and record nutritional information on more than 2,000 foods commonly available in New Zealand. You can set goals for how much fat, carbohydrate or fibre you are eating and keep an online record of your personal progress.

The website also allows you to keep an online record of your blood glucose level using the Glucose Tracker function.

The site, which is still in the process of development, includes an online forum where users can ask or answer questions about diabetes, as well as an online library and links to other sites and research articles.

There is also a useful BMI calculator.

Diabetes Plan is the brainchild of the Otago Diabetes Research Trust.

Chairman Wayne Bowen said: “We are proud to announce the launch of the Diabetes Plan website, which has been developed to help people manage their diabetes by providing resources and tools that put them in control.”

The food planner function allows people to search for the food they are planning to eat that day – for example muesli for breakfast, a tuna

? sandwich for lunch and spaghetti for supper. You can find each item’s energy, protein, fat, saturated fat, carbohydrate, sodium and dietary fibre.

You can record what you eat over a day and see how much you are eating. You can also set goals for how much energy, fat or fibre you want to eat per day and compare your progress over time.

If a certain food isn’t there, you can add nutritional information yourself and either keep it available on your own profile, or allow someone else to see it.

Beef madras: How much fibre do I have?

The Glucose Tracker function allows you to record your blood glucose every day and use it to record your progress.

The site also includes a diabetes forum, where you can ask questions about your diabetes management and answer other users’ questions.

The website is being supported by leading New Zealand obesity and diabetes expert Professor Jim Mann, who says: “Making dietary change is never easy especially when it involves habits of a lifetime. It is hoped the Diabetes Plan website will help the process.”

For more information or to try it out go to: www.diabetesplan.co.nz Do you use technology to help you manage your diabetes?

Recommend the apps or websites you use. Contact editor@diabetes.org.nz

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DIAB E TES AWA RE NE SS W E E K

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PREG NA NCY

Diabetes Awareness Week November 13-19:

Pregnancy and diabetes This year’s Diabetes Awareness Week focused on diabetes in pregnancy. Diabetes New Zealand’s Communications Manager Lisa Woods answers your questions about the campaign.

Q: Why did you choose to focus on pregnancy and diabetes for this year’s Diabetes Awareness Week?

Diabetes during pregnancy is a serious issue and can be very dangerous if it is not managed properly. It can put the health of the mother and her baby at risk. With thousands of Kiwi women affected each year, we wanted to shine the spotlight on what is one of our country’s most serious maternal health issues.

Q: How many New Zealand women have diabetes in pregnancy?

One in 20 Kiwi women have diabetes during pregnancy. This includes women who have Type 1 or Type 2 diabetes before pregnancy and women who develop issues with blood glucose levels (gestational diabetes) while pregnant.

Q: What can happen if diabetes isn’t controlled in pregnancy?

High blood glucose levels in the mother around the time of conception and early pregnancy can increase a baby’s risk of developing abnormalities to the heart, spine and kidneys, and increase the chance of miscarriage.

If blood glucose levels are high during later pregnancy the baby has more chance of: • Becoming very large – this can cause problems during delivery.

• Being very small.

• Being stillborn.

• Developing very low blood glucose levels immediately following birth.

A woman who has had gestational diabetes has a significantly increased risk (50-60 per cent) of developing Type 2 diabetes in the future.

Q: What were the key messages you were making as part of this campaign?

Diabetes during pregnancy is serious. The good news is that most women can have a healthy pregnancy by working with their health care team to manage their blood sugar levels.

Diabetes during pregnancy is serious. The good news is that most women can have a healthy pregnancy by working with their health care team to manage their blood sugar levels.

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PREG NA NCY

Diabetes Awareness Week is the biggest promotional week for diabetes in the calendar. Over seven days every November, Diabetes New Zealand and its local branches raise awareness about diabetes and share information about simple ways to stay healthy.

If you are pregnant or planning a family and worried about diabetes, it’s important to talk to a health professional.

The theme for Diabetes Awareness Week this year was diabetes and pregnancy. Our campaign asked New Zealanders to “Help our smallest Kiwis stay sweet as”.

Q: How did you get these messages into the public domain?

This year we partnered with Pharmacy Brands, which helped us raise awareness by running instore awareness campaigns in their pharmacies across New Zealand.

Pharmacy Brands represents over 300 pharmacies including: Amcal, Care Chemist, Life Pharmacy, Radius and Unichem.

Pregnancy and diabetes One in 20 women have diabetes during pregnancy.

This includes women with Type 1 and Type 2 diabetes and those who develop gestational diabetes.

Diabetes New Zealand branches also ran local events and spread the word among thousands of Kiwis.

Local GP clinics across the country helped us raise awareness by giving out information to pregnant women who visited them during Awareness Week. And a range of businesses and organisations ran internal awareness campaigns to raise awareness amongst their staff, volunteers and members.

We depend heavily on donations, legacies and membership fees to help us do our work.

Please help us educate and support people with diabetes so they can live well with it.

DI A B E TE S AWA RE NE SS WEEK

Diabetes Awareness Week

By raising awareness we can encourage people with prepregnancy diabetes or gestational diabetes to get the support and treatment they need to stay healthy.

Ways to give

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Every year thousands of New Zealand women need special care and attention to help them manage diabetes during pregnancy.

There is help available. If you have diabetes it’s very important to talk to your doctor before you plan to get pregnant. If you are already pregnant and worried about diabetes, make an appointment today to talk to your midwife, doctor or other health specialist.

There is lots of information about pregnancy and diabetes on the Diabetes New Zealand website: www.diabetes.org.nz.

How can you help?

• • • • •

You can make a regular donation or a one-off donation.

You can call 0900 86369 to make an instant $20 donation.

You can sponsor a special event such as Diabetes Awareness Week.

You can sign up to payroll giving.

You can leave us a bequest in your will.

A third of money donated can be claimed back as a tax refund.

Donations are tax-deductible up to the donor’s full annual income.

Visit www.ird.govt.nz for more information.

Please talk to us to discuss your donation options.

Call Freephone 0800 369 636 or email fundraising@diabetes.org.nz

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FESTIVE FOOD

Have a happy and healthy Christmas You can make healthy choices and still enjoy wonderful food over the festive season, as dietitian Ann Gregory explains.

Christmas and the summer holidays are the time for catching up with family/whānau and friends. In all cultures, food is a way of showing hospitality, respect and love for our guests. It can also be a time when all the positive healthy lifestyle changes we have made during the year are put to the test. Here are some ideas for a happy and healthy Christmas.

Plan in advance The best way to avoid over-indulging this Christmas is to do a bit of clever preparation.

Plan the meals for the holiday period, make a shopping list and only buy what you need. Then the leftover nibbles and treats will not be there to tempt you after Christmas.

Do not over cater. Plan the serving sizes. For example you only need 120-160g of meat per person and 90-120g of potato, or other starchy food per person. It will save you money too.

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To decrease the temptation to pick at them every time you open the fridge, freeze leftovers straight away.

Have healthy snacks on hand Have raw vegetable crudités, such as sticks of carrot, celery, pepper, gherkins with flavoured cottage cheese or dips made with low fat yoghurt or low fat sour cream instead of nuts and chippies. Try rice crackers in place of chippies.

Try to limit the number of nibbles you have. They can be calorie dense and very moreish. Do not sit next to the dish of nuts or chippies – pass it on to someone else and reduce the temptation!

Try these ideas for Xmas Use less bread in stuffing, increase the amount of onions and fruit.

Make sure you skim off as much fat as possible when making gravy.

Don’t roast potatoes in lots of fat, roll them in vegetable oil, season and roast. Have one small potato per serving with some plain boiled potato.

Use low fat mayonnaise or salad dressing, or try oil and vinegar dressing with salads. Keep to a tablespoon serving.

When cooking, measure the oil don’t just glug – this helps to manage the kilojoules.

Remember the healthy plate model and have lots of veggies to help fill you up.

Limit sweet treats Treats you would not normally eat are part of Christmas and we look forward to them but aim for one treat a day, not three! If you overdo it one day don’t give up. Reduce the number of treats you eat the following day.

Don’t ice the Christmas cake – decorate it with nuts and dried fruit instead.

Make filo pastry cases and fill with fruit mince – it makes a delicious lower fat alternative to mince pies.

Use low fat milk to make custard for the trifle or have it with your Christmas pudding. Mix equal amounts of low fat yoghurt with whipped cream and add vanilla essence – it makes a great ‘cream’ with Christmas or any other pudding.

Remember alcohol It is easy to over indulge in the drinking department at Christmas.

Remember not to drink on an empty stomach (especially if you are on insulin). Alcohol will also stimulate your appetite making you eat more calories. Try limiting yourself to a glass of wine with your meal or make a spritzer (white wine topped up with soda water) for a pre-dinner drink. Use sugar-free mixers with spirits. Better still have soda water with a splash of lime as a refreshing pre-meal drink.

Julia is Co Founde r & Director of Dollop Puddings

Julia Crownshaw A Chelsea NZ Hottest Home Baker Judge says...

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If you’re looking for a low GI homemade muesli with a great taste, using LoGiCane Sugar is a wonderful option”.

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FESTIVE BA KI NG

Sure To Rise: Ten tips for diabetes-friendly baking Kiwis love their baking.

Where else in the world would you find a society that embraces morning and afternoon tea with such enthusiasm and affection?

Across the country co‑workers, housewives, retirees and children regularly down tools for morning tea to mark a special occasion or just … because. It is a great way to get to know people and helps foster the other great Kiwi institution – a sense of community.

Baking something fresh is cheaper, healthier and tastier than buying cakes and biscuits from the supermarket that are filled with sugar and have a long list of ingredients that you cannot control.

Here at Diabetes magazine we often get questions from readers about baking. Some newly-diagnosed readers are worried they will never eat a muffin again. Others want help and advice on how to make a favourite cake diabetesfriendly, or substitute healthy ingredients for unhealthy.

We asked Ann Gregory, cake lover and senior dietitian at Wellington Hospital, for some help. Here are her top tips for diabetes-friendly healthy baking. Enjoy a little treat this Christmas!

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Ann Gregory's healthy baking tips We all enjoy a sweet treat from time to time. Whether we have Type 1 or 2 diabetes, or are just trying to lose weight, we should be eating healthily.

The tips below will help you reduce the fat, sugar and energy in your baking.

3

Make sure you use low fat milk and dairy products or try buttermilk, which is low in fat and great to use in muffins and cakes.

1

Reduce the amount of sugar in the recipe. Try cutting it by a quarter, you probably won’t notice and you will reduce the amount of carbohydrate and kilojoules too. A good guide is to use ¼ cup of sugar to 1 cup of flour. If using condensed milk use the light variety.

2

Don’t ice the cake or muffin, or if you really must, just put a small drizzle on top. Instead of icing sugar, decorate the top with fruit, nuts or try sprinkling cinnamon or cocoa powder.

4

Use a low fat spread in place of butter or oil – this will reduce both the fat and the kilojoules. Do not spread butter or margarine on scones, muffins or loaves – they all taste just as good without it and you will reduce your intake of fat and kilojoules.

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Look for recipes that use wholemeal flour or oats, or substitute half the white flour with wholemeal flour. This will increase the fibre and help slow the absorption of glucose.

FESTIVE BA KI N G

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FOOD

Baking something fresh is cheaper, healthier and tastier than buying cakes and biscuits from the supermarket.

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Try adding seeds such as sunflower, sesame and pumpkin or dried fruit to the recipe. This will increase the fibre as well as giving the finished product some crunch.

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Freeze extra muffins and scones on the day you make them.

Then you won’t be tempted to snack on them. When you’re ready, take one out of the freezer, defrost for 10 seconds in the microwave and pop it in the oven for 10 minutes at 150°C – it will taste delicious. You can also freeze uncooked biscuits, great for hassle-free entertaining and no leftovers to nibble on the next day.

Sustaining

and healthy...

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Reduce the amount of chocolate in recipes. Using dark chocolate with a high cocoa content will give you the taste for less sugar and kilojoules.

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Use a sugar substitute such as aspartame or stevia. You can find recipes using sugar substitutes on the internet.

8

Downsize the portions – make mini muffins and scones and smaller sized biscuits.

Cut slices into more pieces than the recipe says.

Share the baking with family and friends and then you won’t be tempted to snack.

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A LFRESCO D INING

Summer dips A dip surrounded by plenty of crunchy vegetable dippers is a great way to encourage your family or friends to eat more vegetables. A few different dips and dippers can make a good informal lunch or even an impromptu picnic. Produce a dip and lots of vegetable sticks as an after-school snack too.

Green pea pesto INGREDIENTS For 1 cup of pesto: 1 cup frozen peas, regular or baby, minted or plain 1 clove garlic (optional) 1 large or two small spring onions 1 tbsp lemon juice or white wine vinegar ¼ cup grated parmesan cheese ¼ cup olive, canola or other oil ½ tsp salt dash of Tabasco or other chilli sauce NUTRITION: KJ: 169 (40kcal), Fat: 4g, Carbohydrate: less than 1g,

Here is a bright green, tasty and easy alternative to guacamole.

It can be made at the last minute from ingredients that you are likely to have on hand.

Use food processor, blender or ‘wand’ to whiz together the peas and roughly chopped clove of garlic until very finely chopped.

Roughly chop the white part and 8-10cm of the lower green leaves of the spring onion(s) after removing the roots. Add the chopped spring onion to the pea mixture and puree until smooth.

Add the lemon juice or vinegar, grated cheese and half the oil and puree until the mixture looks paler and smooth.

Add the remaining oil, salt and chilli to taste and puree again. Taste and adjust seasonings if desired. The mixture will become thinner as the peas thaw.

Serve immediately or refrigerate for up to several hours. Serve with your favourite dippers, or on baked kumara, over new potatoes, or as a sauce with other cooked vegetables. It’s also delicious as a spread on bread.

Credit: Recipes and image courtesy of Simon and Alison Holst.

Flatbread crisps Think beyond corn chips and potato crisps, both high in fat!

Cut rectangular or triangular shapes from tortillas. Lightly brown them in the oven at 150-175°C, under a grill or on a bbq rack. Cut pita bread pockets in strips or triangles, separating the two sides. Cook as for flatbreads above.

Cut slices of French bread, breadsticks, etc, and bake until crisp and dry.

Crunchy vegetable dippers Fresh crisp raw vegetable pieces are colourful and tasty. Suitable veges to use include: asparagus; capsicums, carrots, zucchini and cucumbers; young green beans; whole snowpeas; and whole button mushrooms.

It is best to prepare the vegetable dippers an hour or so before you need them.

When you have cut the vegetable you are working with into strips, rings, diagonal slices or smallish chunky pieces, hold the pieces under the cold tap, shake off excess water and put each type of wet, prepared vegetable in a separate plastic bag and close it tightly. The vegetables soak up the small amount of water and become crisp. Any leftovers can go back in the plastic bags and be refrigerated until needed.

READER GIVEAWAY We have 10 copies of Easy Everyday Recipes for the Whole Family by Simon and Alison Holst to give away. All you have to do is email us with your name and address. The name of 10 lucky readers will be drawn out of a hat.

Email to admin@diabetes.org.nz with your entry using the phrase Easy Everyday Cookbook Giveaway in the subject line.

Please submit your entry no later than 31 January 2013.

To buy a copy of the cookbook, call Diabetes NZ on 04 499 7145 or email admin@diabetes.org.nz.

Spring giveaway: the lucky winners of Type 2 Diabetes for Dummies were Wali Kamali of Invercargill, Richard Smit of Whangarei, Cyril J Moore of Auckland, Chris McKenna of Greytown, and Ramari Rangihika of Whakatane.

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FAM I LI E S A ND CH ILD REN

Keeping our children healthy

New food and exercise guidelines for children and teenagers aged two to 18 years have been published.

The Ministry of Health guidelines are based on the latest evidence and expert recommendations.

The New Zealand Food and Nutrition Guidelines for healthy children and young people are designed to ensure optimal growth and prevent nutritional deficiencies, obesity and diet-related chronic diseases, such as diabetes. The guidelines also cover how much physical activity children should be doing.

Choose healthy foods

Mix it up

Limit drinks such as fruit juice, cordial, fruit drink, fizzy drinks (including diet drinks), sports drinks and sports water. Energy drinks or energy shots are not recommended for children or young people.

Eat a variety of foods from each of the four major food groups each day: • Vegetables and fruit, including different colours and textures • Breads and cereals, increasing wholegrain products as children get older • Milk and milk products, or suitable alternatives, preferably reduced or low-fat options • Lean meat, poultry, fish, shellfish, eggs, legumes, nuts and seeds.

Eat enough for activity, growth and to maintain a healthy body size.

Eat regularly over the day – have breakfast, lunch and dinner, and include in-between snacks for young children, or if hungry.

Prepare foods or choose pre-prepared foods, snacks and drinks that are: • low in fat, especially saturated fat • low in sugar, especially added sugar • low in salt (if using salt, use iodised salt).

Drink plenty of water during the day. Include reduced or low-fat milk every day.

Do not give children less than 13 years of age coffee or tea. If young people (13 years and older) choose to drink coffee or tea, limit to one to two cups per day. Alcohol is not recommended for children or young people.

Eat together Eat meals with family or whānau as often as possible. Encourage children and young people to get involved in cooking family meals, shopping for the ingredients, or growing their own food.

How much exercise should my child do?

Children and teenagers should: • Take part in regular physical activity, aiming for 60 minutes or more of moderate to vigorous activity each day.

• Spend less than two hours a day (out of school time) in front of television, computers and gaming consoles.

• Be active in as many ways as possible, for example, through play, cultural activities, dance, sport and recreation, jobs and going from place to place.

• Be active with friends and whānau, at home, school, and in your community.

Source: Ministry of Health. 2012. Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 years): A background paper (1st Ed).

Wellington: Ministry of Health.

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LEAVI NG H O M E

Helping your teenager fly the nest

The prospect of a teenager leaving home to live on their own for the first time is stressful for many parents. But there are things you can do to help the transition go smoothly, as diabetes nurse specialist Kirsty Newton explains.

term. How much support has to be negotiated between the teen and parents.

Leaving home is a time of transition – for the teen as they anticipate independent living, and for the parents as they learn to let go. Parents whose children were diagnosed with diabetes at a young age can find this transition period hard as their teen’s diabetes management has become an extension of their own lives.

Teenagers must also learn to keep to the management regime, to delay or prevent complications in the future. This can be a difficult concept for an age group that lives in the present and who may consider themselves ‘bullet proof ’ and therefore not vulnerable to the future complications of diabetes, even though they know about them.

Negotiating the transfer of diabetes knowledge, responsibility and management to your teenage child can be a difficult experience for everyone, but it must be done if the teen is to be successful and independent.

One of the significant issues in diabetes management in this age group is the random approach many of them have towards insulin injections and testing. Good habits established in early to mid teens carry on into adulthood, along with the benefits of good control which are long lasting. Sadly the reverse is also true.

The literature shows that teens whose parents have an arms-length supporting role do better long

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Establish good habits The time of transition is an active process in that teens should be self testing, giving insulin and making decisions about managing high or low blood glucose levels.

There are three aspects of managing to live with a chronic condition – choices, control and empowerment.

Empowering your teen (see side panel) will enable them to develop the capacity to take responsibility for their diabetes. Disempowerment can lead to them feeling overwhelmed by the responsibility.

Watch out for worrying signs Anxiety and depression are common among teens/young adults with diabetes. Suddenly they have a lot of things on their plates, such as independent living, adjusting to living with peers and possibly engaging in some risky behaviours (alcohol, drugs, sexual activity).

Some may struggle to manage their academic workload. There is also the issue of accessing health services, managing prescriptions, hypos, hypers and sick days without the usual support of family and their usual diabetes team.

Keep an eye out for the warning signs of anxiety and depression.

These include: Sleep disturbances, poor concentration, irritability, feelings of hopelessness, anxiety

LEAVI NG H O M E

attacks, self medicating (eg alcohol and drugs), not taking their insulin regularly, self harming/cutting, social isolation, failing grades/ missing classes.

There are good support services available for teens/young adults who need some help and direction.

If they are at university or other institution there will be a student health service with links to counselling and student support services. If they are working there is often the option of the Employee Assistance Programme or counselling through their GP service. The main thing to ensure for any teen with diabetes leaving home and living somewhere else is that they engage with some kind of health service.

Manage risks My best advice for parents is to prepare for the departure of their teen well in advance. Make sure they know how to manage their diabetes

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independently. Prepare with them and plan to support them from a distance. But don’t over-manage them. If you find you are doing so, ask yourself ‘Whose diabetes is it?”

Risk taking is a normal part of adolescence. Talking to your child about these risks can help mitigate the dangers.

Make sure they know the most common reasons for hospital admission, which are: • too much alcohol • random use and under-dosing of insulin • not managing sick days.

The two main messages to get across to your teenager are that they must take their insulin and they must treat hypos correctly.

Kirsty Newton works for Capital and Coast District Health Board and specialises in helping teenagers and young adults manage their diabetes.

How to empower your teenager (so they can manage their diabetes) Plan with them, well in advance of their departure date.

Throughout adolescence, encourage them to take on more responsibility for diabetes management – for example testing, insulin doses, carb counting, safety in exercise, stress management, sick day management.

Get them to attend clinic appointments on their own; join them for the last five to 10 minutes.

Promote resilience! Give them tasks to do such as taking their script to the chemist and learning to manage repeats.

Teach them how to cook and shop.

Teach them to manage money.

Claim a disability allowance (if a

FAM I LI E S A ND CH ILD REN

student, they get this through Study Link).

Make sure they are referred to the diabetes service in the place they are going to (your current diabetes service should do this).

Get them to sign up with a GP near their new home – research possible options that may have good diabetes awareness, for example youth one-stop shops, medical centre or university health service.

Ask your diabetes nurse educator for handouts on alcohol, sick days, physical activity, drugs and smoking.

Talk to your teen about safe sex, safety with alcohol and other behaviours that may impact on their diabetes.

Work out your type of teenager As a diabetes nurse specialist working with teens and young adults, I have found over the years that there are basically three groups of teens with Type 1 diabetes.

1

There are those who leave home with reasonably good diabetes management skills. They may have their ups and downs as everyone does but they have accepted their diabetes and are well prepared for life after school and independent living.

2

There are those who have never really accepted their diabetes, find their management difficult and living away from home and studying or working puts them under a lot of pressure which doesn’t help their diabetes control.

3

There are those who have never taken on the responsibility for their diabetes management, still need to rely on a lot of support from home and often struggle with anxiety and depression.

Summer 2012 | DIABETES

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C ARE A N D PRE VE NTI O N

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SUMME R FEET

Summer survial kit for feet Summer is here and there is nothing better than walking on the beach and enjoying a bbq on those long, hot summer evenings. But you can never take a holiday from looking after your feet, as Napier podiatrist Judy Clarke explains.

Check your feet every day

Diabetes can cause foot problems through gradual changes to your circulation and the nerve endings (causing lack of feeling). This is why it is very important you check your feet regularly, especially on holiday when you may be more active than usual. Hopefully the following words of advice will help you to care for your feet while enjoying your holiday.

If your skin is dry apply a moisturising cream every day, avoiding the areas between your toes as this can increase the chances of getting tinea. You may need to apply extra moisturising cream if your skin gets very dry in the hot weather.

Any type of cream is good, there is a huge range of choices. Find one that suits you and use it regularly. There is a good one containing urea called Nutraplus, which can be prescribed by your GP and is an excellent choice for your skin.

On the journey Long journeys can make your feet swell. Try to walk about every half hour if possible - even a short distance will help. This will keep the circulation moving and keep the swelling down. Make sure your shoes are not too tight.

You should check your feet at least once a day for any blisters, breaks in the skin, pain or any signs of infection such as swelling, heat or redness, just as you would at home.

Look especially in between your toes for signs of tinea (fungal infection) and around your heels for any fissures/cracks.

Wash your feet every day Wash your feet every day in warm water and mild soap. Rinse them thoroughly and dry them carefully, especially between the toes.

Moisturise your feet every day

there are no rough seams or small objects caught inside the shoe.

Avoid walking barefoot Never walk barefoot, especially on the beach. You run the risk of injuring your feet by stubbing toes or standing on sharp objects, which can damage skin. You may also not know how hot the sand is, if you have lost some sensation in your feet, and you could end up burning them without realising it.

If you go into the sea, wear some sort of waterproof footwear to protect your feet. Avoid wearing jandals as they may cause blisters between your toes and do not give you enough protection.

Minor cuts and blisters Take a small ďŹ rst-aid kit containing sterile gauze dressings and tape.

If you get a small cut, graze or any breaks in the skin, bathe in warm salt water (a tablespoon of ordinary salt in a bowl of warm water) to clean the wound and tape on a dry sterile gauze dressing. If there is swelling, redness, throbbing pain or pus, consult a Podiatrist or GP immediately. Do not burst blisters but ask for help.

Footwear

Finally

Take any shoes you have had especially made for you on holiday.

Make sure your shoes are the correct size/width/depth. Check

Protect against sunburn. The skin on the top of your foot is very sensitive and sunscreen is essential. Apply regularly throughout the day.

Every day: check, wash and moisturise‌

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DIABETES | Summer 2012

NZ O BES ITY CO NFERENCE

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CARE AND P RE V ENTION

Pre-birth lifestyle vital Obesity is better prevented early rather than inadequately treated later in life, says Professor Wayne Cutfield, who was a keynote speaker at the recent Australia and New Zealand Obesity Society conference in Auckland.

More than a quarter of New Zealand men and women are now obese, according to new government figures published in September.

Liggins Institute Director Professor Wayne Cutfield challenges the belief that our health depends on genes and lifestyle, particularly in middle age. Rather, he says, events before you are born are critically important.

Data from researchers at the Liggins Institute, the National Research Centre for Growth and Development, and their international colleagues point firmly to the importance of factors in the pre-birth environment, he says.

These include a woman’s health, weight and eating habits before pregnancy.

Prof Cutfield said: “The optimal foetal environment is delicately poised and even small deviations from a normal pattern of development can have a significant impact, increasing the risk of obesity-related diseases and diabetes.

“The foetal nutritional environment from before conception and throughout pregnancy is critically important for health lifelong.

“Children born small for their gestational age, preterm, post term and to women who experienced extreme morning sickness have all been shown to have increased risks of later obesity, cardiovascular and metabolic diseases such as diabetes.”

The Australian and New Zealand Obesity Society’s Annual Scientific Meeting was held in Auckland in October. The theme was ‘For our Children’s Children’.

It brought together leading obesity doctors, academics and researchers to discuss the latest research, treatment and public health initiatives to manage and prevent obesity in New Zealand.

There has been a rise in obesity in New Zealand adults in recent decades - from 9 per cent (males) and 11 per cent (females) in 1977 to 27.7 per cent and 27.8 per cent respectively in 2008/09, according to the Ministry of Health.

The latest figures come from the 2008-2009 Adult Nutrition Survey. In the survey, Ministry of Health and Otago University researchers collected information from 4721 New Zealanders aged 15 years and over.

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CO M M U N IT Y

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WORLD D IABETES DAY

NZ leads the world in blue monument challenge

New Zealand took part in worldwide celebrations to mark World Diabetes Day on 14 November.

Across the world, countries lit their iconic buildings blue in recognition of the Blue Circle as the global symbol of diabetes.

Diabetes Otago secured sponsorship from Novo Nordisk to light the roof of the Forsyth Barr Stadium in Dunedin. The stadium was lit up blue on 14 November, the only building in New Zealand to mark World Diabetes Day. Since 2007, iconic buildings and sites all over the world have been lit up in blue to mark World Diabetes Day on 14 November and raise awareness of diabetes.

Over 1,000 monuments and buildings in more than 80 countries have been floodlit blue for diabetes.

Diabetes Otago planned a day of special events at the stadium, involving the young and not so young, to mark World Diabetes Day. Chris Baty, President of Diabetes New Zealand opened the day’s proceedings, which included a presentation by Craig Cumming and Errol Sharp called ‘Making the most of life with diabetes’.

Nutrition students at the University of Otago gave a talk about how to

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DIABETES | Summer 2012

Lake Pavilion of Taichung, Taiwan, in blue for World Diabetes Day 2010.

make a superb diabetes lunch. And Masterchef Nadia Lim was there to give a cooking demonstration on how to prepare meals for people with diabetes.

Youngsters from the local primary schools took part in sports and games on the turf at the stadium, while local radio hosts broadcast from the venue.

There was lots of good expert advice on hand too, with Chris Higgs, from the University of Otago, explaining how people can control sugar levels by activity, while Rachel Taylor, also from the University of Otago, talked about obesity in children.

The day ended with local celebrities cooking up a storm and a panel discussion called Diabetes – Today’s Crisis.

Wayne Bowen, Chairman of the Otago Diabetes Research Trust, said: “It was an amazing day, the whole programme was a fantastic promotion of World Diabetes Day and got plenty of media coverage.

We are really delighted.”

World Diabetes Day World Diabetes Day is a chance for the 366 million people living with diabetes around the world to unite and bring awareness to this silent killer. It is organised by the International Diabetes Federation, of which Diabetes New Zealand is a member.

Blue Circle Champions are high profile individuals who have been touched by diabetes in one way or another.

One of the newest Blue Circle Champions is Josu Feijoo, a Spanish climber and the first person with diabetes to be training to become an astronaut.

Josu has had Type 1 diabetes for 18 years but he has proved he can overcome any challenge and achieve control over the disease.

He is the first person with diabetes to have reached the North and South Poles and to climb Mount Everest.

Now he has been selected to be one of the astronauts on board Virgin Galactic’s VSS Enterprise, leading him closer to his dream of being the first person with a chronic condition to go into space.

UNI FI CATI O N

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COM MUNITY

Full steam ahead Diabetes New Zealand branches and national office came together formally as one unified organisation on 1 October. This follows the Special General Meeting in March where a clear majority of branches (formerly called societies) voted to unify into one single organisation.

Unification has been a long journey, but happily we have now arrived. It is a significant milestone for Diabetes New Zealand and something the organisation can be incredibly proud of.



Now the work begins to do what we unified to do – making a difference for people affected by diabetes. And that we will.

We have an ambitious but very exciting agenda planned to make the most of our newfound strength as a united voice.

This includes the development of an innovative diabetes education website, a long-term awareness and action campaign, an advocacy strategy and the delivery of more

support to people affected by diabetes.

Please spread the word to anyone who might want to join Diabetes New Zealand. See the form below for membership options. And of course every member receives a free subscription to Diabetes magazine.

Lisa Woods, National Communications Manager

Join Diabetes New Zealand today!

Join Diabetes New Zealand today. Membership includes access to services from your local branch and a free annual subscription to Diabetes magazine (four issues per year).

Tick if you would like to be affiliated with a branch. ■ Nearest branch ■ Other branch – Please specify __________________________ Title

■ Mr ■ Mrs ■ Miss ■ Ms ■ Dr ■ Prof

Gender: ■ Male ■ Female

First Names

_________________________________________________________________________________________________________

Last Name

_________________________________________________________________________________________________________

Phone Day (0 ) ____________________________________ Evening (0 ) ____________________________________

Email

_________________________________________________________________________________________________________

Address

_________________________________________________________________________________________________________

Date of Birth

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Occupation

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Ethnicity

_________________________________________________________________________________________________________

If you or a member of your family/wha¯nau has diabetes we invite you to share your details with us. This will allow us to provide you with more relevant information.

Diabetes

■ You ■ Child ■ Partner ■ Other ■ No

Diabetes type

■ Type 1 ■ Type 2

■ Gestational diabetes

Membership includes free home delivery of four issues of Diabetes (worth $18) straight to your door. If you do not want to join Diabetes New Zealand, you can subscribe to the magazine for $18 per year (four issues), simply choose this option in the payment box below.

■ Please join me as a member of Diabetes New Zealand. My cheque for ■ $35 (waged) or ■ $27.50 (unwaged) is enclosed (please tick).

■ Please subscribe me to Diabetes magazine only. My cheque for $18 is enclosed.

OR charge my Visa/MasterCard: Name on card _______________________________________________________________________________________________________________________________ Expiry date _____________________________________________________________ Card No

■■■■ ■■■■ ■■■■ ■■■■

■ I would like to include a donation of $

Signature

_____________________________________________________________

_______________________________________

Post to (no stamp required): Freepost Diabetes NZ, Diabetes New Zealand, PO Box 12-441, Wellington 6144

Summer 2012 | DIABETES

33

THE L AS T WORD

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INSULIN FOR LIFE

Help save a life today Insulin for Life is helping save lives in developing countries around the world.

It’s a simple idea – people from rich countries donate their unwanted insulin, meters and test strips. These donated supplies get sent directly to developing countries and given to people who cannot afford insulin and other life-saving diabetes supplies.

Today you could help save the life of a child in Fiji or a mother in Nepal.

It’s an amazing idea but it’s true.

If you have any unwanted, unused diabetes supplies and donate them to Insulin for Life, you could be helping save lives somewhere in the world.

Insulin for Life Australia is a notfor-profit organisation that collects and distributes insulin and other diabetes supplies that would otherwise be wasted.

Recipient organisations include diabetes associations and clinics, children’s diabetes camps and programmes involving Australian medical students. Recipient countries include Fiji, Nepal, the Phillippines and Ecuador.

Diabetes New Zealand is collecting supplies as part of the Insulin for Life global network. There are Insulin for Life affiliated centres in Austria, Canada, Germany, the Netherlands, the United Kingdom and the USA. In particular Diabetes NZ is keen to take any unexpired, unopened blood glucose testing strips as people transition to the new meters.

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DIABETES | Summer 2012

Your unwanted insulin, meters or test strips could help a child in Fiji.

The cost of insulin varies greatly in different countries. There is no public subsidy in some developing countries, so individuals and families struggle to pay the daily cost – sometimes more than 50 percent of the average annual income.

The lack of affordability means people with diabetes in those countries are more likely to develop complications earlier and die prematurely. This has a huge economic cost on their families, as

they cannot work as productively as someone without diabetes.

In contrast, the price of insulin in developed economies is usually heavily subsidised by governments or insurance arrangements. The yearly cost of insulin is usually well below 0.3 percent of average annual income – less than $US 3 each month.

To find out more go to www.insulinforlife.org

Can you help?

Items must be no longer needed, unused, unopened, and in-date.

The following items can be donated: • Insulin and pre-filled insulin pens (at least six months to use-by date).

• Glucose test strips (at least six months to use-by date).

• Unused glucose meters that are less than two years old.

• Unopened boxes of insulin syringes (at least six months to use-by date).

Please send by ordinary mail. No cool pack is needed for insulin – it stores well for the very short period involved in transit.

Please send to: Diabetes Auckland, 62-64 Valley Road, Mount Eden, Auckland 1024. If you have any queries about the scheme, contact Marguerite Durling on 09 623 2508.

IMPORTANT MESSAGE TO ALL PEOPLE WHO TEST

Blood Glucose and / or Blood Ketones PHARMAC proposes to: • Continue fully funding FreeStyle Optium / Optium blood ketone test strips for all users, per existing 2010 - 2012 prescribing conditions. • Continue fully funding FreeStyle Optium / Optium blood glucose test strips for those using Optium Xceed / FreeStyle Optium as their sole meter for glucose and ketone testing prior 1st June 2012.* This is great news and many Kiwis may be able to continue using their chosen blood glucose and ketone meter for the next 5 years!

For all other users of Optium and FreeStyle Lite products: There is NO need to switch brands before March 2013.

In fact all Abbott Diabetes Care strips feature very long expiry dates.

Visits to your pharmacy before March 2013 will see expiries of late 2013 2014. You can continue to use your chosen meter until your strips expire.

Overwhelming feedback tells us that most people wish to use their current test meter for as long as possible.

Medica Limited and ABBOTT Diabetes Care sincerely thank our loyal customers who have enjoyed using our innovative diabetes products in New Zealand for over 20 years. Thanks also to everyone who provided support and feedback during the Public Consultation period.

M E D I C A

L I M I T E D

www.medica.co.nz 0800 106 100 PO Box 303205 North Harbour 0751 *Subject to finalising an appropriate agreement and via Special Authority, see www.pharmac.govt.nz MSE120820010322

A 24-hour insulin that I can take once a day? 2

“Sweet...!”

Lantus® (insulin glargine) is now fully funded for Type 2 diabetes mellitus patients requiring insulin.1,2 For thousands of Kiwis, this will be something to smile about.

Lantus® is a long-acting basal insulin. ‘Basal’ is a term used to describe the slow, steady release of insulin needed to control your blood glucose between meals and overnight. Lantus® provides a continuous level of insulin over 24 hours, similar to the slow, steady (basal) secretion of insulin provided by the normally functioning pancreas.

This means that only one dose of Lantus®, given at the same time each day, is needed for 24-hour basal control. 2,3 How is Lantus used in people with Type 2 diabetes?

In Type 2 diabetes, Lantus is given by subcutaneous injection once daily and can be used in combination with oral diabetes medications and/or with short or rapid acting insulin as instructed by your doctor. 2,4,5 Talk to your doctor about whether Lantus® could be right for you.

References: 1. February 2012 Pharmaceutical Schedule Update, Pharmac. 2. Lantus Data Sheet, August 2010. 3. Goykham S, et al. Expert Opin. PharmacoTher 2009; 10(4):705-718. 4. Fulcher G, et al. AMJ 2010; 3(12):808-813. 5. Nathan D, et al. Diabetes Care, 2009; 32:193-203.

Lantus® is a Prescription Medicine that is part of the daily treatment of Type 1 & Type 2 diabetes mellitus. Do not use if allergic to insulin glargine or any of its ingredients.

Precautions: for subcutaneous (under the skin) injections only, do not mix or dilute. Close monitoring required during pregnancy, kidney or liver disease, intercurrent illness or stress. Tell your doctor if you are taking any other medicines, including those you can get from a pharmacy, supermarket or health food shop. Interactions with other medicine may increase or decrease blood glucose.

Side Effects: hyper or hypo glycaemia, injection site reactions, lipodystrophy (local disturbance of fat metabolism). Contains insulin glargine 100U/ml.

Use strictly as directed and if there is inadequate control or you have side effects see your doctor, diabetes nurse or educator. For further information please refer to the Lantus® Consumer Medicine Information on the Medsafe website (www.medsafe.govt.nz). Sanofi, Auckland, freephone 0800 283 684. Lantus® is fully reimbursed when prescribed by a medical practitioner. Pharmacy charges and doctors fees apply.

TAPS PP1903

GLA 12.02.001