Diabetes Winter 2012

Diabetes Winter 2012

Living well with diabetes

Stem cell therapy Can Kiwi scientists find a cure for Type 1 diabetes?

Top tips to beat the winter chill Exercising the MaÂŻori way

Icebergs and insulin One woman's Arctic adventure

Families and children

Planning for pregnancy

Did you know?

People with diabetes are more susceptible to gum disease.1 Diabetes & Dental Health

Fight gum disease with Colgate Total toothpaste

It is recommended that people with diabetes make regular visits to a dental professional to detect and treat gum disease. The twice daily use of an antimicrobial toothpaste is also recommended to minimise the progression of gum disease.2

Colgate Total toothpaste reduces up to 90% of plaque germs that can cause gum disease.3 Colgate Total has a clinically proven antibacterial formula which works by removing the plaque bacteria on the surface of teeth and gums. Its formula also helps prevent plaque bacteria reappearing for up to 12 hours by creating a protective barrier around the teeth and gums.

12 Hour Antibacterial Protection Against Plaque Visit www.colgate.com.au for further details Colgate Total 12 Hour Protection Toothpaste contains Sodium Fluoride 0.22%w/w Triclosan 0.3%w/w. With regular brushing, fights gingivitis, cavities, plaque and protects gums.

Medicines have benefits and some may have risks. Always read the label and use as directed. If symptoms persist see your Dental professional. Colgate-Palmolive Ltd., Lower Hutt.

TAPSPP1380. 1) Taylor and Borgnakke, (2008). Oral Diseases, 14: 191-203; Khader, Albashaireh and Hammad, (2008). La Revue de Sante de la Mediterranee orientale, Vol 14, No.3: 654-661; 2) Blinkhorn, et al. (2009), British Dental Journal, Vol 207, No.3: 117-205; funded by Colgate-Palmolive Pty Ltd, Australia. 3) Fine, et al. (2006). Journal of the American Dental Association, 137: 1406-1413; funded by Colgate-Palmolive Co, New York.

Diabetes: the national magazine of Diabetes New Zealand | Vol 24 no 2 Winter 2012

INSIDE winter 2012 4 5

From the President From the Chief Executive

Upfront

6

News, views and research

Families and children

18 Sport and children: how to keep them safe

28 Planning for a healthy pregnancy

34

Treatment

Research

8

20 Can bariatric surgery

ational rollout for nurse N prescribing scheme

reverse diabetes?

Care and prevention

Travelling with diabetes

9 Beating the winter chill 12 Caring for your teeth

22 Sailing across the Arctic

Win a copy of Nadia’s Kitchen See page 34

Living with diabetes

24 Young BMXer a great diabetes advocate

Focus

10 Groundbreaking Kiwi stem

Profile

cell research

26 Don Beaven:

“The father of diabetes”

Physical activity

14 Developing a uniquely

Community

Māori approach to exercise

30 Destination Unity 31 Latest on Pharmac's proposals 32 Being disaster ready

Food

16 Winter warming soups

The last word

34 Nadia's Kitchen 24 Subscribe to DIABETES magazine and receive a free issue when you first subscribe.

Call 0800 369 636 or go to our website for details.

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

k

Reflecting on the past makes today seem pretty good By the time this drops into your letterboxes the formal celebrations of the golden anniversary of Diabetes New Zealand will be over.

What a significant milestone to celebrate. Fifty years is a long time but I prefer to reflect, rather than dwell, on history. It can yield good stuff – like valuable lessons and some perspective.

Only days ago, at the beginning of June, I too celebrated a significant personal anniversary – 46 years of living with Type 1 diabetes. And yes, I have learned a lot over those years, like recognising good fortune. Those of us with diabetes have benefited from the passage of time even though the big one (a cure) has not come about.

Back in 1966 the equipment used was barbaric. The glass syringes and coarse steel needles had to be boiled to be sterilised. This made the needles blunt. They developed wicked barbs due to repeated use and my dad would try and sharpen them on a whetstone to save the cost of new ones. Yes, that’s right – all supplies including insulin and urine

testing gear had to be paid for!! They were not cheap and therefore tough on family budgets.

I used to be so acutely embarrassed at having to test my wee – how does one explain that to school friends with any kind of dignity? The insulin used was of beef origin which my body reacted to, causing unsightly hollows in my thighs where I injected. Even though we progressed to porcine (pig) insulin things didn’t improve enough for me to feel comfortable wearing swim suits around my friends, especially once boys were part of the mix.

I can only shudder at how poor diabetes control inevitably was, back then, based on the insulins of the day and urine testing (which cannot ever provide an accurate read of glucose levels). No wonder diets were strict and our lives ruled by the clock.

www.diabetessupplies.co.nz

DIABETES | Winter 2012

Yep, that’s when reflection gives you some perspective about diabetes – having it isn’t the best news story in the world but there are things over time that have made living with it better. And the result of that is that it is now possible to live a good life of a normal span. Sure it requires commitment, work and discipline – but it’s possible. And that makes me feel pretty darn fortunate.

Yours, in living a good life.

Chris Baty National President

While I could tell loads more stories, there are better things to reflect on.

The single biggest improvement to my quality of life was the ability to test my own blood glucose, which happened in about 1980. Being able to do this meant I could really know that part of me that is diabetic, which becomes very empowering in diabetes self-management. Even moving onto an insulin pump did not have as profound an effect on my diabetes self.

diabetes nz supplies

4

And the best part these days is that all these requirements, including Type 2 medications (and now even pumps for some) are funded.

Diabetes NZ Supplies is a registered charity 100 per cent owned by Diabetes New Zealand. All profits we make go directly back into helping people with diabetes. We provide a wide range of useful products from pedometers to diabetes-friendly foods. We also supply blood glucose testing strips directly to your door. See the website for details.

Call us (Monday to Friday, 8–5pm) on 0800-Diabetes (0800 342 238)

k

FROM THE CHIEF EXECUTIVE

Making a difference for people with diabetes Pharmac’s proposals on the sole supply of blood glucose meters and test strips, and the strong public reaction to those proposals, have been a hot topic of discussion in New Zealand over the past three months.

We all know the Government is setting clear expectations about our health services –improving quality and doing more with less. This is challenging in a world where diabetes is spiralling out of control and the cost of care continues to climb.

Here at Diabetes New Zealand, we believe our purpose is to ensure the ‘voice’ of people with diabetes is heard from a collective (rather than individual) perspective. We believe we should be speaking up for people’s rights within the existing healthcare system. We advocate for better services, comment on policy and service delivery and provide opportunities for people with diabetes to shape thinking and support diabetes education.

In fulfilling this role, we must be mindful of the Charities Act 2005.

It is clear, following recent legal cases, that non-governmental organisations will not be recognised as a charity if they are only set up to carry out advocacy activities.

Having a strong advocacy platform is essential for people with diabetes and Diabetes New Zealand has an important advocacy role to play.

However, when we use the word advocacy we know it means different things to different people and can generate different feelings and expectations when talked about.

In our advocacy role, Diabetes New Zealand can help resolve problems and improve communication, diffuse tensions and conflicts. We provide information and opinions that would otherwise not be heard; represent groups that otherwise have no public voice; and provide a cost-effective channel for consultation. We must

also be impartial and ensure we remain as independent as possible.

We believe we can help make services for people with diabetes better and more cost-effective. We can help prevent future problems by being involved in the development of policies and practices at local and national level. This work also raises awareness and understanding of diabetes among the general public.

This advocacy platform needs to be built on well-developed skills, expertise and plans. Linked to this is the importance of attitude. Maintaining professionalism, being friendly yet firm, assertive and persistent. Some of our issues, for example the Pharmac proposals, will take time to resolve.

It is our responsibility, as a good advocate, to be in the debate for the long haul and not burn our bridges early on in the process.

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 PATRON: Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: Joe Asghar COMMUNICATIONS MANAGER: Lisa Woods DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 3, Revera House, 48-54 Mulgrave 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)

Winter 2012 | DIABETES

5

UP FRO NT

k

NEWS, VIEWS AND RESEARCH

Sir Don Beaven Research Fund

Eating fruit and veg cuts risk

Diabetes New Zealand is launching an exciting research fund dedicated to diabetes research – the Sir Don Beaven Research Fund.

A new study has found that people who eat a range of fruit and vegetables could be helping to reduce their chances of developing of Type 2 diabetes. The study, published in the journal Diabetes Care, assessed how much fruit and vegetables was eaten by more than 3,700 people aged between 40 and 79 in the UK.

The fund is in memory of Prof Sir Don Beaven, our former Patron, who was one of New Zealand's (and the world’s) greatest researchers into diabetes. He worked tirelessly and with unparalleled passion to improve the lives of people with diabetes.

Sadly Sir Don Beaven passed away in 2009 but this fund is an important way we can honour his memory and all that he did for Diabetes New Zealand and people with diabetes. It replaces the Diabetes New Zealand Education and Research Fund.

The fund is intended to support projects with a demonstrable benefit to people in New Zealand with diabetes. At the time of writing, priority areas for funding were being finalised. For more information see www.diabetes.org.nz.

Read more about Sir Don Beaven’s historical legacy on pages 26/27.

Diabetes annual review People with diabetes are being urged to continue having an annual check up once the Get Checked programme finishes next month.

From 1st of July, district health boards will provide Diabetes Care and Improvement Packages, replacing the Get Checked programme. Get Checked was a success in improving only certain aspects of diabetes management and made little difference overall, while nearly one-third of people with diagnosed diabetes were not using the free annual checks.

The $12 million Diabetes Care Improvement Packages will let district health boards look at their own population needs and build on initiatives that have worked well in their region and further improve these achievements. Initiatives include nurse-led clinics, patient group education sessions and community outreach services. This means the Diabetes Care Improvement Packages are likely to be delivered in many different ways depending on the population needs.

District health boards submitted their individual plans to the Ministry of Health at the end of March and Diabetes New Zealand was involved in the review of these.

The Ministry of Health recommends patients with diabetes have an annual review. In addition to the population initiatives, district health boards will continue to fund the cost of tests carried out as part of this review, including a blood test to measure HbA1c (a longer term measurement of blood sugar control).

6

DIABETES | Winter 2012

It revealed those who ate the most had the least likelihood of developing Type 2 diabetes over the next 11 years, compared to those who ate the least. Of the group, 653 people developed Type 2 diabetes.

The scientists noted the people who consumed the widest range of fruit and vegetables had the lowest diabetes risk – perhaps because it brings a good variety of nutrients, such as vitamins and minerals, as well as fibre and phytochemicals, which could help to protect cells from damage.

Source: diabetes.co.uk

New Zealand's first diabetic dog A former trainee police dog is being retrained as New Zealand’s first diabetic response dog. Merenai Donne, of the Kotuku Foundation Assistance Animals Aorearoa, is training the 16-month-old German Shepherd to detect extreme low blood sugar in humans. Diabetic response dogs live with people who have hypoglycaemic unawareness, which can lead to potentially fatal low blood sugar, without the usual symptoms. If Uni passes the stringent training, he will become the first diabetes dog in New Zealand.

New! Feijoa-based fruit conserves • • • •

•

20% more fruit then a normal jam high in Vitamin C and anti-oxidants preservative-free contains Xylitol (produced in your own body), which has a GI factor of 7 and has other health benefits such as: -- minimal effect on blood glucose levels -- helps prevent tooth decay, middle ear infection and candida -- helps to maintain bone density 5 flavours; Pure Feijoa, Feijoa & Blueberry, Feijoa & Raspberry, Feijoa & Boysenberry, and Feijoa & Strawberry

www.fruatelp.com

NEW S , VI EW S A ND RES EA RCH

k

U PFRONT

TB drug hope for T1 A new drug therapy for treating patients with Type 1 diabetes has shown an early success in killing off certain autoimmune cells that attack the pancreas, and also raised levels of a marker that indicates that insulin is being produced. The research, carried out at the Massachusetts General Hospital in the United States, has offered promising results in its phase I humans trials, although it is still too early for it to become a viable alternative for use by humans with diabetes.

The tuberculosis vaccine Bacillus Calmette-Guerin was given to 12 people with diabetes who had suffered from the condition for an average of 15 years.

The treatment was shown to kill the pancreas-attacking T-cells and boost the body’s protective T-cells.

Source diabetes.co.uk

Type 2 diabetes harder to control in kids Type 2 diabetes progresses more rapidly in children than in adults and is harder to treat, a new study shows.

Researchers believe that rapid growth and intense hormonal changes at puberty may play a part. The first large-scale US study of Type 2 diabetes in children followed 699 children aged 10 to 17 years at medical centres around the country for four years. It found that the usual oral medicine (Metformin) stopped working in about half of all patients within a few years and they had to add daily shots of insulin to control their blood sugar.

The results were published in the New England Journal of Medicine.

Source: Reuters

Artificial pancreas trial An ‘artificial pancreas’ that could potentially automate care for millions of Type 1 diabetes patients has received US Food and Drug Administration (FDA) approval for an important testing phase – the first US outpatient clinical trials.

The hand-held device was developed by the University of Virginia School of Medicine. It was created by reconfiguring a standard smart phone, which automatically monitors blood sugar levels and provides insulin as needed. It is hoped it will relieve patients from having to regularly check their blood sugar levels and administer insulin shots. Earlier inpatient trials at the University of Viriginia and Europe, as well as an ongoing outpatient trial that began last year in Italy and France, have shown promising results.

Source: Science Daily

Winter 2012 | DIABETES

7

TREATM ENT

k

NATIONAL ROLLOUT FO R NURS E PRES CRI BI NG

Diabetes nurse prescribing trial a success A project that allows nurses to prescribe medicines to people with diabetes has been hailed a success after patients said it improved their quality of care.

minute that it would be unsafe but we had to test it. It has shown to improve access to care for patients and improved quality of care.”

The diabetes nurse prescribing scheme will now be rolled out across New Zealand. Up to 20 nurses in primary health or specialist diabetes services will be encouraged to apply to take part in the initiative.

Eligible nurses will have to pass strict criteria before they will be allowed to prescribe medicines.

The benefits of the scheme include improved patient safety and better diabetes care.

The scheme has been widely used in the UK and has an excellent safety record there.

Project manager Dr Helen Snell

Project manager Dr Helen Snell said: “We didn’t doubt for a

Ways to give 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.

8

DIABETES | Winter 2012

Four demonstration sites were set up last year, as Diabetes reported in the Winter 2011 issue. As well as insulin and other diabetes medications, nurses were allowed to prescribe medicines for associated conditions, such as high blood pressure and cholesterol.

The six-month trials in Hawke’s Bay, Mid Central Health, Auckland and Hutt Valley, involved 12 diabetes nurse specialists who were able to prescribe medicines to patients with Type 1 and Type 2 diabetes. They were closely monitored by doctors.

The results showed there were no reported adverse events and patients liked the convenience of seeing a nurse for all their diabetes needs.

Nurses also reported better job satisfaction – being able to provide all the diabetes care a patient needed from education to insulin.

“It completes the process.

You know you’ve done all the education, started someone on insulin, got it all sorted, handed them the script, they’re going to start insulin tonight. And they walk out and they’ve got everything they need.”

A NURSE INVOLVED IN THE DEMONSTRATION PROJECT.

One patient said: “My diabetes nurse is able to give me the time and understanding I need to understand how my medications work and how they will affect my body, without the feeling of being rushed.”

Another patient commented: “It’s much more convenient, it means I can avoid a second unnecessary trip to the doctor for just a script.”

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

D IABETES A ND CO LD WEATH ER

k

CARE AND P RE V ENTION

Top tips for beating the winter chill Don't let the cold get you down.

Dr Bob Smith offers some timely advice on how to keep healthy this winter.

Watch your blood sugars Winter is here and people with all types of diabetes tend to see their blood sugar levels rise when the temperature drops. Regular testing will help you catch any high or low blood sugar levels and help keep them under control. Cold hands can make testing trickier, so warm them up before doing your test.

Try to avoid getting ill It is harder to control your diabetes if you are ill, so it makes sense to try to ward off illnesses as much as possible during the flu season. As well as making you feel rotten and less energetic, blood sugar levels often rise significantly higher when you have a cold, flu or a virus. Keep yourself warm, eat well and watch your blood sugar levels. Consider seeing your doctor for a flu jab, it is free of charge for people with diabetes.

Do a little daily activity If you tend to feel the cold during the winter, exercising regularly could help. Being physically active can help regulate your glucose levels by increasing insulin sensitivity (in all types of diabetes), keeping you warm and improving your mood.

Exercise warms you up by increasing your metabolism.

Physical activity is also good for the mind and gives you more energy, leaving you in a better position to manage all your activities.

Boost your vitamin D levels Around five percent of adults in New Zealand are deficient in vitamin D and a further 27 percent are below the recommended level.

Vitamin D is essential for bone strength. The risk of deficiency rises if you live south of NelsonMarlborough and get little time outdoors between May and August.

If you have liver or kidney disease, or are on certain medications, you may be at risk of vitamin D deficiency. Talk to your doctor if you are worried about it.

Walking outside in the sunshine is a great way to boost vitamin D in the winter.

Eating foods rich in vitamin D such as oily fish (salmon, tuna, sardines, eel and warehou), milk and milk products, eggs and liver is another natural way to increase your vitamin D.

Banish the winter blues Watch your diet Many of us eat more in the colder months and we tend to reach for high calorie comfort foods, ready meals and fat-filled takeaways when it gets cold. This is the body’s natural response to the cold but try to keep an eye on what you are eating and make sure you don’t eat too much.

Stick to a wholefood diet with lots of fresh vegetables and fruit – warming soups and winter stews provide comfort as well as lots of vitamins and minerals.

Winter can be a tough time of year and the cold weather, lack of sunlight and illness often combine to make people feel a bit gloomy or even depressed. It will help if you follow the tips above, and exercise regularly and eat healthily.

Try to plan time out with family or friends during the winter months and enjoy winter activities together, even if it’s just playing cards in front of the fire. If you find you are not coping, talk to someone you trust about it. It’s important to reach out to others and seek help.

Winter 2012 | DIABETES

9

FO CU S

k

STEM CELL THER APY

Stem cell therapy: Can Kiwi scientists find a cure for diabetes?

Researchers in New Zealand are poised to conduct clinical trials on patients with Type 1 diabetes using stem cells to allow the gradual recovery of insulin. Finding a cure for diabetes has a special resonance for scientist Dr Paul Turner, who is leading the ground-breaking study.

I was diagnosed with Type 1 diabetes when I was nine months old. At some point after my birth my immune system turned nasty. It had a genetic predisposition towards nastiness but it also needed a trigger, something to push it over the edge and encourage it to begin attacking the beta-cells in my pancreas that produce insulin. Perhaps the trigger was a viral infection, or maybe something else as yet unknown.

The net effect however was Type 1 diabetes and a lifetime of blood sugar monitoring and insulin injections, with the ever present spectre of long term complications lurking in the background.

10

DIABETES | Winter 2012

I am now 41 and not very fond of my immune system because it has let me down. Especially my T-lymphocytes, a subset of white blood cells that do the most damage in diabetes by stopping my body producing insulin. It now seems likely that the destruction of my beta cells was not a one-off event.

T-lymphocytes continue to attack any beta cells they find in my body – and this may happen for a long time.

This finding could lead scientists to a possible therapy – or even cure – for Type 1 diabetes.

Much research worldwide has focused on the goal of preventing Type 1 diabetes in the first place, by preventing the initial auto-immune destruction of insulin producing beta cells. But recent research has suggested an even more exciting prospect – the gradual recovery of insulin in patients with no detectable insulin function by suppressing the auto-immune response in their body.

Researchers have achieved this using mesenchymal stem cells, an important adult cell type that is being widely studied for regenerative medicine applications. These stem

cells can change the behaviour of cells in the immune system by instructing reactive immune cells (T lymphocytes and other cells) to stop proliferating and become quiet and non-aggressive. It is this property that we would like to further investigate as a therapy for Type 1 diabetes.

After reading the Chicago study (see box right), Dr Jim Faed and I realised that our work growing stem cells with very similar properties but taken from adult bone marrow, could be integrated into similar research right here in New Zealand.

We work in Dunedin for the Spinal Cord Society of New Zealand, based in the Centre for Innovation at Otago University. We have drawn up plans with Dr Jim Mann and Dr Ben Wheeler, from the Edgar Centre for Diabetes and Lipid Research, and Dr Sarah Young, an immunologist from Otago University, to run two clinical trials to see if the Chicago study findings can be repeated and improved.

We feel two trials are needed. Both would involve obtaining a small sample of bone marrow using standard methods employed in

STEM CELL TH ERA PY

major hospitals. The stem cells would be grown in the laboratory and their immune suppressing properties activated. In the first trial we would infuse activated stem cells back into the patient and measure their ability to switch the behaviour of aggressive T lymphocytes to ‘peaceful’ T regulator cells.

Trials like this are occurring internationally but without the activation step, and results are not yet clear. The second trial will be similar to the Chicago study. The stem cells from each person will be used in the laboratory to ‘condition’ their white blood cells before reinfusing them. We will measure C-peptide levels during fasting and also after a glucose challenge (when levels are expected to rise further).

We are very excited about trying these approaches but there are caveats as you may expect with any research. We need to finish the preliminary laboratory work focused on growing the stem cells and checking their quality before we try to gain permission from the Standing Committee on Therapeutic Trials, and the Health and Disability Ethics Committee, so we can start the trials.

I have had Type 1 diabetes for 41 years now so I have a great vested interest in this research and I am excited to be part of it.

k

FOCUS

Dr Paul Turner at work in his lab.

Campaign to raise funds for Phase 1 trials Adult stem cell therapy is predicted to be the next great advance in medicine.

If either of the two proposed clinical trials is shown to be useful in treating Type 1 diabetes, then stem cell therapy may help other auto-immune conditions like multiple sclerosis, Crohn’s disease and rheumatoid arthritis, to name but a few. All of these disorders are caused by the failure of normal regulation of immune responses.

However Dr Turner’s research and clinical trials cannot proceed without appropriate funding in the order of $1.4 million.

If you would like to make a donation towards this cause, then the Spinal Cord Society NZ website www.scsnz.org.nz provides a means for you to do that. An email plus a donation will ensure that your contribution goes only towards the joint SCSNZ-Diabetes research work.

The Chicago study: patients recover insulin function after stem cell therapy A ground-breaking clinical trial by a joint Chinese-American group (known as the Chicago study) was published earlier this year. Researchers grew stem cells from human umbilical cord blood to treat white blood cells from people with Type 1 diabetes. These stem cells have the ability to change aggressive T-lymphocytes into ‘peaceful’ T regulator cells that no longer attack. Instead they help turn off the autoimmune response.

Insulin made in the pancreas is produced as a single long chain which folds together like a knot, before part of the chain is sliced

off to leave active insulin. The sliced off bit is called C-peptide and is not present in injected pharmaceutical insulin. Therefore C-peptide can be used to measure insulin that has been produced by a person’s own beta cells in their pancreas.

The results were astonishing. After 12 weeks all treated patients had some increase in production of C-peptide, meaning they were making their own insulin in larger amounts.

Even patients who had C-peptide levels too low to be measured before treatment started producing some insulin.

In practical terms this translated to an

average reduction in injected insulin of between 25–38 per cent and an improvement in long-term control as measured by a decrease in HbA1c of between 1.68 and 1.91 per cent. Anyone who has tried to lower their HbA1c levels by fine tuning diabetic control will know how difficult it is to obtain drops like this.

You can read the full Chicago study research paper ‘Reversal of Type 1 diabetes via islet cell regeneration following immune modulation by cord blood-derived multipotent stem cells’ (by Yong Zhao et al) at: www.biomedcentral.com/1741-7015/10/3

Winter 2012 | DIABETES

11

C ARE A N D PRE VE NTI O N

k

D IABETES A ND O RA L H EA LTH

Caring for your teeth It may come as a surprise to hear people with diabetes are more likely to have problems with their gums, teeth and mouth – especially if their blood sugar levels are not well controlled.

Wellington dentist Dr Anna Ferguson explains.

People with diabetes are at an increased risk for serious gum disease because they are more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums.

Emerging research suggests the relationship between serious gum disease and diabetes is a two-way street.

High blood sugars increase the risk of developing gum disease. Conversely having gum disease can make it harder to keep blood sugar in check.

Gum disease is a common infection that occurs when bacteria in the mouth form into a sticky plaque which

sits on the surface of the teeth. If plaque is not removed by regular brushing and flossing, a gum inflammation called gingivitis can develop. This is the first stage of gum disease. If you ignore it, the gum disease will spread to the bone and tissues surrounding the tooth.

The most severe form of gum disease is called periodontitis. If untreated, this can lead to loosening of your teeth, raised blood sugar and the eventual loss of the tooth.

People with serious gum disease are more likely to suffer from heart disease although researchers aren’t sure why. One theory is that the oral bacteria travel into the bloodstream and attach to fatty plaques in the arteries, causing inflammation, which leads to a heart attack.

Gum disease is the most common oral complication of diabetes. There is also an increased incidence of dental caries, fungal infections (candida) and dry mouth.

These conditions are related to your ability to maintain good blood sugar control. The better your blood sugar the fewer oral complications you will have.

The good news is that there is plenty you can do to keep your teeth, gums and mouth healthy.

First and foremost, control your blood sugar. Good blood glucose control can also help avoid candida and dry mouth, which can cause soreness, ulcers, infections and cavities. Second, practise good dental hygiene – regular brushing, flossing and visits to your dentist/hygienist.

12

DIABETES | Winter 2012

D IABETES A ND O RA L H EA LTH

k

CARE AND P RE V ENTION

Signs of gum disease

Protect your mouth by keeping blood sugars as close to normal as possible, brush twice a day and floss daily. See your dentist at least once a year and get your teeth professionally cleaned.

• Bleeding gums.

• Red, swollen, or tender gums.

• Gums that have pulled away from your teeth. Part of the tooth’s root may show, or your teeth may look longer.

• Pus between your teeth and gums (when you press on the gums).

• Bad breath.

• Adult teeth that are loose or moving away from each other.

• Changes in the way your teeth fit when you bite.

• Changes in the fit of partial dentures or bridges.

If you wear a denture remove it daily and clean it with a soft brush.

with your doctor, and dietitian, medications, suitable meals and carbohydrate intake following the surgery.

The goal of brushing your teeth is to remove plaque thus preventing cavities (holes in your teeth) and gum disease. Talk to your dentist about the best kind of toothbrush to use. Choose a good quality brush that is comfortable, with soft bristles. Consider buying an electric toothbrush that is gentler on gums. Ask your dentist to show you how to brush your teeth correctly.

Floss once a day.

Keep your dentist and hygienist informed of any changes in your condition and any medication you might be taking. For acute infections, such as dental abscesses, seek treatment immediately. Postpone any nonemergency dental procedures if your blood sugar is not under good control.

Brush at least twice a day, after breakfast and in the evening just before bedtime. A fluoride toothpaste will keep the teeth strong, and some toothpastes cater for sensitive teeth. An anti-bacterial oral mouthwash may also be a good idea – ask your dentist if you need one.

If you suffer from a dry mouth, have regular drinks of water and try a sugar-free chewing gum. Salivary substitutes are available – talk to your dentist about these.

Visit your dentist regularly. Get your teeth professionally cleaned and determine with your dentist/hygienist how often this should be done each year. If there is periodontal disease, the dentist may refer you to a periodontist – a specialist in the diagnosis, prevention and treatment of gum conditions.

Relax before you visit the dentist because stressing out may make your blood sugar rise. Make absolutely sure that your dentist knows you have diabetes. Some dentists may require you to know your blood sugar level. Discuss with your dentist the best time for your appointment around medication and meal times. You should have your normal medication and meals prior to your dental appointment.

If you require extensive periodontal surgery or dental extractions (more than one tooth) you will need to plan

Winter 2012 | DIABETES

13

P HYS I CA L A CTI VITY

k

INSPIRED BY H I STO RY

Exercise the Ma¯ori way

Like so many Māori families, diabetes has had a significant impact on my whānau (family) with my father dying at 46 due to complications brought on by diabetes, and my older brother suffering major health problems exacerbated by diabetes.

Unfortunately it’s not so unusual and poor health appears to be rampant amongst Māori. Often Māori are fully aware of their health situation but feel helpless to do anything about it – especially when statistics suggest it is pointless to do so.

So I’d like to try something new.

Why don’t we park the poor health statistics for a moment and identify strengths of Māori, especially in terms of Māori health. Some years ago, I completed a PhD in exercise and sport psychology – perhaps subconsciously in an attempt to avoid diabetes by being as informed as I can. I also hoped to make it past 46 – I’m almost there.

During this time I began to think we could progress Māori health more rapidly when we were able to prove that Māori had a history of

14

DIABETES | Winter 2012

good health. Recently, through my work, I was able to convince a group of elderly Māori they come from a genetic line that afforded fantastic health potential – ranging from higher bone density to unparalleled muscular development. This helped them pursue what is rightfully theirs (see the Gisborne study in the box at right). It’s a much better starting point for an article than talking about a father dead at 46 years old.

quickness, speed, coordination, flexibility, muscular endurance, strength and aerobic conditioning.

Importantly, these techniques were garnered from pre-European Māori’s most abundant resource – the environment they lived in and shared with other living beings.

Māori looked to their atua (gods), kaitiaki (guiding animals) and tipua (spiritual animals, for example taniwha) to make sense of their world and strengthen their control over their collective destiny (iwi, hapū, whānau).

For the past decade I have been teaching indigenous health, sport and physical activity at the University of Otago, the University of Hawaii, and latterly as part of a Māori health initiative based out of the Tairawhiti (on the East Coast).

During this time I have developed an interest in the origin of Māori physical activity and its potential to improve contemporary Māori health. I discovered pre-European Māori had a comprehensive array of training techniques at the highest level. This included expertise in strength and conditioning techniques for power, agility,

‘I have discovered preEuropean Ma¯ori had a comprehensive array of training techniques at the highest level. This included expertise in strength and conditioning techniques for power, agility, quickness, speed, coordination, flexibility, muscular endurance, strength and aerobic conditioning.’

— DR IHIRANGI HEKE

Māori began to look to the characteristics and personality traits of their atua, kaitiaki and tipua as guiding forces to build strength and conditioning programmes for physical attributes (tinana), mental toughness (hinengaro) and spiritual connections to their environment (wairua). A kind of ‘total health’ approach gifted from the gods.

I want to prove to contemporary Māori that their pre-European ancestors valued physical training

COURTESY OF NEW ZEALAND DEFENCE FORCE/CHRIS WEISSENBORN

Dr Ihirangi Heke is an expert in Māori health and physical activity. He writes about an exciting new area of research using traditional strength-based training from pre-European times to encourage more Māori to exercise.

I NS PI RED BY H I STO RY

and consequent health. My intention is to build physical activity programmes that use the environment in a contemporary manner to improve and increase physical activity and health. The initiative will develop a socially and culturally valid strength-based approach.

This will be a global first: culture informing-physical activityinforming health. I hope this approach can show how Māori could lead other indigenous people in the shift to valuing and improving their health. Lastly, it means many of the activities unique to Māori, for example whakapapa, tikanga, kawa, atuatanga, kaitiakitanga and tipuatanga, may be the key to Māori understanding the role of physical activity – and why it should be valued because of its connection with our genetic origins.

Of course, more conclusive evidence is needed and I can hear the academics among you saying: ‘sounds good but where’s your proof?’. It is coming. See the Ministry of Education’s support for a new curriculum based on atuatanga (Māori theology) for all wharekura (schools) and wananga (tertiary institutions).

The most interesting part of my work has been showing Māori they can reclaim the experiences of their ancestors. They can readily change when shown they come from a lineage that valued courage and fortitude instead of giving in to contemporary illnesses that threaten their very existence.

I prefer to think that Māori can determine their own mana rather than have it decided by a medical model that assigns pre-determined roles – that Māori are automatically at high risk of diabetes, cardiovascular disease, lung cancer and so on. I think this approach is destined for big things.

Watch this space as more Māori

k

P H YS I CAL A C TIVITY

Dr Ihirangi Heke (far right) wants to use the physical environment to develop activity programmes for modern Ma¯ori.

The Gisborne study Dr Ihirangi Heke recently took part in a research study in Gisborne, where a group of elderly Māori were involved in a physical activity programme aimed at showing their innate strength.

Twelve kaumatua took part in a research project that increased their physical activity, analysed their gait on a treadmill, and tested a newlydesigned diabetic shoe. They were split into three groups: one received gait analysis; the second gait analysis and a new pair of diabetic shoes; and the third gait analysis, new shoes and a six-week training programme.

Now, what does this have to do with diabetes or a strength-based approach? For a start we didn’t focus on the illnesses these individuals had, other than to obtain informed consent. We told them they were the culmination of centuries of Māori who had overcome introduced diseases,

health organisations begin to return to the actions of their ancestors.

Watch for physical activity programmes that use Tangaroa (the atua of the sea) and wave speed for interval training, rather

social and political oppression.

We said they were Māori who had flourished, where others had not. That got them thinking. They started to believe that they could get themselves up and moving again. And they did!

All 12 increased their physical activity output and their self esteem.

All 12 became the envy of the other 140 individuals that made up their kaumatua group, not just because of the new shoes they were sporting, but because they seemed to be getting something special the others wanted.

All 12 have continued to sustain their physical activity efforts. One individual went from bent over and hobbling to an upright powerful stride. Best of all, these individuals have been able to recruit others to physical activity because of the gains they have seen.

than the clinical environment of contemporary gyms. Watch for Māori moving forward as they learn more about where they have come from rather than what they have become. Just watch this space.

Winter 2012 | DIABETES

15

FO O D

k

RECIPES

Winter warming soup always a winner It’s cheap to make, delicious and good for you. Winter is soup season and what could be easier than to knock up a basic vegetable soup recipe that can be easily adapted into 10 different versions to suit your mood and tastes. Thanks to our friends at Healthy Food Guide for their diabetes-friendly Basic Soup – 10 Ways recipe.

Soup, soupe, potage, zuppa – whatever the language, soup is a great menu option for the winter. Why?… because it is versatile. It can be a quick and nutritious lunch, a healthy afternoon snack or a hearty and filling meal.

Making your own soup is easy. As the recipes show, a basic soup can be easy to make and then adapt to fit the occasion. A light vegetable soup for a healthy lunch or a hearty chicken soup with vegetables served with a crusty wholegrain roll for a warming nutritious meal on a cold winter evening.

Using a variety of vegetables of different colours helps towards your five-a-day and provides a good intake of antioxidants. Adding beans and lentils helps to boast your fibre intake. Try using herbs and spices to flavour your soup instead of salt. Try thickening with puréed vegetables, lentils and beans and enjoy a healthy warming meal.

Ann Gregory, Diabetes dietitian

Reproduced with permission from Healthy Food Guide magazine.

For more healthy recipes and advice, see the latest issue, on sale now in supermarkets.

16

DIABETES | Winter 2012

RECI PES

Basic soup: 10 meals!

Serves 4 Time to make: 20 mins BASIC RECIPE: 1 large onion, finely chopped 2 teaspoons oil 3 cups full-flavoured liquid vegetable stock about 3 cups chopped vegetables – more for a thicker soup salt and pepper, to taste Step 1 Cook onion in oil until soft.

Add stock and vegetables. Simmer for 10 minutes, or until vegetables are soft.

Step 2 If a creamier soup is preferred, blend using a stick blender or food processor. Season to taste.

VARIATIONS White bean and chorizo soup (Pictured) Add 1 teaspoon crushed garlic and 2 sliced chorizo sausages to almost-cooked onion (Step 1). Cook for 1–2 more minutes to brown chorizo. Add 1 teaspoon fresh or dried thyme and 1 teaspoon paprika.

Use finely-sliced celery and carrot as the vegetables. When vegetables are soft, add one 390g can cannellini beans (drained).

Heat through and serve.

Cauliflower and bacon soup Dice 3–4 rashers lean bacon. Add to onion (Step 1).

Use 1 head of cauliflower and 2 potatoes as the vegetables. Simmer until soup has thickened. If you prefer a thicker, smoother soup, blend using a stick blender or food processor. Add 1/2 cup grated edam cheese and serve as soon as cheese melts. Top with chopped fresh parsley.

Leek and potato soup Add sliced leek and 1 teaspoon crushed garlic to onion (Step 1). Add 1 bay leaf to stock. For the vegetables, cook 3 large (or 4 medium) potatoes in boiling water until tender, drain then mash. When soup is cooked, remove bay leaf and add mashed potato.

Stir well to combine. Add 1 cup trim milk and a little white pepper. Serve topped with chopped fresh parsley and a little grated cheese.

Pumpkin soup Add 1 teaspoon crushed garlic to onion (Step 1). Increase stock to 4 cups. Use 5 cups peeled, chopped pumpkin as the vegetables or include 1 large potato in the mix. Blend to a creamy consistency and add 1/4 teaspoon nutmeg before serving with a little crispy bacon to garnish (optional).

k

FOOD

Curried kumara soup Add 1 teaspoon crushed garlic and 2 teaspoons curry powder (more if you like it hot) to softened onion (Step 1). Cook for 1 more minute to develop flavour. Use kumara or a kumara/potato mix as the vegetables. When cooked, blend to a creamy consistency then add 1 cup trim milk. Heat and serve topped with chopped fresh chives.

Pea and corn soup Use 1 1/2 cups frozen peas and 1 1/2 cups frozen corn as the vegetables. Serve as is or blend for a thicker, creamier soup.

Hearty chicken and vegetable soup Make Basic soup using chicken stock.

Increase stock to 4 cups. To the vegetables, add 1/2 cup small pasta such as small macaroni or orzo and 1 large (or 2 medium) skinless chicken breast.

When pasta and vegetables are cooked, remove chicken and leave to cool for a few minutes. Shred and return meat to pot. Add 1 cup chopped spinach and simmer for 5 more minutes. Serve with a blob of basil pesto.

Minestrone To the stock add 1/2 cup pasta shapes and cooked lean bacon.

Add one 400g can chopped tomatoes or tomato purée and one 390g can red kidney or cannellini beans (drained) towards the end of cooking. Serve topped with grated parmesan cheese and chopped fresh parsley.

Lentil and vegetable soup If a slightly curried flavour is preferred, add 1 tablespoon curry powder to cooked onion (Step 1). Replace 1 cup of the stock with one 400g can chopped tomatoes in juice. Add 1/2 cup red lentils when adding vegetables. Increase vegetables to at least 4 cups of colourful vegetables.

Broccoli and blue cheese soup Make Basic soup increasing stock to 4 cups.

Use 1 head of broccoli and 2 medium courgettes as the vegetables. When cooked, blend to a smooth consistency then add 100g crumbled blue cheese.

Heat through. For a smoother soup, blend further. Serve with a sprinkle of crumbled blue cheese over the top.

NUTRITION PER SERVE (BASIC SOUP RECIPE): Energy: 820kJ, Calories: 196cal, Protein: 8g, Fat: 4g – saturated: 1g, Carbohydrates: 30g – sugars: 25g, Dietary Fibre: 14g, Sodium: 700mg, Calcium: 230mg, Iron: 6mg.

Nutrition information for the 10 variations is available on www.diabetes.org.nz

Winter 2012 | DIABETES

17

FAM I LI ES A N D CH I LD RE N

k

MAKING S PO RT REWA RDI NG

How to help a child take part in sport safely and without too much (parent) stress Renata Porter is a mother and wife of some of the funniest people she knows. There is a lot of laughter, love, and ‘going with the flow’ in her house. Both her kids have Type 1 diabetes.

Her daughter Kelsey was diagnosed when she was four years old. She is now 18 and faces all of those teenage worries. Her son Marty was diagnosed at 9. He is 12 and a boy… need she say more? The family moved from the US to New Zealand in August of 2009.

Mum-of-two Renata Porter is an active member of Diabetes Youth and a keen supporter of the on-line diabetes community. Today she gives some practical advice on how to help children enjoy sport.

There you are, sitting on the sidelines clenching a juice box in one hand and your child’s blood glucose metre in the other. You are like every other parent excited and proud to watch your son or daughter play sport. But in other ways, you are oh so different – scrutinising every move, evaluating every missed shot, trip or wobble. “Is she just clumsy today or is she low?”

Kids love sport, parents love sport and you aren’t about to let Type 1 diabetes stand in the way. However, the reality is that most T1s and their parents approach any exercise with uncertainty. Sport can be the most rewarding of activities for your children and a great pathway to wonderful opportunities, but being a T1 child can make the path scary. (Never mind your squeezing the heck out of that juice box, will any be left if they actually need it?).

So here are some ideas to help you make it a rewarding experience.

18

DIABETES | Winter 2012

First things first, you need to discuss the level of activity with your doctor. If your child is training two hours a day, three times a week, then on those days you will need a recommendation on reducing insulin. When talking to the doctor, give him/her a real sense of what your child goes through when they play sport, and also explain game days. Often on game days there is a lot more adrenaline, and they may or may not play as long as they usually practise, so you need to be very precise with the doctor.

After you have made your insulin adjustment plan, it’s best if you think about your child’s training/ playing routine in three sections: Before, during and after. That way you will be able break down what works and what doesn’t so you can learn and prepare for the next time.

Remember to take notes so you can change things as you go along.

Before You will need to evaluate the day. Is this a two-hour hard training session, is it a 30-minute session or is it game day? On days where activity is high you might consider an extra snack, preferably one with a good carb/ protein mixture before they train.

Make sure your child tests before they train and you take note of what

their blood glucose reading was and what type of snack you gave them.

This will allow you to adjust if it’s not enough or too much. Keep in mind that if your child goes in with a really high blood glucose it will be hard for them to concentrate, so you need to find the balance that suits them.

During Have your child test again during break times. If they are in the middle of a training session, tell the coach ahead of time that you are going to want your child to stop to test during a water break. Take it from me, coaches don’t like pushy parents on the turf… so tell them ahead of time.

If you feel they are at a decent blood glucose, but they have an hour to go then you might consider a small sports drink. If they are low, they will need a quick sugar booster and maybe a bit of sport drink to keep them going. If they are high, just keep them on the water and adjust your ‘before’ snack. What’s important is the discovery of what works and what doesn't. Take notes, so you know what to change next time.

After Your child should test again after training to make sure they aren’t low. Keep in mind that quite often a T1 will go high after a hard training

MAKING S PO RT REWA RDI NG

k

FAM I LI E S A ND CH ILD REN

session. Don’t rush to give them insulin to get them down, because all too often they will drop and you don’t want them to drop when they have insulin on board. This is important because a lot of practices are at night and your child might go low in the middle of the night.

You should ask your doctor how he wants you to handle this because every child is different. What we do after training is ignore the high blood glucose number and just bolus for the next upcoming meal.

Then test again a few hours later, that will usually tell us if we made the right decision.

In addition to breaking down the day, I would also recommend you spend time talking with your child about the need to take notice of how they ‘feel’ throughout each stage. This will help build up their blood glucose/ activity awareness. Not foolproof, but it definitely helps if they understand what a high/good/low blood glucose feels like during activity.

Lastly, for those of you who have younger ones, work out a hand signal system so they can give you a signal on how they feel or what their blood glucose level is. This works really well during games when you can’t get anywhere near your child to actually hear what they are saying.

Caution: do NOT use the thumbs up/thumbs down signal. The other children/parents/coaches might interpret that to mean something else. (Yeah, that was another one of my lessons learned.)

Simple preparation and study will allow both you and your child to feel confident in their sport. It will allow you to enjoy their accomplishments and let go of a bit of worry, so put down the strangled juice box!

Useful websites for more information and inspiration: http://t1.org.nz/: devoted to Type 1s in New Zealand who love sport. www.teamtype1.org: showcases athletic teams with Type 1 members from all over the world. A truly inspiring site.

Winter 2012 | DIABETES

19

RES EA RCH

k

WEIGHT LOSS SURGERY

Can bariatric surgery reverse diabetes?

Does weight loss surgery provide a long-term treatment for Type 2 diabetes? Caroline Wood reports on two studies that claim surgery can help patients come off their diabetes medication.

two years after the procedure.

Weight loss surgery is controversial, expensive and doctors don’t agree on its long-term effects.

The studies, published in the New England Journal of Medicine, followed patients one and two years after weight loss surgery.

But more studies are suggesting that bariatric surgery can reverse Type 2 diabetes, leading some doctors to argue it should be offered to more people with Type 2 diabetes.

Others disagree, saying the longterm benefits have not been proven beyond the short-term – and a national database of New Zealand operations and their outcomes should be set up.

Two US studies hit the headlines in New Zealand earlier this year.

They tested permanent weight loss surgery in people with long-term severe Type 2 diabetes. Both studies showed that patients who had bariatric surgery were able to reverse their diabetes – at least in the first

Some people were able to stop taking insulin as soon as three days after their operation. Cholesterol and other heart risk factors also greatly improved. In one study patients were able to stop all diabetes drugs and their disease stayed in remission for at least two years.

One study leader Dr Fransesco Rubino, chief of diabetes surgery at New York Presbyterian Hospital/ Weill Cornell Medical Center, said weight loss surgery had proved to be a very appropriate and excellent treatment for diabetes. “The most proper name would be diabetes surgery,” he said.

The surgery, sometimes referred to as ‘stomach stapling’, is a means of losing weight. This is achieved either by reducing the size of the stomach by tying a band around it, removing a portion of it, or by re-routing the small intestines to a small stomach pouch (also called a gastric bypass).

In New Zealand the surgery costs between $17,000 and $25,000 per

person, and is only suggested for morbidly obese people, where it is considered to be the only intervention that can help them lose weight. Some public funding is available for some patients, others pay for the operation privately.

Dr Michael Booth (left), a surgeon at the Waitemata Specialist Centre who specialises in bariatric surgery, performed about 150 procedures last year.

About 30 per cent of his patients have diabetes. Of them, about 80 per cent initially came off their diabetes medications completely, the remainder had medication reduction. After five years, six out of 10 patients were still diabetesfree. Of those whose diabetes symptoms returned, they were not as pronounced and still needed less medication.

Dr Booth believes there is a strong need for local New Zealand-based research into the long-term merits of bariatric surgery for patients.

“Patients have to be willing to change their habits, improve their diet, eat properly, exercise regularly. This operation is merely a tool to help you lose weight and gain control of your appetite.

The rest is up to the patient.”

— DR MICHAEL BOOTH

20

DIABETES | Winter 2012

WEI G HT LO SS S URG ERY

k

RE SEARCH

Weight loss surgery – pros and cons Bariatric surgery is not recommended for everyone.

Patients need to have a Body Mass Index of over 40, or at least 35 if they have health problems such as diabetes. Candidates need to demonstrate they have tried to lose weight over a long period and failed. Patients must also be able to participate in treatment and be willing to do the long-term follow up.

Benefits

• Dramatic weight loss – most people see an immediate drop in weight, often one to two kilograms per week initially, which slows over the subsequent months. Plateauing occurs from nine to 12 months and weight regain can be commonly seen after this.

• Health improvements – diabetes resolves in about 60–90 per cent of patients (depending on the kind of operation they have).

Other conditions like high blood pressure, high cholesterol and obstructive sleep apnoea (OSA) are substantially improved.

Risks and side effects

• ‘Gastric dumping syndrome’ where food bypasses the stomach too rapidly and enters the small intestine undigested. Symptoms include nausea, weakness, sweating and, occasionally, diarrhoea.

• A common risk of restrictive surgery is vomiting caused by food blocking the stomach pouch outlet. It is important to make sensible food choices and chew food well.

“There is currently a real need to perform randomised controlled trials to assess the relative merits of the commonly-performed procedures looking at weight loss, resolution of comorbidities such as Type 2 diabetes and obstructive sleep apnoea.

“Complications, as well as aftercare and quality of life, should also be assessed. Such findings would also be relevant to surgical training as some procedures are more complex to perform and learn with a longer learning curve.”

• Patients who have weight loss surgery may develop nutritional deficiencies such as anemia and osteoporosis. These deficiencies can be avoided if vitamin and mineral intakes are maintained.

• Occasionally patients require follow-up operations to correct complications, for example abdominal hernias, infections or breakdown of the staple line.

• Sometimes patients develop gallstones, ulcers or bowel obstructions in the longer term.

• Patients must be closely monitored post-operatively and commit to eating healthily and taking regular exercise.

• Possibility of weight gain over the long-term.

• Possible psychological changes, including impact on self esteem and relationships.

Severe obesity is a major cause of type 2 diabetes.

Find out what you can do about it.

He says the studies also need to look at the long-term (minimum of five years) benefits for patients.

“These procedures all look good at one year, but what about at 5 and 10 years? As a minimum requirement there should be a national database to collect such information in a prospective fashion so results can be audited and published,” he added.

Dr Booth said bariatric surgery is a useful tool to help people with Type 2 diabetes but not a magic bullet.

“Patients have to be willing to change their habits, improve their diet, eat properly, exercise regularly.

This operation is merely a tool to help you lose weight and gain control of your appetite. The rest is up to the patient.”

Tel 09 623 2409 Email info@awls.co.nz www.aucklandweightlosssurgery.co.nz

Winter 2012 | DIABETES

21

TRAVELLI N G W ITH D I A B E TE S

k

I NS ULI N A ND I CEBERGS

Sailing north of the Arctic Circle on an adventure of a lifetime

Dunedin lawyer Ruth Jeffery, 45, left her job to sail from Alaska to Scotland via the treacherous Northwest Passage. She tells her story.

My sister Helen emailed me: “We’re going to sail the Northwest Passage and want another crew member.

Interested?”

Interested? Heck yes! And if my sister wasn’t concerned about my limited sailing experience then neither was I. A few months later I was off to Alaska to join Helen and her husband Ian on their 39 foot yacht Kotuku. The yacht set sail from Cordova in south-west Alaska, headed up to the Arctic Circle and across the top of Alaska and Canada then down past Greenland, crossing the Arctic Circle again – thus completing the Northwest Passage.

Then we sailed across the Atlantic to Scotland. The trip took five months.

A mammoth amount of planning went into the trip. The remoteness,

22

DIABETES | Winter 2012

ice and limited facilities meant catering for every contingency.

We anticipated the trip would take five to six months, longer if we got caught in the ice, or had equipment failures. As the towns we hoped to stop at along the way (weather and ice permitting) have no road access and limited facilities we needed to carry all the food and spare parts we could possibly need, many of which had to be sourced outside Alaska.

This meant that when I left New Zealand I was carrying everything from a head gasket set to dried peas!

My partner John was our contact person in New Zealand for emergencies and also sent us the ice charts daily. We didn’t have the internet or a satellite phone but did have a system where we could send very brief email messages via the single sideband radio, when radio reception was good. We could also get weather maps the same way – vitally important especially crossing the Atlantic in the storm season.

I was diagnosed with Type 1 diabetes in 1992 during my OE. For this trip, I took seven months

supply of everything I might need (insulin, sites and lines for my pump, batteries, testing strips, ketostix, glucose, back up meters). Being on a pump had advantages – it was much easier to push a button in rough weather than trying to inject. But there were disadvantages too – bulky packaging of sites and cartridges and needing to take a back up of longacting insulin (and pens and needles) in case of pump failure.

The things that required the most thought and research for me were: • Insulin – how much to take? And how was I going to store it with no fridge? The manufacturers confirmed that insulin will only last six weeks at room temperature and I needed it to last six to seven months. The best place to stow it turned out to be in the bilge (under the floor boards of the yacht next to the hull) where the sea temperature keeps the hull cool. In the warmer parts of the trip I collected bags of snow to chill it further.

• Insurance – could I get insurance that would cover me for diabetes

INSULIN A ND I CEBERGS

and sailing offshore and in the Arctic? The short answer was ‘no’.

I settled for cover for injury and illness (but not related to diabetes) in the Arctic, but not offshore, and kept my fingers crossed!

• Kayaking – the only means of getting ashore and around was by kayak. I knew even less about kayaking than I did about sailing – and being tipped out into frigid waters was not an option!

• Coffee – we could only carry enough for one cup a day…

The first part of the trip was the ‘holiday’ where we could day sail and anchor at night. My partner John joined us for this part of the trip, leaving us at Kodiak Island. The scenery was spectacular and we had plenty of opportunities for kayaking and hiking. The wildlife (including grizzly bears) is not alarmed by people in kayaks, so we were able to get really close. During the trip we saw lots of whales, seals, sea otters, bears, foxes, moose, caribou, reindeer, musk ox, eagles and other bird life.

As the sea ice melted we moved as fast as possible up into the Arctic Circle. We needed to get through the Northwest Passage while it was open, which is only a few weeks each year – if it opens at all. So five to 15 day passages became the norm, with brief stops in Tuktoyaktuk, Cambridge Bay and Gjoa Haven to get fuel, water and fresh vegetables. We had a rotating

k

TRAV E LLI NG WITH DI ABE TES

Ruth’s route The Northwest Passage is a sea route along the northern coast of North America that connects the Atlantic and Pacific Oceans.

The red dotted line shows the route the yacht took. It left Cordova, in Alaska, and sailed along the northern coast of Canada, through the Northwest Passage, then down past Greenland and across the Atlantic Ocean to the west coast of Scotland.

watch system – two hours on watch, two hours of standby (to help the person on watch as required) and two glorious hours in which to sleep and sleep!

In midsummer we had 24 hours of daylight. Often I would wake for my 12 o’clock watch and spend the first few minutes trying to remember if my last meal was breakfast or dinner so I could figure out if it was midday or midnight!

Being diabetic adds to the challenge of sailing. Memorable examples include inserting pump sites in rough seas, unscrewing the floor boards to get insulin, a glucose meter which was often too cold to function, the unpredictable variability in exercise – some watches involved gentle lazing about on deck, others were spent grinding, winching and hauling sails, helming in huge seas (over 30 feet at times), or clambering around a deck reefing the sails as Kotuku did her best to fling me off!

When it was cold I tended to go hypo – unless it was stormy in which case the adrenaline rush meant I would run high! I soon

decided that being alone on deck and going hypo wasn’t a good scenario (particularly as I get very indecisive when I’m low – not great if the wind is picking up and you need to put a reef in, or if the navigation is tricky).

But that was countered by the incredible experiences such as sailing through fog with icebergs appearing out of the gloom, stunning sunrises and sunsets, the most amazing auroras, and the icebergs that were not so easily seen in the dark… I should know – I hit one!

Other highlights were the amazing sailing experiences – from flat calm to gales. Being on the top of a huge wave makes you feel on the top of the world – the bottom of a trough makes you feel decidedly humble!

The wildlife was amazing and the people were incredibly friendly and generous. The locals gave us fish – fresh, frozen, dried, smoked and even muktuk (raw whale blubber).

The scenery ranged from the snowcapped, forest-covered, mountains in the south, to the barren landscapes of the north. But one of the most wonderful sights was the lush green coast of Scotland after a hard, wet, Atlantic crossing.

Winter 2012 | DIABETES

23

LIV ING W ITH D I A B E TE S

k

EMMELI NE' S STO RY

Young BMXer a great diabetes advocate Emmeline Carroll is a talented BMX rider and recent winner of a Diabetes Youth John McLaren award for sporting excellence. Emmeline, who was diagnosed with diabetes at the age of 4, writes in her own words about her life and her love for BMX racing. This is her fourth year of racing and she travels all over the country to compete. In 2012, she came fourth in both the South and North Island title races and fifth in the nationals at Rotorua. Her long-term goal is to represent New Zealand and make the Olympic team.

I am like any normal 13 year old except I have diabetes. I have learned to deal with my condition but have days where I wish I didn’t have it. I live with my mum and dad and two cats in Christchurch.

This year I have taken more responsibility for my diabetes.

My mum is teaching me how to use insulin to cover the food I am eating and which foods are better for me when I am training. Mum uses questions to get me to think about how I look after my diabetes.

She wants me to be as prepared as possible for any situation, like earthquakes.

When I was diagnosed I was pretty mean to my mum and I didn’t like

24

DIABETES | Winter 2012

the needles. I still don’t like the needles but I thank both my parents for making me do my own injections because it has meant I have been able to be more independent and stay over at my aunties’ houses.

BMX is about strength and speed.

When I turn 14, I will start to incorporate weights into my training programme. My dad and I are planning on starting boxing to help improve fitness.

I find people are scared of my diabetes and therefore I don’t get a lot of invites to stay over at people’s places. This does sadden me but I have good friends in BMX and softball so it evens out. I am lucky I have so many cool aunties and cousins.

I really enjoy BMXing and I get a buzz out of it every time I race.

My mentors are my dad (who represented New Zealand in the 1980s in South Africa), Sarah Walker, Cayleb Martin (NZ test team from my club, 2011), Marc Willers (NZ Olympic contender) and Dave Mohi (World number 1, 2010).

I have amazing parents who help me achieve good control of my diabetes using a combination of insulins.

My mum is a nurse and shares her knowledge with me so I can better understand my diabetes. My dad also helps. He is my coach/trainer for BMX and has a lot of knowledge that he passes onto me. Both parents support me and encourage me to achieve the best I can.

My absolute passion is BMX and my goal is one day to be as good as Sarah Walker (Kiwi world-class BMXer), if not better.

I train most days of the week.

Training involves a combination of going for a run, doing sprints on my bike, doing rollers and gates.

The training regime takes about two hours each time.

My dad has built me a mechanical gate so I can practice and get better at gate starts. My dad also trains me on tactical techniques that help me outmanoeuvre my opponents on the track. I also play softball and train for this for an hour on Wednesdays (in season), which also helps with my fitness.

I enjoy the atmosphere at race meets and travelling around the country to race.

One of my main achievements throughout my BMX career so far is letting people know more about diabetes. People have seen that diabetes doesn’t hold me back.

EM M ELI NE' S STO RY

k

LI V I NG WITH DI ABE TES

BMX: A tough sport Bicycle motocross or BMX is an extreme sport where competitors race on bicyles along tracks with obstacles. BMX also refers to the bicycle itself, which is designed for dirt and motocross cycling.

BMX started in the early 1970s when children began racing their bicycles on dirt tracks in southern California, drawing inspiration from the motocross superstars of the time. The size and availability of the Schwinn Sting-Ray and other wheelie bikes made them the natural bike of choice, since they were easily customised for better handling and performance.

BMX racing was a phenomenon by the mid 1970s. Children were racing standard road bikes off-road, around purpose-built tracks in California. The 1972 motorcycle racing documentary On Any Sunday is generally credited with inspiring the movement nationally in the US. Its opening scene shows kids riding their Sting-Rays off-road.

By the middle of that decade the sport achieved critical mass, and manufacturers began creating bicycles designed especially for the sport.

I promote a healthy diet, not just to keep myself well but as a lifestyle choice. People ask me questions about my diabetes, the needles, the testing and how come sometimes I am allowed sweets.

In 2003, the International Olympic Committee made BMX a full medal Olympic sport for 2008 Summer Olympic Games in Beijing, China. Many great BMX riders go on to other cycling sports like downhill such as Australian Olympian Jared Graves and youth BMX racer Aaron Gwin.

In BMX it is common to see kids fill up on lollies and sugary drinks to give themselves a boost before they ride. I have shown this is not necessary. People have become more clear about the differences in diabetes (Type 1 vs Type 2) and I have been able to clear up things they may have wrong.

I believe that even with the state of our city and lack of BMX tracks available, I am still achieving great results. The aim for our club (North Avon Christchurch club) is to rebuild our track at a new site and apply to hold the national BMX titles in 2014 or 2015 and we will be holding the South Island titles in 2014.

I believe I am worthy of the John McLaren award because I am committed to my chosen sport.

I have clear goals and act as an advocate for people with diabetes now. I have so much fun when I am riding and for a moment feel normal.

Source: Wikipedia

Emmeline Carroll, 13, in action earlier this year. She is No. 59 in red.

Weddings • Family Groups Children • Special Occasions Copy Restoration • Digital

Phone 04 385-7731

www photo.woolf.co.nz

Call us for all your photographic needs

Winter 2012 | DIABETES

25

P RO FI LE

k

TH E BEAVEN PAPERS

Don Beaven’s historical legacy Professor Sir Don Beaven was a worldwide diabetes expert and a prominent campaigner.

He was a huge supporter of Diabetes New Zealand and an early proponent of unification.

Researcher Courtney Harper, from the University of Auckland, has been given unrivalled access to the Sir Don Beaven papers. This trove of documents is helping to tell the story of diabetes in New Zealand, an area that has received little attention from academics.

Professor Sir Don Beaven dedicated his life to diabetes, becoming a worldwide authority on the condition, championing better care for patients and being a tireless promoter of healthy living. His tenacity and strength of spirit stayed with him until his untimely death in November 2009, when he perished trying to put out a house fire at his Banks Peninsula bach – using just a garden hose. He was 84 years old and had spent the best part of 50 years campaigning for better diabetes care in New Zealand.

Dubbed the ‘father of diabetes’ Beaven was a doctor, research specialist and teacher. He was loved and respected as the founder of diabetes research and care in New Zealand. He had very strong links with Diabetes New Zealand, helping

26

DIABETES | Winter 2012

to set up the first local diabetes society in Christchurch and then others around the country. He played a key role in supporting Diabetes New Zealand throughout his life, including eight years as its much loved Patron. He also set up what was to become the New Zealand Society for the Study of Diabetes. He worked with a huge range of diabetes organisations over half a century, and fought for people affected by diabetes to the very end of his life.

In this article I want to share some insights into Beaven’s influence as it is emerging in research for my PhD thesis. My thesis will trace the historical transition of diabetes issues from medical management to public health.

Prof Sir Don Beaven believed New Zealand society and culture often worked against good health.

Most historical writing about diabetes has focused on the heroic tale of the discovery of insulin.

Scholars are now beginning to explore the recent social and policy history of diabetes, particularly in the United States. My research builds on this work.

The collection includes letters and postcards sent to his mother, first wife and daughters during his travels and study periods overseas. He was an avid observer of the daily life, cultural peculiarities and political character of different societies.

Other papers include reports, correspondence and notes collated during his working life.

I have nearly completed my primary research, which has included reading official government records and those of diabetes organisations, published research, journals and oral interviews with key figures.

Unfortunately I was unable to interview Beaven before he died, but I have been able to get a glimpse of the passion and energy he injected into improving the lives of people with diabetes through his personal papers, which are archived at the Macmillan Brown Library, University of Canterbury. Beaven kept everything, which makes the papers a veritable goldmine for anyone interested in the history of health and medicine in New Zealand.

Beaven led the country in establishing modern diabetes education for patients and a multidisciplinary approach to treatment.

In the late 1970s he helped establish the country’s first diabetes nurse educator position and the first diabetes community centre, both in Christchurch.

There are also many photographs and personal mementos. Copies of his speeches, journal articles and newspaper columns cover topics in health, society, politics, and good food and wine. The material runs from the early 1950s to the 1990s.

It is particularly voluminous around the 1970s and 1980s when Beaven was at the peak of his professional life and a high profile public figure.

TH E BEAVEN PA PERS

k

PROFILE

Beaven was a strong advocate for improving health services through regionalisation, consumer and local community involvement. He was immensely proud of the model set by the Christchurch Diabetes Centre, a joint venture between the Christchurch Diabetes Society and the North Canterbury Hospital Board. However, Beaven was increasingly concerned about the process of health service planning, the time it took to institute approved initiatives, and the lack of long-term perspective demonstrated by an under investment in diabetes research and prevention.

In the early 1980s Beaven was one of the leading voices in a campaign to politicise and publicise diabetes as an under-studied, under-valued and under-financed health issue. He had self-described socialist sympathies which he felt were at odds with those of the medical establishment in New Zealand. Despite this, he was elected Vice-President of the Royal College of Physicians, serving for two years from 1980. He jested that the college ‘appears to have made a somewhat erroneous decision’ as this should have been ‘a prestigious slot rather than one for ageing activists’.

Beaven’s political beliefs evolved in the early 1950s during 15 months of solo practice in the isolated rural South Island community of Karamea. Then he worked as a medical registrar in Middlesex and London where he met with a number of members of the British Labour party.

His activism developed in the 1960s and 1970s as he rose up the professional ranks and was typically expressed through official submissions and committees.

This often left him frustrated at bureaucratic structures.

He denounced what he saw as the overly-centralised authority of the

Professor Don Beaven and Sally Collins, in 1964, with a patient they saved from a diabetic coma.

Health Department, right-wing conservatism of the organised medical profession, and petty personality politics in university and hospital medicine.

Gradually Beaven’s health activism became more overtly political.

Teaching medical students provided him one outlet. In a letter to Jonathan Hunt, the Labour Party’s spokesperson on health in 1978, Beaven wrote: ‘I am very anxious to try and raise the political consciousness of undergraduate medical students and…encourage them to undertake debates on the nature of health services and particularly the disparity in standards of delivery of care to wealthy and poor people in New Zealand.’

Besides his political views, another factor that shaped diabetes advocacy in New Zealand was Beaven’s experience overseas. Periods of study leave and shorter trips to attend international diabetes meetings and conferences spurred Beaven to make changes to diabetes services in Canterbury and helped secure New Zealand’s place within a wider diabetes scientific community.

In the 1980s Beaven became a

high-profile diabetes campaigner.

He was involved in many New Zealand diabetes organisations and cultivated an activist-advisor persona with the media, health administration and politicians. He told one newspaper that what made him successful, apart from a sense of humour and a good wife, was that he did ‘not waste too much time sleeping. Life is very short. If you sleep for only 6 hours, you have 2 hours extra on every other person, in which you can do useful things’.

Beaven became a leading diabetes campaigner as a result of his strong political views and his experiences overseas, seeing how other countries dealt with diabetes.

Beaven believed New Zealand society and culture often worked against good health. He felt good leadership was needed to deal with the problem: ‘As New Zealand is a post-colonial country, it is often very immature and therefore needs leadership. One should try and give leadership in a number of areas’.

I believe his leadership and attitudes personified the ideological transition of diabetes from medical condition to public health problem in late 20th century New Zealand.

Winter 2012 | DIABETES

27

CHILD REN A N D FA MI LI E S

k

ATHENA ’ S STO RY

Planning for a healthy pregnancy Mum-offour Athena Smith runs a support group for women with Type 1 diabetes. She is planning to become a midwife and specialise in diabetes. She hopes her story will inspire other women thinking about starting a family.

My name is Athena, I have had Type 1 diabetes for 27 years after being diagnosed at the age of three. My greatest and proudest accomplishments in life are being a diabetic mother to four beautiful kids, and having chosen a supportive husband who sees a positive side to everything.

‘I plan to train in midwifery and then specialise in diabetes so I can use my knowledge and experiences to help other women with diabetes.’

— ATHENA SMITH

28

DIABETES | Winter 2012

Any pregnancy is stressful and comes with a long list of complaints, but the added pressure of diabetes and the work needed to gain perfect control throughout this journey add extra emotional stress and frustration.

So a little before our wedding in 2006, I mentioned to my specialist at North Shore Hospital that we were wanting to start preparing ourselves for a baby, and I was then referred to Auckland Hospital under the maternity diabetes team there.

Pre-pregnancy planning was required and it took me about six months to get my HbA1c (overall average blood sugars) from 9 to under 7 (75–53 in new units) with lots of testing, adjusting my insulin and regular check ups. It’s amazing what you can do when you put your mind to it and focus. I was so proud of myself to have finally got my blood sugars into a normal range.

By October 2006 I was expecting my first child. From the day I found out to the day I delivered, I tested every two hours and adjusted my insulin accordingly to get control.

But at times I would feel frustrated if I went high and couldn’t get it down straight away and I was constantly worried about what damage I may be causing my unborn baby. The staff at Auckland would always be so positive and lift my spirits in the times I was down. And yes, first pregnancies are the worst for paranoia, especially with diabetes.

I was aware of the worst case scenarios – big babies, heart defects, stillbirths — but tried my best to keep a positive outlook. We had a lot of check ups and ultrasounds, but I enjoyed seeing my baby grow at each scan and I became a pro at learning what was what on the pictures.

Generally most of us are induced early due to several risk factors,

ATH ENA ’ S STO RY

some of which I have already noted. My son arrived at 38 weeks (induced), a healthy 8lb 4oz, by C-section after a 22‑hour labour.

All my hard work had paid off.

Six months after he was born we found out surprisingly we were expecting number two. My HbA1c was still in the 7s so I felt good about that. I was wanting to keep on top of my control anyway after my first was born. I have to admit I was a lot more relaxed this time around, even though I still got frustrated, I knew I had done it successfully before. I was hoping this time for a normal delivery after my previous C-section and the medical team were willing to give me a go, so at 37 weeks and after a sixhour labour my second son arrived, a bit bigger at 8lb 7oz. I got my normal delivery, of course everything was very monitored throughout labour but I was very happy.

I felt very confident when number three was on its way, still had my HbA1c at 7 as you get used to gaining such tight control and are in a good habit of it after your baby arrives, I wanted to keep it that way.

After he was born, however, he did have quite low blood sugars but successful breastfeeding brought them back up.

It takes a while for babies of diabetic mothers to gain control of their own

k

blood sugars after birth and they are often low due to the mother having slightly higher ones through labour and delivery so they are still carrying extra insulin on board. He was my biggest baby born at 36 weeks weighing 9lb 14oz, induced early as I had hardly any amniotic fluid around him which can be diabetes related but can also be just one of those things. My control was good through this pregnancy.

Then came my little girl, a fantastic pregnancy as it almost felt normal to me this way of life. She was my smallest baby born at 38 weeks weighing 7lb 3oz with an easy drug-free delivery. They do say breastfeeding can affect your blood sugars by making them lower and intially for me that was the case but as my body got used to everything it all came right.

As for the future, I plan to train in midwifery and then specialise in diabetes so I can use my knowledge and experiences to help other women with diabetes. I hope my story will enlighten other diabetic woman who are perhaps thinking of starting a family.

Diabetes New Zealand’s website features lots of advice and tips on how to have a safe pregnancy.

Go to: www.diabetes.org.nz.

Athena’s mothers and pregnancy support group I run a support group for Type 1 women who are pregnant or thinking of starting a family. Some woman are referred to our group from maternity diabetes at Auckland Hospital. Occasionally we have guest speakers, physicians, obstetricians, lactation consultants etc. It’s a great place to come and have a cuppa with other mums and great support for women going through a pregnancy with diabetes as we have all been through it.

If you are interested, email Athena at: theenybabes@hotmail.com and I will add you to my mums’ list. I send out reminder emails a week before. All you need to bring is a gold coin donation towards room hire.

Where: Diabetes Auckland: 62-64 Valley Rd, Mt Eden.

When: Last Monday of the month, 10.30am to 12 noon.

CH I LDRE N AND FAMILIES

Pregnancy and diabetes Key points 1 If you maintain healthy blood glucose levels before and during your pregnancy you have close to the same chance of delivering a healthy baby as all other women.

2 High blood glucose around the time your baby is conceived and during the first 12 weeks of pregnancy increase the chances of your baby developing an abnormality.

3 For this reason it is important to plan your pregnancy and get help and advice from your specialist diabetes service well before becoming pregnant.

4 Your insulin requirements increase during pregnancy particularly through the second and third trimester (13–28 weeks and 28–40 weeks).

5 You will need to maintain very close contact with your nearest specialist diabetes service for the duration of your pregnancy.

6 Your insulin doses will change frequently during the time you are carrying your baby.

If you have Type 2 diabetes the same advice applies. But please remember diabetes tablets are not safe to use before or during your pregnancy. It may be safest to transfer onto insulin before and during the pregnancy.

See your medical team for advice if you are planning a pregnancy.

Winter 2012 | DIABETES

29

CO M M U N IT Y

k

D ESTINATION UNITY

Destination Unity full steam ahead As reported in a special insert in the last edition of Diabetes, an overwhelming majority of societies voted to unify as one organisation at the Special General Meeting in March.

the unification process. We are also beginning to see savings as we bring together functions that once had to be done separately across every society, for example auditing. An insert is included in this magazine, which updates you on the latest Destination Unity news.

This means the Diabetes New Zealand National Office and local societies will come together as a single unified organisation. It is one of the biggest and most exciting achievements in our 50-year history.

Societies that have formally agreed to join the new unified organisation are: Auckland, Northland, Waikato, Bay of Plenty, Rotorua, North Taranaki*, Taupo, Whanganui, Wairarapa, Kapiti, Horowhenua, Pacific Wellington, South Canterbury, Waimate, Southland, Milton, Otago, South Otago, North Otago, West Coast and Ashburton. Societies that have formally advised us they do not wish to join are: Christchurch, Hawke’s Bay, Manawatu, Tauranga and Marlborough. At the time of writing some societies were still deciding

By unifying, we create a stronger voice for people with diabetes in New Zealand. We are already seeing the benefits of unification, including receiving a Ministry of Health contract for the supply of education resources for three years instead of the usual one. This is a major commitment from the Ministry and confirms its faith in

whether or not to join.

You are automatically a new member of the new unified Diabetes New Zealand if you were already a direct member, or a member of a local society that has formally notified us it wishes to join. These societies will move to the new unified organisation as ‘branches’.

You will cease to become a member of Diabetes New Zealand if your local society has chosen not to join the new unified organisation. You can still join Diabetes New Zealand directly if you wish (and you will receive a free subscription to Diabetes magazine).

For more information visit www.diabetes.org.nz, ring 0800 369 636 or email admin@diabetes.org.nz.

Alternatively you can fill in the membership form below and post it.

* North Taranaki and South Taranaki are planning to form one society with the intention of joining Diabetes New Zealand.



Membership Application for Diabetes New Zealand By joining Diabetes New Zealand you automatically have access to your local Diabetes New Zealand Branch as well.

Title Mr ❑ Mrs ❑ Miss ❑ Ms ❑ Dr ❑ Prof ❑

Gender

Male ❑ Female ❑

First Names _____________________________________________________________

Phone

Day (0 ) _____________________________ Evening (0 ) _____________________________

Last Name

_____________________________________________________________

Mobile

_____________________________________________________________

Address

_____________________________________________________________

Email

_____________________________________________________________

Date of Birth

_____________________________________________________________

Occupation

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Diabetes

Year of diagnosis _______________________________

Type 1 ❑ Type 2 (on insulin) ❑ Type 2 (on oral medication) ❑ Type 2 (diet control) ❑ No diabetes ❑ ❑ Please join me as a member of Diabetes New Zealand. My cheque for $32* is enclosed or charge my Visa/MasterCard: Name on Card

Card No

Expiry date Signature

* Membership fees are due to change from 1 July, 2012. See www.diabetes.org.nz or call 0800 369 636 for new membership rates.

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

30

DIABETES | Winter 2012

PH A RM AC CO NS ULTATI O N

k

COM MUNITY

Latest on Pharmac’s proposals Earlier this year Pharmac proposed a radical shake-up of the way it funds essential diabetes supplies – profoundly affecting more than 120,000 New Zealanders.

thrown away because they won’t work with the new test strips. Some people were worried about the practical effect of changing their brand of meter. People also wanted more information on the technical abilities of the new meters.

Pharmac says the changes will save $10m a year. It says it will lead to improved access for people with diabetes to high quality meters, strips and insulin pumps. However many people were upset about the move to sole supply.

The second, less controversial, proposal related to insulin pumps and consumables. Pharmac would provide a free pump and consumables to patients who meet certain criteria. There would be one pump on offer – the Animas 2020.

There is currently no national public subsidy for pumps in New Zealand.

A new pump costs thousands of dollars and most patients have to buy one using their own funds.

Pharmac estimates the proposal will benefit about 600 people.

Pharmac received 3,000 submissions during its consultation. There were concerns about a range of issues and it became clear thousands of existing meters might have to be

Given the significance and potential impact of the proposals, Diabetes New Zealand made detailed formal submissions on both.

Representatives from Diabetes New

The first proposal related to blood glucose meters and test strips.

Pharmac wants to stop publicly funding six brands of meters and strips and move to funding three meters and strips from one supplier.

Glucose meters and test strips

Consultation on the proposals has now closed but both consultation documents can be viewed on Pharmac’s website.

There is also a question and answer section: www.pharmac. govt.nz/patients/haveyoursay/ diabetesproductsproposals. Our submissions and the latest news about both proposals, can be found on our website: www.diabetes.org.nz.

The table below summarises Pharmac’s proposals and Diabetes New Zealand’s response.

Pharmac proposal

Diabetes New Zealand’s position

How to find out more information

Pharmac is proposing to move to a sole supply model for blood glucose meters and test strips.

Diabetes New Zealand has made it clear to Pharmac that it does not support this proposal.

Under the proposal most people will have to choose between three models of CareSens meter and test strips all distributed by Pharmaco. There will be funding for other meters in some circumstances, for example ketone testing.

Our concerns centre on: • How a sole supply model would affect security of supply.

• The practical effect on people with diabetes as they manage their condition.

• How the proposal would be implemented in practice.

You can find more information about the CareSens meters, including questions and answers about the product, at: www.pharmaco.co.nz.

Pharmac says patients can choose to privately fund test strips so they can carry on using their current meter. Or choose to buy the meter of their choice but with no public subsidy.

Pharmac consultation on insulin pumps and consumables

Zealand also met with Pharmac to stress their concerns, particularly in relation to the proposal for a sole supply model for meters and test strips. They repeated these concerns at a recent Parliamentarians’ meeting, at the invitation of the MPs present. As of writing, Pharmac was still analysing submissions and its board had not made a final decision on the proposals.

Pharmac is proposing to fund insulin pumps and consumables for the first time.

One type of insulin pump and consumables would be fully funded.

Patients who want a pump will have to meet certain criteria. Their specialist would apply for the pump on their behalf.

We believe there hasn’t been enough public consultation on this proposal or analysis of its likely impact on people with diabetes.

Diabetes New Zealand supports the move to subsidise insulin pumps and consumables, but feels more detail is needed to ensure the success and safety of the scheme.

We raised a number of questions to this effect in our submission.

More information on the proposal can be found by visiting www.pharmac.govt.nz.

You can find out about the Animas 2020 pump on www.animas.co.nz.

Winter 2012 | DIABETES

31

CO M M U N IT Y

k

GET READY, GET THRU

Be disaster ready: plan, prepare and protect New Zealand is at risk of natural disasters due to its location and environment.

Storms, flooding, tornados, earthquakes, tsunami and volcanic eruptions could all strike without warning.

Lynne Taylor, of Diabetes Christchurch, and Dr Helen Lunt and Kit Hoeben, of the Christchurch Diabetes Centre, share some of the lessons they learned from helping people in the aftermath of the quakes.

Life in Christchurch is still tough 20 months after the first quake in September 2010. Since then residents have endured 9,500 aftershocks, including three of more than six in magnitude. As everyone knows, the 6.3 quake that hit the city at 12.51pm on 22 February last year devastated the city. The desolation and damage, particularly to the central city, Sumner and eastern suburbs, was overwhelming. The loss of power, water and sewerage had a major impact, and many people with diabetes had to abandon their homes with no medications, belongings, transport or food.

Reflecting on these events and what they have meant for people with diabetes in Christchurch has been a healing process. We want to share our experiences to help others become better prepared.

The biggest challenge in the

32

DIABETES | Winter 2012

aftermath of both quakes was to contact as many people with diabetes as possible. Diabetes Christchurch called well over 200 members to see what their personal situation and circumstances were and how we could help and support them. We also replied to an incredible number of phone calls, messages and queries over the following days and weeks. We were able to sympathise and listen. This played a major part in helping those with diabetes cope with a major traumatic event.

We also learned the absolute importance of diabetes education.

It became clear how vital it was that people were able to self-manage their diabetes following a disaster.

For example, they needed to know how to make their own insulin adjustments to cope with changes in dietary intake.

Dr Helen Lunt wrote an information sheet on how to cope.

It included advice about how sugar levels change under stressful circumstances, helpful tips about blood testing more often, the shelf life of insulin, sharps disposal etc.

The leaflet was distributed widely by email, internet and through GPs and pharmacies.

Pooling diabetes supplies and working with Diabetes Christchurch, together with support from diabetes suppliers from around the country (thank you – you know who you were), the Ministry of Health and Christchurch District Health Board allowed us to offer medical supplies without a script, and with no GP fee or pharmacy charges. We think most patients were able to replenish supplies reasonably quickly.

G ET REA DY, G ET TH RU

k

COM MUNITY

Some personal stories “In my opinion, the most important lesson we learned was that managers don’t view diabetes care as being a priority during a disaster.

But we know from the experience in other countries that the impact of a disaster on people with diabetes can be devastating. It is vital to be a strong advocate for your patients’ welfare. This includes keeping some sort of diabetes service going.”

– Diabetes nurse

“Once the Diabetes Centre opened again, it was difficult for some staff and patients to go back into the building, because of building repair work. Some patients would not use the lift.

Some did not turn up because they did not believe the building was open. To my surprise and pleasure, some people came after years of staying away because the quake had given them a new appreciation of life and the need to maintain good health.”

– Diabetes nurse

Lessons we learned the hard way!

• If you leave work and have to walk home, you may regret wearing those high-heeled shoes. Have a pair of walking shoes at work (possibly in the ‘grab bag’ you now keep by your office door with water and a muesli bar in it).

• Lock your work filing cabinet drawers during the day – they are nasty things when they jump out at you in a quake.

Most of our shelving and cupboard units are now braced to walls.

• Carry your cell phone with you (ie don’t leave it on your desk).

This is especially important if all your emergency phone numbers are stored on the phone. We have sold a large number of wind-up torches that also charge a mobile phone and have a good radio and alarm.

You can buy these torches at www.diabetessupplies.co.nz • Have as many contact numbers for colleagues, family and friends as possible in your phone and written down – your cell phone memory is not much good to you when you have a flat battery and no electricity.

• Regularly update your emergency kit. Some people regretted putting their emergency kit in a garage with a remote control door as it didn’t open when the power went off.

“I had expected to see a large number of people with diabetic ketoacidosis (DKA).

Many people’s access to insulin was difficult, especially if their fridge was not working, or supplies had run out and their pharmacy was closed, or just not accessible.

On top of this, there were a lot of broken glucose meters in Christchurch and food supplies were erratic. Imagine my surprise when I found that DKA admissions were low in the first couple of weeks following the quake! This is a tribute to all the disaster planning our nurse educators had done before the quake and also a tribute to the resourcefulness of parents of kids with Type 1.”

– Physician

Make a plan, Stan Get your family or household together and agree on a plan.

A detailed emergency plan helps alleviate fears about potential disasters, and can help you respond safely and quickly. A household emergency plan will help you work out: • What each of you will do in the event of a disaster such as an earthquake, tsunami, volcanic eruption, flood or storm.

• How and where you will meet up during and after a disaster.

• Where to store emergency survival items (especially essential medicines).

• What you need to have in your getaway kits and where to keep them.

• What you need to do for members of the household, family or community with a disability or special requirement.

• What you need to do for your pets, domestic animals or livestock.

• How and when to turn off the water, electricity and gas at the main switches in your home or business. Turn off gas only if you suspect a leak, or if you are instructed to do so by authorities.

If you turn the gas off you will need a professional to turn it back on and it may take them weeks to respond after an event.

• What local radio stations to tune in to for civil defence information during an event.

• How to contact your local council’s civil defence emergency management office for assistance during an emergency.

It is also useful to learn first aid and how to deal with small fires and shock. Parents and caregivers should talk to children about disasters and explain in detail what to do to keep safe. This can help to reduce fear and anxiety and helps everyone know how to respond.

See www.getthru.govt.nz for more advice on preparing for an emergency.

Winter 2012 | DIABETES

33

THE L AS T WORD

k

NAD IA'S KITCHEN

Nadia Lim’s new recipe book Nadia Lim wowed New Zealand with her imaginative recipes on MasterChef New Zealand, winning the competition in 2011. Now she has achieved her life’s dream – writing a cookbook full of fresh, easy and delicious recipes.

The Auckland dietitian and nutritionist specialised in helping people with diabetes before her new-found fame and her recipes reflect her love of healthy, balanced food. Recipes are organised seasonally and are inspired by her Kiwi and Malaysian Chinese heritage. Each comes with a nutritional analysis.

Most of the recipes in the book are complete balanced meals, rather than components of a meal. Nadia also explains her food philosophy, which is based on natural, additive-free ingredients, and gives lots of easy-to-follow tips and ‘how to’ ideas.

Try this delicious and healthy noodle soup (see below) taken from Nadia’s Kitchen and then enter our competition to win a copy of the cook book.

You can buy Nadia's Kitchen from Diabetes New Zealand Supplies for $49.95 (including delivery) and $5 from each sale will go directly to Diabetes New Zealand. Go to www.diabetessupplies.co.nz

GINGER MISO UDON SOUP This flavoursome noodle broth makes a quick, convenient meal, ready in less than 10 minutes. Miso, a main ingredient in Japanese cooking, is made from fermented soy beans; its taste is described as ‘umami’ (the fifth taste alongside sweet, salty, sour and bitter), which translates as ‘savoury deliciousness’. You can easily vary the protein — try salmon, mussels, egg or tofu.

Dashi is a fish stock flavoured with bonito.

SERVES 4

METHOD Bring stock to the boil in a large saucepan with the ginger.

Meanwhile, cook udon noodles according to packet instructions. Divide prepared noodles between four deep bowls.

Add chicken to boiling stock. Add prawns and bok choy and cook for 1–2 minutes.

Place miso in a small bowl with one ladleful of boiling stock. Whisk with a fork then add to main saucepan with stock. Turn off heat.

Divide broth and contents between bowls. Garnish with spring onions and carrot.

NUTRITIONAL INFORMATION (PER SERVE): Energy: 1246kJ (294 cal); Carbohydrate: 35g; Protein: 22g; Fat: 8g; Saturated fat: 2g

34

DIABETES | Winter 2012

Win a copy of Nadia’s Kitchen Nadia Lim has given us two copies of her new recipe book to give away.

All you have to do is email us with your name and address.

The name of two lucky Diabetes readers will be drawn out of a hat.

Please submit your entry no later than 31 July 2012. Email to: admin@diabetes.org.nz with your entry using the phrase ‘Nadia’s Kitchen’ in the subject line.

PHOTOS: KIERAN SCOTT

1 1⁄2 litres chicken stock or dashi 6 slices ginger 350–400g dried or 700–800g pre-cooked udon noodles 300g boneless, skinless chicken breast, thinly sliced 10–12 prawns, shelled with tails left on 4 baby or 2 large bok choy, washed and quartered lengthways 2 tablespoons miso paste, preferably white miso 1 bunch spring onions, sliced to garnish 2 carrots, cut into matchsticks to garnish

Helping to Manage Your Diabetes Care

Diabetes

Optium™ Ketone Test Strips

Insulin Syringe

Paradigm REAL-Time Insulin Pump Continuous Glucose Monitoring

Infusion Sets Suitable for all Insulin Pump Brands

Autoject® 2

HYPO-FIT® Gel

Cooling Wallets

Diabete-ezy™ Test Wipes & Carry Case

Order Online www.medica.co.nz Order by Freephone 0800 106 100

SALTER Nutri-Weigh Scales

Always read the label and follow the manufacturer’s instructions.

Taps No: CH3147

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