Diabetes Wellness Spring 2020 by Diabetes New Zealand

wellness DIABETES

SPRING 2020 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

LIFE-CHANGING CAMPS • FOOD ON A BUDGET • WALKING PRESCRIPTIONS • WHAT DO SIBLINGS NEED? NEW HEALTHCARE ROLES • HEALTHY PIZZA • DIABETES NZ AWARDS

LOVING LIFE Multisports athlete Emily Wilson

FREE HOME RESISTANCE WORKOUT

measures spoon-for-spoon like sugar Sticky Date Pudding with Salted Caramel Sauce Preparation 15 minutes

Instructions

Nutritional Information

Chilling 30 minutes

1. Put dates and water in a medium saucepan over a high heat. Bring to the boil, then simmer for 2 minutes or until dates are slightly softened. Remove from heat and stir in bicarbonate of soda. Set aside to cool to room temperature.

Average Quantity Per Serve:  Energy 1411 kJ (337 Cal)  Protein 4.5g  Fat Total 20.8g - Saturated 13g  Carbohydrate 33g - Sugars 17g  Sodium 512mg

Serves 12

Ingredients 250g pitted dates, roughly chopped 1½ cups boiling water 1 tsp bicarbonate of soda Cooking oil spray, to grease 100g butter, chopped, softened 1¼ cups Equal Spoonful 3 eggs 1½ cups self raising flour 1 tsp ground ginger 1 tsp mixed spice 1 tsp ground cinnamon Ice-cream, to serve

Salted Caramel Sauce 125g butter, chopped ¼ cup Equal Spoonful 1 heaped Tbsp Golden Syrup 150ml thickened cream Pinch of sea-salt flakes

2. Meanwhile, grease 12 holes of a standard muffin tray with cooking oil spray. Line base of each hole with a disc of baking paper. 3. Preheat oven to 180°C. Put butter in the bowl of an electric mixer and beat on high, with paddle attachment, until pale. Add Equal Spoonful and beat until mixture resembles crumbs. Add eggs and ½ cup of the flour and beat well with a wooden spoon for 1 minute or until combined. Add spices, remaining flour and the cooled date mixture, and mix until well combined. Spoon mixture evenly into prepared holes (approx. 3 cup batter into each hole). Bake for 25 minutes or until golden. 4. Meanwhile, to make salted caramel sauce, put butter in a small saucepan over a medium heat and cook, stirring occasionally, until melted. Stir in Equal Spoonful and golden syrup. Bring to the boil and stir in cream. Bring back to the boil, stirring continuously, then simmer, stirring, for a further 4 minutes or until light golden. Stir in sea-salt flakes. 5. Serve puddings with ice-cream and salted caramel sauce.

The Essential Ingredient Equal Spoonful has almost no calories and measures spoon-for-spoon like sugar. Perfect for your recipes cereals and drinks. Find more delicious recipes at club

.co.nz

Contents SPRING 2020

VOLUME 32 | NO 3

4 EDITORIAL

20 TECHNOLOGY: Dexcom and t:slim updates

5 YOUR DNZ: 2020 Diabetes NZ awards

22 MOVE: Craig Wise talks tai chi – a gentle exercise for everyone

6 YOUR DNZ: How you can help us to help the diabetes community 8 COMMUNITY: The empowering environment of diabetes camps

12 COMMUNITY: To youth from youth – words of encouragement from two Auckland campers

23 RESEARCH: New study highlights unmet needs of siblings of children with chronic health conditions 24 LIFE WITH TYPE 1: Meet multisports athlete Emily Wilson

28 NOURISH: Helen Gibbs shares ideas for reducing your food costs 30 COMMUNITY: 2019 McLaren Award winners 32 MOVE: The great milk-bottle workout with Craig Wise 36 MOVE: Make walking a habit – with your doctor's help 38 LAST WORD: Diabetes nurse Lorna Bingham

13 CARE: Tracking your health habits with Sharecare 14 NOURISH: Four creative (and healthy!) ways with pizza

18 CARE: Health Improvement Practitioner William Teleaga

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

DIABETES WELLNESS | Spring 2020

Editorial

ho would have predicted at the start of this year that we would experience a worldwide pandemic, that “Covid-19” would become a part of our everyday language, and that it would impact on our very way of life? I am aware that for many people with diabetes this has been a stressful period, particularly at alert level 4. At Diabetes New Zealand, we stepped up our support by making sure our website provided relevant and useful information and increasing the number of staff responding to our 0800 helpline. The Ministry of Health advised Heather Verry, our Chief Executive, that there had been very positive feedback on the way the organisation reacted. My thanks to all Diabetes NZ staff who worked tirelessly during this period, under difficult conditions. Going forward, being able to continue our support activities in a Covid-19 environment means a very strong focus on fundraising to make up the expected shortfall from grant funding. Our expectation is that branches and the national office will be affected at a time when people need our support more than ever. The Board has established a fundraising sub-committee, chaired by Maurice Trapp – who has the “bit between his teeth”. The Board has also increased the in-house fundraising resource, with Jo Chapman, our Business Development Manager, increasing her hours to full time. Jo is also charged with supporting branches in their fundraising efforts. During the Covid-19 lockdown and the subsequent reduction in alert levels, many organisations – Diabetes NZ included – resorted to new technologies to communicate. Our Trustees met using the Zoom platform, and more recently the Chief Executive and I engaged with branch chairs (and some committees) to discuss and receive feedback on the recently released strategic plan. It was a useful and rewarding conversation as other issues were raised for the Board and management to consider. As a result, we will be setting up a regular monthly Zoom conversation with the Chief Executive, a Board member, and branch chairs – along with their committees if they wish. This will provide an opportunity for all trustees to interact with branch chairs and gain a better insight into issues at the grassroots level. I recognise the significant contribution made by many people to improve the performance of Diabetes NZ and also acknowledge those volunteers who work with us to support people with diabetes. Thank you all. Our winter issue of Diabetes Wellness magazine focused on Covid-related issues. This issue returns to the “new normal”. With recipes, fitness and nutrition features, research updates, and stories about life with diabetes, we hope it will inspire and uplift you this spring. CATHERINE TAYLOR

Board Chair, Diabetes NZ

DIABETES WELLNESS | Spring 2020

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

DIABETES NEW ZEALAND Patron Sir Eion Edgar Board Chair Catherine Taylor Chief Executive Heather Verry Diabetes New Zealand National Office Level 10, 15 Murphy Street, Thorndon, Wellington 6011 Postal address PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Email admin@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Twitter twitter.com/diabetes_nz

DIABETES WELLNESS MAGAZINE Editor Johanna Knox editor@diabetes.org.nz Publisher Diabetes New Zealand Design Rose Miller, Kraftwork Print Inkwise Magazine delivery address changes Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email admin@diabetes.org.nz Back issues issuu.com/diabetesnewzealand ISSN 2537-7094 (Print) ISSN 2538-0885 (Online)

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman jo@diabetes.org.nz or +64 21 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes Wellness does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

Your DNZ

2020 DIABETES NEW ZEALAND AWARDS APPLICATIONS OPEN Every year, Diabetes NZ celebrates inspiring members of our community. Applications are now open for these important awards. Please apply if youâ&#x20AC;&#x2122;re interested or encourage others to do so.

THE SIR CHARLES BURNS MEMORIAL AWARD

This award will be presented to any member of Diabetes NZ who can demonstrate, to the satisfaction of the Awards Committee, that they have managed their diabetes for 50 years or more through the use of insulin therapy. THE JOHN MCLAREN YOUTH AWARDS

Our youth awards celebrate the pursuit of excellence by young people with diabetes. They recognise the determination and resilience of young people as they strive to achieve their goals, despite the challenges their condition brings. In 2020, one award of $1,500 will be made in each of three fields: sporting, academic, and cultural. Anyone 25 years or under as at 30 November in the year the award is applied for and has diabetes is eligible to apply.

THE DIABETES NZ AWARD

Diabetes NZ Awards may be granted to individuals who have, directly or indirectly, made a significant difference to the diabetes cause in New Zealand. The award recognises exceptional achievement and is made in the knowledge that personal sacrifices must always be part of such a contribution to diabetes. THE LIFE MEMBERSHIP AWARD

The award of a Diabetes New Zealand Life Membership is the most prestigious honour awarded by the organisation. A Life Membership is conferred on someone in recognition and appreciation of outstanding service by that person for the benefit of people with diabetes. To ensure this award remains a distinguished and exceptional honour, a maximum number of 40 Life Members is permitted at any one time.

HOW TO APPLY FOR AN AWARD Applications for all awards close: 5pm Monday, 28 September Application forms are available on Diabetes NZ's website. Go to: www.diabetes.org.nz/diabetes-nz-awards.

To learn about our amazing 2019 McLaren Award winners, see page 30.

DIABETES WELLNESS | Spring 2020

Your DNZ

Help us to help the diabetes community In these remarkable times, the work of Diabetes New Zealand is as vital as ever – and your support means everything. There are a host of ways you can help.

ore than 250,000 New Zealanders have been diagnosed with a form of diabetes, and many more are at risk or undiagnosed. Every one of these people has a story, and Diabetes NZ – a non-profit trust – works for all of them. We rely on grants and the generous donors, sponsors, and supporters who see the importance of our work. We are grateful to those supporters, and now we’re calling for more people and groups to join in helping our cause.

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WHERE DO YOUR DONATIONS GO?

Diabetes NZ undertakes wideranging work for people with diabetes and their loved ones. These are just some of the ways we support our community: • We have 14 branches around the country that offer social

DIABETES WELLNESS | Spring 2020

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and practical support and advice to those with type 1, type 2, gestational diabetes, and prediabetes, as well as some of the rarer forms of diabetes. We run a free 0800 helpline that offers support and advice on diabetes to anyone who calls. About 200 people a month use this service, receiving help with a wide range of questions and issues. We host life-changing camps for young people with type 1 diabetes and their families. We lobby the government on behalf of the diabetes community, raise public awareness of issues, and continually push for the best standard of care to be offered to those with any form of diabetes. We distribute “newly diagnosed packs”, worth more than $100 each, to young people in hospital facing the traumatic experience of a new diagnosis with type 1. Our regular magazine, our e-newsletter, and our national website disseminate up-todate New Zealand-specific information on diabetes. We advocate powerfully for the diet and lifestyle changes that New Zealanders as a population need to make – and need to be enabled to make – to stem the rising tide of type 2 diabetes.

HOW CAN YOU HELP? There are many ways you can support our work, and every bit counts. Here are some of the things you can do to help us to help the whole diabetes community. REGULAR DONATIONS

We are very grateful to all our donors, whatever amount they can afford to give. If you’d like to set up a regular donation, it’s simple and would be hugely appreciated. To donate: • Email fundraising@diabetes.org.nz • Call 0800 342 238 • Or simply visit our website at www.diabetes.org.nz and click on the “donate” button. GIFTING IN LIEU

Asking for donations to Diabetes NZ in lieu of a material gift at any time is a wonderful way to help. See above for how to donate. PAYROLL GIVING

Through New Zealand’s payroll giving system, your employer or payer (if you get schedular payments) deducts the money on your behalf and passes it on to the organisation of your choice. It’s a way to donate regularly and easily, and for every dollar you donate you get 33.33

cents back as a tax credit. The credit reduces the amount of PAYE or withholding tax you pay. To find out how to set up payroll giving, see www.ird.govt.nz/roles/ employees/payroll-giving-as-anemployee. FUNDRAISING EVENTS

Getting involved with an event that involves peer-to-peer fundraising is one of the most fun ways to help. Through this form of fundraising, you and other participants reach out to your social networks, asking them to donate to Diabetes NZ as you reach your event’s goals. Some of the fundraising events that Diabetes NZ branches and members will be getting involved in this year include: • The Rotorua marathon (26 September) • The Auckland marathon (1 November) • City-to-surf, Tauranga (1 November) • Dress in Blue for World Diabetes Day in November. Or, why not come up with your own fundraising event? Join in! Ask for more information at fundraising@diabetes.org.nz or by calling 0800 342 238.

CORPORATE PARTNERSHIPS

We are proud to have a number of corporate partnerships, including our champion sponsors: Fitbit, Equal, and Anytime Fitness. We have a number of opportunities available, including excellent advertising packages. We invite companies to partner with New Zealand’s leading diabetes organisation. We’ve been supporting New Zealanders with information and resources to help identify and manage diabetes symptoms for more than 50 years. For more information, contact Jo Chapman, Business Development Manager at jo@diabetes.org.nz. SUBSCRIBE TO DIABETES WELLNESS MAGAZINE

Diabetes Wellness is Diabetes NZ’s flagship publication. This quarterly magazine has been the leading source of information about diabetes for the New Zealand situation since 1988 and is affordable and accessible. Buy one for yourself, or gift one to someone you care about. 100% of the profit from your purchase goes directly to supporting our work. Subscription details are below.

Invest in your health Subscribe for just $28 a year* Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand * Four issues delivered to your door – $7 per issue, including P&P. RRP is $32.00 To subscribe for this special price visit www.diabetes.org.nz and click on 'Magazine Subscription' DIABETES WELLNESS | Spring 2020

Community

EMPOWERED FOR LIFE For many hundreds of young people with type 1 and for their families, diabetes camps are a lifeline – a chance to have fun, learn, and overcome enormous challenges

Above: At Otago branch's summer camp, three friends enjoy the challenging activities provided by Evan Jamieson from Adventure Masters.

DIABETES WELLNESS | Spring 2020

hen the news came that Diabetes NZ Otago Branch’s winter 2020 diabetes camp was back on, cheers went up from diabetes families all around the region. The Southland Ski Club had been forced to cancel it because of Covid-19. But towards the end of June, as New Zealand’s Covid situation looked up, branch co-ordinator Noeline Wedlock got the news that they were “all go”. It means that, this September, 20 to 30 teenagers living with diabetes will once again be able to join together in Queenstown for one of the highlights of their year – the Dunedin Branch’s ski and snowboard camp.

SOUTH ISLAND CAMPS

It’s not the only camp the branch runs. Noeline explains that they also run a summer camp for eight to 12 year olds with diabetes. She says the benefits of the camps are almost too numerous to list, but “the first one would be the friendships built between our diabetes youth themselves, and also the relationships built with medical staff who they’d normally only ever see at clinics”. She adds that “to be with others who are dealing with the same challenges of diabetes on a day-to-day basis in this extreme environment is very empowering”. Heather Bates, outgoing co-ordinator of Diabetes NZ

Nelson Youth agrees. There, they run an annual family camp. “It supports a vulnerable part of the community who live with a serious, life-long health condition. It connects local families who might not have met before, gives the children a sense of hope, and helps build their confidence in living with diabetes. It makes them feel normal with people around them who understand the daily challenges of living with type 1.”

She notes that the family camps are beneficial for siblings of kids with type 1 as well. They’re a sometimes forgotten group, and to be able to meet other siblings in the same boat is invaluable. “Not everyone can make the camp, so having smaller events throughout the year keeps the group in touch and connected. Smaller social events also break the ice for the new families who aren’t too sure about coming to the family camp yet.”

Top right: Otago's winter camp for teens. Other photos: Otago's summer camp for 8-12 year olds. At lower right are the Southern District Health Board's Ruth Thomson (dietitian) and Jenny Rayns (diabetes nurse specialist). Endocrinologist Dr Ben Wheeler also regulary attends Otago camps.

AUCKLAND CAMPS

Natalie Hanna from Diabetes NZ Auckland Branch says, “We try to run several different camps a year, aimed at different age groups and catering for different situations, although we’re sometimes limited by funding.” Their Living Every Day Brave camp, for nine to 12 year olds, runs in January. Natalie says, “It has a component for Youth Leaders as well, with around 10 or 12 young adults attending as mentors. “We have a strong group of youth leaders at the moment, so we’re trialling having them more involved in the camp planning process. They have a fantastic insight into what it’s like living as a kid or teen with type 1, having lived through it themselves. We also want the camp programme to involve more of a leadership learning component for them.” Normally, Auckland branch also runs a Type 1 Teens Living Brave camp in the April school holidays, although Covid saw it cancelled this year. Instead, there will be a day “camp” in December. For whole families, there is a popular annual sleepover – a one nighter at Kelly Tarlton's Sea Life Aquarium. And then there is the family camp, which usually attracts about 70 people every year. Natalie believes it’s vital to have some camps that are just for young people with type 1 and others that are for the whole family. “A whole-family camp is good for kids who are younger than nine, and who aren’t sure about leaving their families, and it’s also for siblings and the whole family to benefit from being around others living with type 1 and to share in education sessions. “Camps are a chance for kids and teens to make lasting friendships, and for the campers to see how others manage

DIABETES WELLNESS | Spring 2020

their diabetes, to learn about new technology by seeing it in action, and to learn from other kids by seeing them manage their own diabetes.” Like other co-ordinators, Natalie thinks the presence of medical professionals at camp is all important. “We get fantastic support from the Starship endocrinology service. We also get lots of volunteer nurses from the Starship children’s medical wards and from the community – for instance, school nurses. “Having specialist medical professionals closely supervising the kids is essential from a safety perspective, but it’s also a wonderful chance to teach them things like giving their own injections, counting carbs, and so on. “Many kids do their own first injections at camp after seeing other kids do it – and with the time for nurses to coach them over an extended time period. My own daughter has recently started doing her own Libre insertions and site changes. After successfully inserting her first Libre, she happily remarked how she’d thought back to a friend doing it at camp – that had been over a year ago! I really thought this showed the lasting benefit of camps.” The presence of medical professionals isn't just important for the kids. “The volunteer nurses also benefit from seeing real-life diabetes management in action.” And for the campers’ families back home, it’s a chance to “take a break from the relentless and continuous job of managing diabetes”. Natalie notes that many kids don’t go on school camps independently, as diabetes management is too much for a school to take on, “so this is one of the few opportunities for both kids and parents to be independent of each other”. Auckland children and teens enjoy a range of camps throughout the year.

DIABETES WELLNESS | Spring 2020

CENTRAL NORTH ISLAND CAMPS

In the central North Island, Diabetes NZ branches collaborate. Lena Fendley in Tauranga explains that they run a biennial camp, but “It would be nice to run this yearly if we can get the funding. In the past, we have also sent about five kids to the Waikato Kids Camp. “We get around 25 families coming along every time, and the 2021 camp is going to be a joint camp with Rotorua and Eastern Bay of Plenty Branches.” Diabetes Help Tauranga recently became an official branch of Diabetes New Zealand, so this will be their first camp as such. As well as having life-changing value for young people with type 1, Lena says the family camps are a huge help for parents. “At our last camp, we had a ‘Break Out Session’ for the parents, where we had guest speakers from MediRay and Nightscout, as well as a dietitian. “Families found this really useful, and the children went out on activities with volunteers during this time. Next time, I’d also like to be provide a bit of down time for the parents so they can chat, get to know each

other, and share experiences. This is especially valuable for new families.” Karen Reed, District Manager based in Rotorua, would like to see camps even more widely accessible in this country: “For me personally, camps have been something that I’ve championed ever since I was a little girl. I was diagnosed at age 10, when I lived in the UK, and I went to two camps run by the British Diabetic Association – as it was known in the early 80s. “They were two weeks long! I learned heaps about diabetes and myself. Then, as soon as I was old enough to go to camps as a leader, I was in. I guess my first would have been when I was 17. And that was the start of my volunteering for Diabetes UK, which grew into, well, where I am today with Diabetes New Zealand.” She says, “Here in New Zealand it’s pot luck whether you can attend a camp or not, depending on where you live, which is so unfair. In the UK, you can attend a camp anywhere in the country and the medical care doesn’t have to be provided by your own medical team. I’m really, really passionate about making camps accessible to all

kids in New Zealand, but it’s a minefield of red tape.” In Rotorua, they’ve run several family camps, “where parents and siblings attend, usually over a weekend, and the families are responsible for the medical care of their child with type 1”. However, Karen would like all children with type 1 to also have access to camps where they can attend without parents and where there is “a medical team to take care of all things medical”. She says, “Our situation in Rotorua is that we might be invited to join Waikato camps, but there is a requirement that we provide a Diabetes Nurse – and our DHB can’t or won’t release one. So our kids have only ever had the opportunity to attend family camps.” Their next one will be the joint one planned with Tauranga in 2021. “I’m really passionate about kids being able to go to a camp and stay away from their families. They are educational, promote the development of coping skills and practical skills. It’s the perfect environment to get over fears and a great opportunity for the parents to let go a bit, not to mention have a break.”

Diabetes NZ Nelson Youth and their families form a tight, supportive community, and their camps foster this.

DIABETES WELLNESS | Spring 2020

Community

To youth from youth Two Auckland campers offer advice to other young people living with diabetes.

f you’ve just been diagnosed with type 1 or type 2 diabetes, don’t worry. Everything is going to be okay. Some advice is that you don’t need to panic or cry. It’s all good. You’ll be fine. If you come across a high, like a really, really high sugar, first thing you need to do is check your ketones. But the really important thing is that you’re still a normal human being. Don’t think, I’m so different from the others. NO! You’re not different. Think to yourself, I’m just like everyone else, good luck, and take care of yourself. Mayyar Kahloon, 10 years old

alofa Lava, My name is Laylani Wendt-Fa’apoi. I’m 16, and in year 12 at Avondale College. I’ve had type 1 diabetes for 14 years! I was diagnosed at the age of two and was in a diabetic coma for three nights and two days. I’ve had diabetes practically my entire life. I don’t know any other way of living! It definitely hasn’t been easy, but I have a great support network. There will be days where you just want a break from it all, but that’s completely normal. An important lesson I learnt throughout my journey is that communication is key. Communication with family, friends, doctors; it’s important to talk to others when you may be struggling.

Despite having diabetes as long as I have, there were times I was hesitant to give insulin in public or in front of friends, but over time I’ve become very comfortable with this. The social aspect of diabetes may be something you worry about. You learn to come to terms with the questions and intrigued people. If you sometimes feel like the odd one out around your friends, you should definitely attend a diabetes camp! I seriously recommend going. Although it’s nerve-wracking, you’ll feel right at home and understood because there are others going through exactly what you are. Personally, it was one of my favourite experiences, and I wish I went earlier! I also wish I had known about the different ways of managing diabetes at an earlier stage. An insulin pump helped me go from an HbA1c of 112 to 58 in less than three months. Explore your options, communicate with your doctors and family, and find out what’s best for you. Everyone is different – it took me a while – but with the help of the team, you’ll be able to figure out what’s best suited for you and your needs. Good luck on your journey with diabetes. I wish you all the best! Laylani Wendt-Fa’apoi, 16 years old

To find out about camps in your area, go to: www.diabetes.org.nz.

DIABETES WELLNESS | Spring 2020

Care

EXPLORE YOUR REALAGE WITH SHARECARE

he Sharecare platform officially launched in New Zealand in May 2020, with Diabetes New Zealand as founding clinical content partner. Sharecare is a free app that anyone can download from their preferred app store and use. Sharecare’s Allison Hall says, “It uses RealAge, a validated health risk assessment that provides the user with immediate health insights, to engage people by raising their innate sense of curiosity about the question, ‘Am I older or younger than my actual age?’ “With that knowledge, the platform begins to help you understand what health

behaviours are making you older or helping to keep you younger.” The app makes it simple to track a wide range of health habits. Every time a user places eight trackers in a healthy range, they earn a “Green Day”. The more Green Days you earn, the more you lower your RealAge. Allison says, “The idea is that small changes can help you live healthier, lower your RealAge, and get even more out of life.” For Diabetes NZ’s community, there is a blood-glucose tracker, but all the other trackers are about overall healthy habits that support a good HbA1c and can assist with lowering the risks of diabetes. Allison says, “Essentially, it makes it easier to have all your

Sharecare is a digital health solution that helps you manage all your health in one place. The Sharecare platform provides each person – no matter where they are in their health journey – with a comprehensive and personalised health profile where they can dynamically and easily connect to the information, daily tracking, evidencebased programs and one-of-a-kind tools to help you live your healthiest, happiest and most productive life. Download the app for free today!

health in one place. For people with, or at risk of, diabetes, Sharecare has health information to support them with their diabetes management, and they can follow Diabetes NZ’s Health Topic. There are also places to record diabetesrelated information, and the app can sync with a range of devices.” She says, “We feel proud and privileged Diabetes NZ are a founding clinical content partner with us. They’re an innovative and passionate organisation who have their members at the heart of all they do. Together, we’ll work to distribute health messages to those who need it across the country. In the future, we hope to add new features and offerings to Diabetes NZ members.”

Nourish

Versatile pizza can be full of fibre, low in salt and fat, loaded with nutritional value, and delicious too.

Healthy and satisfying

4 CREATIVE WAYS WITH PIZZA

BLUE CHEESE AND WALNUT PIZZA SERVES 4

4 wholemeal pita pockets ½ cup chopped or lightly crushed walnut pieces 1 large onion or 2 small 1 Tbsp olive oil Dried or fresh rosemary 2 handfuls of mesclun salad BLUE CHEESE SAUCE: 40g blue cheese 1 Tbsp low-fat milk

Preheat your over to 250°C.

To put together the pizza:

To semi-caramelise the onions:

Divide the cooked onions in four and spread across the four pita breads.

Dice the onion or slice it thinly. Gently heat the olive oil in a wide pan, until the oil ripples with heat. Add the onions and stir to coat in the oil. Keep the onions cooking at a low heat for up to half an hour or until they are very soft and gently browned. Do not let them burn. To make the blue cheese sauce: Gently heat the blue cheese and the low-fat milk in a small pot and stir till the cheese is melted and mixed well with the milk.

DIABETES WELLNESS | Spring 2020

Sprinkle on rosemary. Sprinkle the walnuts evenly over the top of each. Drizzle the blue cheese sauce across each pizza. Put the pizzas in the oven and cook for 10 minutes or until piping hot and beginning to brown. To serve, scatter mesclun salad over each pizza. NUTRITION PER SERVE: ENERGY 1250kJ (300kcal) | PROTEIN 10g | FAT 18g (SAT FAT 4g) | CARBOHYDRATE 26g (SUGAR: 6g) | FIBRE 5g | SODIUM 320mg

CLASSIC MARGHERITA

LOADED VEGE PIZZA

SERVES 4

4 medium-sized wholemeal wraps, or 2 large wraps cut in half 2 Tbsp tomato paste ½ tsp balsamic vinegar 1 tsp onion powder or flakes 1 tsp garlic powder or granules 75g lite sour cream ½ cup chopped fresh basil

4 wholemeal pita pockets 1½ cups of cooked, mashed or pureed pumpkin 3 large cloves of garlic, crushed or very finely chopped 1 Tbsp olive oil 2 tsp dried basil, oregano, or your favourite dried Italian herb mix 2 cups of your favourite pizza veges, chopped (e.g. mushroom, capsicum, spinach, onion, aubergine, zucchini) 1 Tbsp dried chives or spring onions, or ¼ cup finely chopped fresh chives or spring onion 100g lite sour cream

Preheat your over to 250°C. To make the tomato base: Mix together the tomato paste, balsamic vinegar, onion powder/ flakes, and garlic powder/granules. To put together the pizza: Spread the tomato base across the four wraps. Drop small dollops of lite sour cream across the pizzas evenly. Put the pizzas in the oven and cook for five minutes or until piping hot and beginning to brown. To serve, scatter fresh basil over each pizza. VARIATION: For a yummy chicken pizza, spray shredded chicken breast with olive-oil spray and scatter it on the pizza before the sour cream.

Preheat your oven to 250°C. In a small bowl, mix together the sour cream and the chives/onions. Set aside. Gently heat the olive oil in a wide pan, until the oil ripples with heat. Add the chopped pizza veges and the garlic, and stir to coat in the oil. Cook at a low heat for around five minutes or until slightly softened. To put together the pizza: Spread the pureed pumpkin across the four pita breads. Distribute the veges across them evenly. Put the pizzas in the oven and cook for 10 minutes or until piping hot and beginning to brown. To serve, drop small dollops of the green onion cream mix across the pizzas. TIP: Leftover roast pumpkin makes an especially flavoursome puree. NUTRITION PER SERVE: ENERGY 966kJ (231kcal) | PROTEIN 8g | FAT 7g (SAT FAT 3g) | CARBOHYDRATE 34g (SUGAR: 6g) | FIBRE 5g | SODIUM 204mg

DIABETES WELLNESS | Spring 2020

POTATO BASE BOLOGNESE PIZZA SERVES 4

1 cup mashed potatoes 1 cup wholemeal flour 3/4 cup tomato paste 200g lean mince 2 tsp balsamic vinegar 1 tsp onion powder or flakes 1 tsp garlic powder or granules 2 tsp basil or Italian herbs 100g reduced-fat feta cheese 2 big handfuls fresh spinach, chopped roughly

Preheat oven to 180°C. To make the base: Mix mashed potatoes and flour together well. Dollop the mixture into a greased oven tray and spread it in an even layer to make a nice pizza base shape. It should be about 5–8 mm thick. Place the base in the oven and bake for about 10 minutes or until it begins to brown on top and feels as if it’s forming a hard crust when you tap it with a fork. Take it out and put it aside. Turn up the oven heat to 250°C. To make the bolognese sauce: Gently heat the olive oil in a saucepan, until the oil ripples with heat. Add the mince, breaking it up with a spoon and stirring it.

Cook at a medium heat for five minutes, stirring regularly, until cooked through. Add the tomato paste, garlic, onion, Italian herbs, and balsamic vinegar and stir some more till mix is piping hot. If it becomes too dry, add a tablespoon of water. To put the pizza together: Spread the bolognese sauce evenly over the pizza base. Crumble the reduced-fat feta over the top. Put the pizza in the oven and cook for 10 minutes or until beginning to brown. Scatter spinach over the top to serve. TIP: For a quicker option, this is a great topping with any pre-bought wholemeal base. Of course, this potato base can also be used with any other topping. NUTRITION PER SERVE: ENERGY 1460kJ (349kcal) | PROTEIN 35g | FAT 15g (SAT FAT 3g) | CARBOHYDRATE 36g (SUGAR: 2g) | FIBRE 5g | SODIUM 337mg

DIABETES WELLNESS | Spring 2020

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Care

Frontline work pays rich rewards A new role is emerging in New Zealand healthcare – the Health Improvement Practitioner, or HIP. Porirua-based William Teleaga is among the first.

he Health Improvement Practitioner (HIP) role is modelled on the Behavioural Health Consultant role that is widespread in the United States. It’s a model of care that has been recently developed by ProCare Health and Tāmaki Health in Auckland. The rationale is this: a GP generally only has 10 to 15 minutes to spend with each of their patients. However, in many communities, patients often need more time than that to talk through issues and find solutions. That’s when it’s useful for a GP to call in a HIP. Each HIP is based in a general practice. William Teleaga works at Porirua Union Health and Community Service. He says, “The HIPs programme was first piloted in Māngere. It went really well, so they carried on with it. I was one of four to be signed on in the Wellington region. There’s one in Kāpiti, one at Victoria University, one in Mana, and me.” HIPs can come from diverse backgrounds. Before this, William worked for 15 years in the mental health sector. He spent the last five years as support staff in a forensic intellectual disability unit

DIABETES WELLNESS | Spring 2020

“I'm really enjoying the job because I can see the need for it. And I'm really enjoying being able to serve my community.” – William Teleaga while studying for a social work degree.Other HIPs may have backgrounds as nurses, doctors, and counsellors. HOW IT WORKS

William says, “I talk to patients for an initial consult and ask a lot of questions to understand what’s happening for them. I can spend 30 minutes with them, and sometimes, if I’ve got time, I spend longer. It’s a safe environment for them, a safe place to vent. “I usually see nine or 10 patients a day, and I don't have to rush them, so people feel like they're being heard.” As well as listening, William is able to spend time explaining things to patients that they may not have previously

understood – for example, all the ins and outs of blood pressure. William is confronted every day by the network of links between stress, physical health, and poverty. “This is a low decile area, and often there’s a lot going on for a patient: stress and pressure at home or work; they might be suffering from anxiety, depression, insomnia, oversleeping, or overeating. They might be isolating themselves. A lot of them have diabetes or gout. “We set a plan in place for lifestyle changes. Not one that I've forced on them, but one that they've worked out themselves through talking to me. “I’ll usually give them a couple of weeks to work on it and then check in with them by phone, or they’ll come in again for another appointment. If things are very hard for them, I might follow up with them sooner. Or I might refer them to our counsellor. I can also refer them to other groups or social services or community programmes.” TRAINING TO BE A HIP

There is a set training programme for people who are selected to become HIPs, and it has three phases: 1. A four-day face-to-face training. 2. Being observed and coached in the workplace by a HIP trainer. 3. Ongoing coaching and attendance at regular webinars.

Now that the four Wellingtonregion HIPs have completed their training, they continue to meet with each other, virtually, once a week, to discuss how things are going and offer each other support. “I'm finding that my work has evolved,” says William. The others he trained with are finding the same thing. “It depends what the practice needs. Because it’s a new role, you’re given the freedom to let it evolve – within what it has to be.” The work is immensely rewarding. “I’ve met people who’ve said I’ve saved their lives, or who’ve lost 30 or 40 kg while I’ve been working with them. I think the role is needed, and things are going really well in other practices, too, from what I'm seeing. I think it’s a needed service.” ON-THE-SPOT CONSULTS

Anyone can see a HIP as long as that person is enrolled in the general practice where the HIP is based. Around half of William’s day is for booked appointments, The other half he spends seeing patients who are referred to him by GPs on the spot. There’s enormous value in being able to see people straight away. There are times when having to make an appointment for another day would mean it might never happen. Another important part of the HIP programme is what’s called the “warm handover”: The GP or nurse takes their patient down the corridor to see the HIP and introduces them, face to face. This seemingly small act can play a vital part in helping the patient to feel comfortable. Lifestyle advisor roles have been around for a while, particularly in hospitals, but it’s a new thing to base them in GP practices. William says, “When you put the role into primary care, attached to GPs, you

catch patients earlier, before they need the hospital. “I come from mental health work, which is challenging and demanding. As a HIP, I’m still getting some of the same issues, but I'm getting better results because we're getting them early. “I'm really enjoying the job because I can see the need for it. And I'm really enjoying being able to serve my community.” That’s another invaluable asset that William brings to the role. He grew up in Porirua, and he knows the community well. “The doctors and nurses here were wondering how it was going to go at first, but I think they can all see the benefits now.” Dr Bryan Betty – who is the Medical Director of The Royal New Zealand College of Medical Practitioners and also one of the GPs at the centre where William works – couldn’t agree more: “I am very keen on the idea, as are the other GPs, and we’re very supportive of it continuing.” With the June 2020 release of the New Zealand Government’s Health and Disability System Review, a report that recommends wide-ranging change to our health system, GPs, like many medical professionals, are cautiously hopeful that beneficial change could be coming to address our population’s health inequities. Dr Betty says that greater integration between primary/community care (such as GP centres) and hospital/ specialist services is seen as “critically important, especially for vulnerable and rural communities”. In the meantime, however, initiatives like the HIPS program are “a major step forward in filling some of the void, especially in the high-needs practices where we don’t get access to this kind of care very easily”.

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on. No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 250,000 New Zealanders with diabetes to live full and active lives.

For a confidential discussion, please contact Nicky Steel admin@diabetes.org.nz or 04 499 7145

Technology

DEXCOM AND T:SLIM UPDATES NZMS Diabetes have released two very welcome product updates.

DEXCOM G6 NOW AVAILABLE

The new-generation Dexcom G6 Continuous Glucose Monitoring System (CGM) is now available in New Zealand for people with diabetes who are aged two years or older. Continuous Glucose Monitoring (CGM) is a diabetes management tool that measures glucose levels 24 hours a day. A sensor inserted just under the skin measures interstitial glucose levels – the glucose in the fluid around the cells. This gives a good indication of blood glucose levels. The Dexcom CGM wirelessly transmits these readings every five minutes to a compatible smartphone, smart watch, or receiver, letting the wearer know where their glucose is at and which direction it’s heading in. (To view a list of compatible devices, see www. dexcom.com/compatibility). New features of the Dexcom G6

• No fingerpricks – New technology means the user doesn’t need to rely on fingerpricks even for calibrations and diabetes treatment decisions.1 • Easy sensor applicator – A full redesign of the applicator now allows for one-touch insertion. • Urgent “low soon” alert – This is designed to provide a 20-minute advance warning ahead of a low.

DIABETES WELLNESS | Spring 2020

• Extended 10-day sensor – Approved for 43% longer wear than previous generation Dexcom CGMs. • Low profile – A redesigned transmitter with a 28% lower profile than previous generation Dexcom CGMs makes the device more comfortable and easy to wear under clothing. • Paracetamol blocking – This new feature enables paracetamol use without any effect on glucose readings.2 In a further update, the Dexcom G6 Continuous Glucose Monitoring System is now approved for back-of-the-upperarm wear. It can also be worn on the abdomen (for patients aged two years and above) and on the upper buttocks (for patients two to 17 years old). As with previous generation Dexcom CGMs, a personalised alert schedule warns of pending high and low blood sugars. Compatibility with smart device apps allows for sharing glucose information with up to five people. Dexcom pregnancy-use update

Dexcom G6 is now approved for use by people with type 1 diabetes who are pregnant and for those with gestational diabetes. T:SLIM X2 UPDATE

Basal-IQ™ Technology for the Tandem t:slim X2 Insulin Pump is now available in New Zealand. For current t:slim X2 Pump users, this update is available as a remote update to download on a home computer. What is Basal-IQ Technology?

This new technology predicts and helps prevent lows with no fingerpricks. It’s designed to be simple to learn and use, with no

complicated settings or modes to manage. The Basal-IQ feature helps reduce the frequency and duration of low-glucose events by predicting glucose levels 30 minutes ahead and suspending insulin from the t:slim pump if they’re expected to drop below 4.4 mmol/L or if a CGM reading falls below 3.9 mmol/L. Insulin resumes when sensor glucose begins to rise. Clinical study results showed a 31% relative reduction in sensor time below 3.9 mmol/L when study participants used a t:slim X2 insulin pump with Basal-IQ technology.3 For more information on Dexcom G6 and t-slim insulin pumps, please contact NZMS Diabetes: www.nzmsdiabetes.co.nz 0800 500 226 nzms@nzms.co.nz REFERENCES

1. If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. 2. G6 readings can be used to make diabetes treatment decisions when taking up to a maximum paracetamol dose of 1,000mg every six hours. Taking a higher dose may affect the G6 readings. 3. Forlenza GP, Li Z, Buckingham BA, Pinsker JE, et al. Predictive low-glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: Results of the PROLOG trial. Diabetes Care. 2018;41(10):2155-2161. doi:10.2337/dc18-0771.

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*If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. References: 1. Wadwa RP, Laffel LM, Shah VN, Garg SK. Accuracy of a Factory-Calibrated, Real-Time Continuous Glucose Monitoring System During 10 Days of Use in Youth and Adults with Diabetes. Diabetes Technol Ther. 2018. For a list of compatible devices, visit www.dexcom.com/compatibility. For 360 Programme terms and conditions please contact us or visit our website. © 2018 Dexcom. Dexcom, Dexcom G6, Dexcom Share, and Dexcom CLARITY, are registered trademarks of Dexcom, Inc. in the United States and/ or other countries. Distributed in New Zealand by NZMS Diabetes, 2a Fisher Crescent, Mt Wellington, Auckland 1060. Ph: 09 259 4062.

Move

TAI CHI – GENTLE, NOURISHING EXERCISE Looking for a new activity that’s suitable for almost everyone? Our fitness consultant Craig Wise suggests trying tai chi.

hen we think of martial arts, our minds go to highintensity karate, judo, or ju-jitsu, but there are other disciplines too, including tai chi chuan – or tai chi as it’s more commonly known. So what is tai chi? Isn’t it that strange thing we see in Hollywood comedies, with lines of people shuffling their feet and slowly moving their arms like a snailpaced Bruce Lee? Well, yes and no. Tai chi is sometimes called “moving meditation”, as it’s based on a series of flowing movements as you shift from one stance to the next. There are 108 moves in the tai chi repertoire, and while they’re easy to learn, the ongoing challenge is in mastering them fully. THE DIFFERENCE BETWEEN TAI CHI AND YOGA

Tai chi and vinyasa flow yoga appear similar in many ways, with their focus on breathing and controlled, flowing movement between poses. However, there are a number of differences. For example, tai chi is based on movements in a standing position with the weight supported by the legs, whereas yoga poses tend to be supported on legs and/or arms, which can stress the wrists and shoulders. Also, the way yoga is often taught, the positions are focused on static core stability and overall flexibility, while tai chi develops core strength through movement.

DIABETES WELLNESS | Spring 2020

THE UPSIDE OF TAI CHI

The slow movement and positioning of the hands and feet enhances the mind–body connection. With this enhanced connection, we get improvements in balance and coordination. There are many other benefits to tai chi, including reduced stress, better sleep, better posture, greater aerobic capacity, better mobility and balance, and an increase in the muscular strength of the legs. Several studies have shown that tai chi reduces the risk of falls in older people and can help in rehabilitation after strokes. The low-impact nature of tai chi makes it suitable for just about everyone, even those who suffer back ache or bad knees – issues which can make yoga tricky. In fact, many people show a greater range of motion as they build up strength in their legs, and the deep breathing involved, coupled with the strengthening of the abdominal area, can alleviate back pain. The big upside of tai chi is that it’s cheap. No expensive equipment is needed, you can do it just about anywhere, and you don’t need to be super fit to start. THE DOWNSIDE OF TAI CHI

If you’re looking for a targeted weight-loss activity, then tai chi might not be your best starting point. But any activity burns calories, so slipping it into your mix won’t be a bad thing. However, its other health effects – such as better sleep, improved mental

health, and more – may ultimately help indirectly with weight loss. There really are no downsides to tai chi. It’s truly an all-levels activity from beginner to advanced. And if you don’t think you can stand for long enough, try chair chi. (There are plenty of chair chi tutorials on YouTube if you want to see what it’s about.) THE VERDICT

With the many benefits of tai chi and its accessibility, why not give it a crack? Tai chi classes exist around the country. Googling “beginner tai chi” along with your location will get you on the way.

WHAT THE RESEARCH SAYS A 2016 literature review by the Canadian College of Physicians concluded there was excellent evidence that tai chi improved balance and aerobic capacity in those with poor fitness. The researchers also found good or excellent evidence that tai chi helped with depression, improved cognitive capacity in older adults, and benefited those with osteoarthritis and Parkinson’s disease. There was also fair evidence of its benefit for – among other things – improving sleep and improving quality of life for those with high blood pressure, fibromyalgia, and osteoporosis. No studies found that tai chi worsened a condition. A safety review of tai chi found “adverse events were typically minor and primarily musculoskeletal; no interventionrelated serious adverse events have been reported.” For more information, see www.cfp.ca/content/62/11/881.short.

Research

WHEN YOUR SIBLING HAS TYPE 1 A new study sheds important light on the unmet needs of children whose siblings have a serious chronic health condition.

assey University psychology researcher Katie Armstrong has found that the siblings of children with cancer, cystic fibrosis, and type 1 diabetes have very high levels of unmet needs. Her study surveyed 204 respondents: 84 siblings of children with cancer, 47 siblings of children with cystic fibrosis, and 73 siblings of children with diabetes. While many siblings cope well, Armstrong found that some “have a range of unmet psychosocial needs which have the potential to lead to adjustment difficulties and mental health problems … A comparison of the three health conditions showed cancer had the highest average percentage of unmet needs (66.3%), followed by cystic fibrosis (53.0%), then type 1 diabetes (48.6%).” She also undertook a review of targeted, nationwide support services available to siblings in Aotearoa New Zealand and found that this was an under-serviced area. HOW IT FEELS

The study says, “Following a child’s diagnosis with a serious chronic health condition, siblings can feel strong negative emotions including fear, anxiety, sadness, resentment, and distress. Parental focus on the unwell child can lead siblings to feel ‘invisible’ and ‘forgotten’ due to reduced parental attention. These

feelings can lead to jealousy of their affected sibling, then guilt for feeling jealous.” Armstrong found that this could be compounded by a feeling of being unimportant or left out when information about their sibling’s health condition was withheld from them, even though parents and health professionals often withhold this information in an effort to protect the sibling. The study said, “Siblings may also feel misunderstood and unsupported by friends and family who do not understand the full impact of the diagnosis on them. These complex emotions are often suppressed due to siblings not wanting to overburden their parents, feeling ‘selfish’ for having needs of their own, and feeling guilty for being the ‘healthy’ sibling.” Any changes to family roles and relationships could add to the siblings’ distress and feelings of being overwhelmed. “The impact of these needs (if left unmet) may lead to depression, anxiety, and posttraumatic stress symptoms and affect beliefs around self-worth.” Armstrong’s findings suggest that “siblings find it very difficult to request help, due to the complex array of emotions they feel around their sibling’s health condition”, and she recommends that “support services should be offered to siblings

so they do not need to ask for help”. Armstrong is currently undertaking further research that builds on her findings so far, and she aims to develop a needsbased intervention programme for siblings. For a copy of the study or for more information, contact Katie Armstrong at: siblingneedsresearch@gmail.com.

HOW TO HELP The report suggests focusing on these things when looking to help a sibling of a diagnosed child: • age-appropriate information about their sibling’s health condition • guidance on how to support their sibling practically and emotionally • professional support offered to them close to the time of diagnosis • support and understanding from peers, family, and teachers • time with parents to feel included and valued • a safe space where they feel validated and can speak freely • recreation and “time out” with other siblings who understand them.

DIABETES WELLNESS | Spring 2020

Life with Type 1

EMILY WILSON

SEIZING THE DAY

DIABETES WELLNESS | Spring 2020

Multisports athlete Emily Wilson was 22 when she found out she had type 1 diabetes. Six years later, she reflects on how it changed her life for the better.

uring my school years, I was a competitive swimmer, then I got drawn to triathlon. But it was competing in the Hillary Challenge – a five-day national secondary schools event near Tongariro – that was the biggest revelation. It involves teams of eight competing in a series of physical and mental problem-solving challenges, then a two-day rogaine around the mountains, and the final day is a head-to-head adventure race, usually involving running, biking, kayaking, rafting, and rope skills. This experience opened my mind to the possibilities and thrill of exploring the unknown, both physically and mentally. It was such a buzz to be part of a team, working together towards a common goal and especially to be off-road, paving our own way, learning heaps of new skills. I felt so alive out there. It’s hard to explain or find the adjectives, but it was an intense feeling of knowing that this was where I was supposed to be. I’d always been a very active and outdoors-orientated kid, but now I was just so inspired to keep adventuring and upskilling in all these outdoor pursuits because they gave me such joy and freedom. After I left school, I studied physiology and sports science at university and kept adventuring. A few years later, I was working in Canada as a Canoe Trip Leader

for a summer camp in Northern Ontario, and I got three infections in a short space of time – strep throat, an infected nail, and a big abscess on my back. The infection on my back – you could lose half your finger into it! It had to be packed from the inside out for weeks afterwards. After the camp, I flew to SouthEast Asia and Nepal, and I had to get random people on the plane to dress it for me as I couldn’t reach easily – yuck. Then I had stomach issues during my next six weeks in Asia, probably from the strong antibiotics they made me take to avoid further infection. I’d also had giardia earlier in the same trip during an adventure race in South Africa, so on my return to New Zealand I thought I better get a check up.

Just through leading by example and living your values, you can have a powerful impact. DIFFICULT DIAGNOSIS

My GP Fiona was onto it. She said, “Emily, you hardly ever get sick, so it’s odd for you to have had all these infections. Let’s give you a blood test.” Sure enough, after a glucose test, my sugars were really high. They sent me to hospital for the night, which was a bit weird as I felt fine, and they diagnosed me with diabetes. I actually didn’t have the antibodies they check for, but the endocrinologist was convinced it was type 1. Because of my sporting activity, my insulin sensitivity is really good. I also have type 1 on both sides of the family. They did also test me for the rare type – MODY – but the

results came back negative. I think I’d had it for years, undiagnosed. I’d always been thirsty a lot, especially over night, and I was emotional a lot too. I’ve also had issues with periods (and having done my thesis in physiology – in particular, female physiology in relation to exercise – I have some of my own theories!) Initially, I was gutted. I remember crying into the mirror the first time I injected myself, knowing that this would be my daily reality. However, life is all about attitude. If you set your mind to something and you work hard, the outcomes are usually pretty good. Being stubborn, persistent, and diligent are good traits to have. A doctor at the hospital told me, “Oh, you’ll have to really modify what you do. You probably won’t be able to compete like you used to, and you’ll have to create lots of routine.” I had a strong grasp of the disease from studying it and a great understanding of my own body. Right there and then, I thought, “Heck no. I’m not adapting my life for diabetes – it’s coming along for the ride.” MANAGING DIABETES WITH SPORTS

Growing up, I’d never had much patience, but this disease soon taught me about that! I learned the hard way, thrashing my body and getting injured. I know now that if I listen to my body and invest time in testing regularly, eating well, stressing less, and exercising often, I can do anything. Stress is the biggest one and the hardest one for me to reduce, but it has a profound effect on my diabetes so I keep trying. After some months of recording everything I did and ate, and trying to figure out patterns (quite hard when no two days are the same), I just threw myself back into sports and resigned myself to figuring it

DIABETES WELLNESS | Spring 2020

out as I went, because it’s a pretty fickle, unpredictable disease at the best of times. I trialled different foods and different ways of injecting. For example, I tried increasing basal and reducing rapid-acting insulin, or injecting more on the start line to combat the inevitable adrenaline spike. After much trial and error – and drowning in technology – I basically figured I just need to under-bolus. There’s no way we can go low if we don’t inject insulin, so I’m always on the cautious side and under-inject – or don’t inject at all sometimes. Yes, I might be high while exercising, with the dump in glucose from the liver also, but in the long run I know that’s not going to kill me. I want to enjoy my time out there. I don’t micromanage my levels when exercising or racing, which can be hard when you’re eating little and often, but I don’t want to have to be adjusting all the time, because it increases the risk of lows and it detracts from my experience. When you’re at the pointy end of competition, you can’t waste precious seconds stopping to check your blood-glucose levels. And when it’s cold or wet, the technology often doesn’t work. The introduction of the freestyle libre has made things much easier, and it’s a great racing and training tool. It’s still always a challenge to know how much insulin to inject at any one time when adventure racing. After all, you never know how long a leg is going to take you and whether you might run out of food, or have to climb an extra hill, or get cold and wet from the weather turning. And, of course, the sleep deprivation wreaks havoc with your hormones, and they’re intrinsically linked to blood-glucose levels.

DIABETES WELLNESS | Spring 2020

I still prefer taking my pens into the outdoors, rather than using a pump. That’s because when I’m surfing, diving, climbing, bushbashing, hiking, paddling, and biking it’s too easy to rip it off my body. No thanks! WORKING FOR THE DIABETES COMMUNITY

As soon as I was diagnosed, I decided to get involved with the community. I had a lot of ideas for ways to inspire people living with type 1 – especially young people. In 2017, I did a self-powered adventure the full length of the country with Jerry the Bear, and I organised a series of teddy bears’ picnics along the way with Diabetes NZ branches. I started in Cape Reinga and paddled, pack-rafted, paddle boarded, road-biked, and mountain-biked my way down the country. I reached Bluff in about five weeks, completing the journey during Diabetes Awareness Month in November 2017.

I've become much more relaxed, resourceful, adaptable, resilient ... and I have diabetes to thank for that. I became the International Diabetes Federation (IDF) young leader for New Zealand in 2015 and went to the IDF Congress in Vancouver at the end of 2015. I had the position for two years from then. All my jobs these days are community based, and I’ve always got great joy out of helping, teaching, and being around people, especially empowering the young people I work with to live their best lives. I get a buzz out of being a part

of something bigger than myself. I guess it’s in my nature to care, and although I often think, “What is it that I can give, and am I doing enough?” I’ve found that even just through leading by example and living your values, you can have a powerful impact on those around you – even if it seems subtle at first. LIFE-BALANCE SECRETS

I’ve always been driven. My twin brother and my younger sister are the same. I have high standards for myself and an innate drive to be better at everything. Our parents never pushed us to do anything as they knew we were all already highly strung, highachievers. They only ever gave us opportunities and endless support. Mum knew we put enough pressure on ourselves! Although this drive might sound desirable, I definitely didn’t have a healthy balance for a long while, and I’ve had my fair share of injuries, unhealthy relationships with food, and times of extreme stress at university (all self-inflicted). I think my type 1 diagnosis was my body’s way of forcing me to listen. I’ve had to learn to manage my expectations, chunk time up, and funnel my energy into one or two things at a time so I don’t get so overwhelmed by the possibilities. I’ve definitely got better at managing stress and letting go of the insignificant things. I’ve become much more relaxed, resourceful, adaptable, resilient, and happier within myself – and I have diabetes to thank for a lot of that. I’m also lucky that, through my jobs, my sport, and all my activities in the community, I get to meet and connect with amazing people every day. I’m inspired by them: inspired to be better, for others and myself, and especially

My Identity

is proud to create

the environment. In 2017, I volunteered for conservation groups working with North Thailand’s elephants. I've also worked and volunteered on marine conservation projects in Costa Rica in 2018, and the Galápagos Islands in 2019. As well as this, I volunteer and work for DOC doing conservation and biodiversity work in remote Fiordland. The outdoors, and training for multisport and adventure races, have definitely made me a better person and allowed me to contribute more to this world. What keeps me hooked on multisports and adventuring is the variety, along with the challenge, the unknown, and therefore the resilience, adaptability, and perseverance you must find within yourself. I’m a really curious person who loves to learn. What you learn about yourself, new places, and other people and how to get the best out of them is invaluable. There’s also the freedom, the joy, the thrill, and the feeling of truly living your passion. There are endless opportunities to grow and improve in every multisports discipline. Sometimes you make slow progress, just like in life, but it’s worth it. Of course, it is not always about just “getting better” or “improving”. That can be exhausting and sometimes unrealistic. However, these activities can be a form of meditation: a time to think about nothing, only the very next step, and to be totally present and aware. It’s a destressor and distractor from a busy mind and an everincreasing to-do list. For me, my activities are a lifestyle, much more than a goal. Each person’s diabetes is so different, and each person’s journey is so different. But there is no doubt that investing in yourself is the best start.

EMILY’S LATEST ACHIEVEMENTS Team events: 4th women’s team, 2019 Redbull Defiance, Wanaka 1st team, 2019 Godzone Adventure Race 3rd team, 2019 World Series Adventure Race, Ecuador 1st team, 2019 Spring Challenge, Cromwell Individual events: 1st, 2019 Peak to Peak Multisport Race, Queenstown 2nd, 2019 Rasdex River Race, Waimakariri 5th, 2020 Kathmandu Coast to Coast Longest Day What’s next? Emily says, “I’m keen to do more backcountry skiing and boarding, making the most of a full winter in New Zealand. (I’m usually away for some of it overseas.) “I also want to take the chance while borders are closed to upskill in all my outdoor activities I enjoy. I definitely think there are a few more adventure races in me when money and travel allow.”

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Nourish

Dietitian Helen Gibbs offers readers some ideas for reducing food costs.

EATING ON A TIGHT BUDGET

or some people, level 1 here in New Zealand will be life as close to normal as we are going to get, at least anytime soon. But for others, this will be a time of huge stress and distress, with reduced incomes, job loss, and significant changes to home and family life. People with any form of diabetes need to eat well to stay well. If you’re on a limited income, there are quite a few ways to save money on food costs. Read on and see if there are any tips you can take up in addition to what you’re doing already. KNOWLEDGE IS POWER

Know what is in your pantry, fridge, and freezer. Make a list and plan to use whatever is there already. Do some research into other ways to save as well. For example, fruits and vegetables that are in season will

DIABETES WELLNESS | Spring 2020

be cheaper than those that are not (and are being imported or grown non-seasonally). So, find out what’s in season and when, and plan your meals based on that. This useful website allows you to find out what is fresh in your local area: whatsfresh.teamrocket.co.nz. JOIN A FRUIT AND VEGE CO-OP

If you’re a competent and flexible cook, then you may find joining your local fruit and vegetable cooperative is a way to get plenty of seasonal vegetables at a low cost. Search on Google or in Facebook for fruit and vegetable co-ops near you. Most of them offer family boxes for under $20 a week. The disadvantages are that you will likely have limited variety, and some of the vegetables and fruit will be seconds. However, if you’re adaptable in the kitchen, the pros may well outweigh the cons. Think of it as a creative challenge.

USE YOUR FREEZER

If you have freezer space and access to cheap and/or seasonal vegetables and fruit, then don’t be afraid to freeze your own. Many vegetables benefit from being blanched before freezing. This is where you dip them in boiling water for one minute before you spread them on the tray and freeze them. Once frozen, they can be put into bags. GET EVERYONE ON BOARD

Even quite young children will sense if you have food worries and will be able to understand that food might need to be different from before. Be open about it. Have a discussion with everyone in the household about the need to stick to a budget. Ask for their ideas and suggestions. Explaining that there will be enough food but each person will have to eat the same meal is useful.

PLANS AND PORTIONS

Plan what you are eating at all meals – and in between. Make your shopping list from your meal plan. Shop to the list. Use click-andcollect services if you struggle to stick to a list when you’re shopping. After you shop, portion items, especially the expensive ones, into meal-sized packs, so that everyone is only eating what they need. See the portion guide below for a few common foods. MAKE DAIRY PRODUCTS CHEAPER

Many people have bad memories of milk powder from the 1980s. Now, it’s much better, and you can improve the taste even more by allowing it to stand in the fridge for two hours before use. You can make the equivalent of calci-trim milk by using 135g standard milk powder in 1 litre of water. Everyone in the family can have this milk if they are over the age of two. Yogurt can be cheaper too: You can make it using a yogurt maker, but instead of a whole packet use 30g (or 2 Tbsp) of the natural starter and 1¼ cup skimmed milk powder.

You can also make more yoghurt using leftover natural bought yogurt. Heat your milk to just below boiling point. Let it cool. Pour it into a sterile jar, stir in the leftover yoghurt, and place it somewhere warm (ideally around 43 to 46 degrees Celsius). Once it’s set, chill it. TIME IS MONEY

If you have time, you can save money by cooking from scratch as much as possible. Beans and legumes are already a cheap, healthy food, full of fibre and protein, but using dried ones rather than canned can save even more money. A 400g tin of chickpeas gives you about 220g of chickpeas once you remove the liquid, and it costs $1.10 to $1.50 if you’re lucky. Instead, soak and cook 100g dried chickpeas to end up with the same amount. Dried chickpeas cost about $0.66 per 100g in packets – and less if purchased from bulk bins. If you don’t have time to regularly cook your own beans and legumes, then cook them in bulk and freeze some. Freeze chickpeas and other beans spread out on a tray so they don’t freeze together in chunks, and then you can use them free flow for up to three months.

SEEK HELP

If you’re on a reduced income, reach out for help. If you have diabetes and are on a reduced income, talk to your medical professional about disability allowance to cover expenses, if you’re not already receiving it. Depending on your circumstances, this may be enough to purchase more food. If, however, your medication and diabetes equipment costs are more than the maximum, then it is possible to apply for additional funding, but this may require supporting evidence from your dietitian. Most additional funds require evidence that the money is being spent on food costs and will need to be applied for every 10-12 weeks. GO EASY ON YOURSELF

It’s important to remember that the cost of living is high, and benefits and some incomes are too low to live on for most families. Like many dietitians, I am a member of groups such as Child Poverty Action who are campaigning for increases in benefits to ensure that people on benefits are not making their health worse because they can’t eat well – so don’t be ashamed if you are finding it hard. As ever, ask for help.

PORTION SIZES PER PERSON

It’s easy to overindulge in cheese and meat. It can end up being expensive too. Here are some generalised recommended portion sizes per adult, per meal.

30g

150g

170g

200g

Cheese

Meat, chicken, or fish without bones

Chicken thighs, bone in

Most other meats, bone in

DIABETES WELLNESS | Spring 2020

Community

In 2019, Diabetes New Zealand gave awards to two young people with big goals. Meet Kaylee Metcalfe and Belle Burdon.

McLAREN YOUTH AWARD WINNERS AIM HIGH KAYLEE METCALFE: ACADEMIC AWARD WINNER

Kaylee says, “I’ve known that I wanted to work in a medical position or a job where I’m helping people and the community since I left primary school.” By year 11, she’d discovered a love for science, and Kaylee is now using the award money to help finance her first year of studying Health Sciences at the University of Otago. “My mum was the one who found out about the McLaren Awards and encouraged me to apply – as a way of helping me to feel accomplished and grateful for how far I have come living with type 1 diabetes. “My mum always said to me that the most important thing for the future is to follow what you’re passionate about and only pursue something if you love it.” Kaylee is still unsure exactly where her studies will lead, “At the moment, my top career path would be to work either in a field of research for treatments and cures for diseases, or in a role where I can support young people growing up with type 1 diabetes.” She says that type 1 diabetes is always at the back of her mind and keeping it under control is affected by, and in turn affects, every aspect of her life. “It adds a layer of responsibility and stress to my dayto-day being. “I’m lucky I was diagnosed very young. I feel it makes it easier for

DIABETES WELLNESS | Spring 2020

me to come to terms with this way of living, as I don’t know any different. “I’ve always aimed to stop it getting in the way of my learning. I maintain tight and optimal control as much as possible so that I can always perform to the best of my ability. However, especially now that I’m a teenager, this is a difficult, unreasonable, and demanding goal, so, instead, I’m endeavouring to find a balance. “I strive to keep the condition under control as much as I can, while still making the most of my life and doing everything a normal teenager does. I accept it as a part of who I am and allow it to help me develop and grow as a person rather than let the challenges interfere. “I’ve always been highly academically driven, and I refuse to use my condition as an excuse. I’m continually aiming to prove to myself and others that type 1 diabetes won’t hinder me from achieving my potential.” She remembers being inspired by a girl at her school. “She was a couple of years above. She was an amazing dancer and gymnast, but she was diagnosed with leukemia and had to take a year off school. After her long, tough journey, she came back to school the following year, worked extremely hard, and was awarded Dux. Now she’s at university. Her courage and drive, her kindness and humble nature,

the way nothing gets in the way of living her life – it inspires me greatly.” When it comes to supporters, Kaylee is most grateful to her mum. “She’s taken loving care of me my whole life, and I’m especially grateful for all the undoubtedly hard hours she put into looking after me and taking care of my type 1 diabetes when I was a baby and young child. She’s always believed in me, inspired me, and let me know she was proud.” She’s also grateful for her younger sister Tarryn – “the most supportive and beautiful sister I could ask for. Ever since she was young she’s been nurturing and loving, and did a decent job of putting up with my moodiness when my blood sugar was high.” Then there’s her friend Caitlin Flanagan, who also has type 1. “We’ve been close since we were little, and it is so nice to have someone who can relate to what you’re going through. We’ll always will be there for each other.”

BELLE BURDON: SPORTS AWARD WINNER

Underwater hockey is in the family for Belle Burdon. She and her sister both play, and her mother and aunt did when they were younger. Belle’s aunt played nationally, as Belle does now, and her McLaren Award is supporting her in doing that. “This year, it’s helped with pool costs and keeping up a gym membership. At a national level, we’re expected to do that.” Belle spends a lot of time in the water. She’s at the pool every day training, as well as helping coach younger players. Sometimes, she’s in the water for five hours at a time. “It’s a small sport,” she says. “There’s a real community, and it’s nice to give back.” Belle was diagnosed with type 1 diabetes in 2010, when she was eight. It adds many challenges to the sport. “When I’m high, I feel sluggish, and it’s hard to play well. Being in water, it’s also hard to tell if you’re high or low – hard to feel what’s going on in your body.” For example, when she’s in the water,

she often finds that adrenaline from nerves feels similar to a low. The solution is a lot of testing and having supportive team-mates who know the signs if she might be going low. She wore a pump when she started playing but found she couldn’t keep it on underwater, so now she’s back to using a pen and fingerpricks. Covid-19 has been tough on the teams Belle plays for. Tournaments they’d been training hard for and, in some cases, working towards for years were suddenly pushed back or cancelled. Recently, some of those events have been rescheduled for next year, which Belle says is exciting but also “a bit sad because some people can’t play with us because of how old they will be by then. So it’s a real mix of emotions.” Type 1 isn’t the only challenge Belle meets. In 2015, she was diagnosed with Stargardt disease, an eye condition causes central vision loss. With a few adjustments, she’s still able to play, and after some campaigning

Belle (left) is proud of her team's successes.

by Belle’s mother Underwater Hockey NZ now uses fluoro pink pucks, which Belle can see better that regular pucks. “My mum is one of my biggest supporters. She’s been with me through everything. She’s always at the pool with me, standing making sure nothing happens. Stargardt disease was definitely a shock for me and my family, but I think diabetes sort of prepared me. It’s given a more relaxed attitude to what comes along. I don’t fight it. I feel very thankful for my diabetes, and its definitely made me the person I am.”

EAT WELL LIVE WELL

Diabetes-friendly meals everyone will love Eat Well Live Well is chock-full of diabetes-friendly recipes from well-known Kiwi chefs. Each dish is quick and easy to prepare and great for the whole family. Head to www.diabetes.org.nz for your copy – $33.00 including delivery – or purchase it directly from your local Diabetes NZ branch, Whitcoulls, PaperPlus and The Warehouse. All profits go towards supporting Diabetes NZ’s work.

DIABETES WELLNESS | Spring 2020

Move

Fitness consultant Craig Wise shares an effective resistance workout that involves no travel time and no special equipment. Exercises demonstrated by Xanthia Wise.

THE GREAT MILK-BOTTLE WORKOUT

hat with family commitments, the demands of work, and the realities of living through a pandemic, getting a workout in the cosy surroundings of home is becoming increasingly popular. During the lockdown period and our emergence back to our new normal, I managed to keep working with my clients. One thing that many of them found helpful was finding ways to use things they had around the home as weights, rather than just relying on bodyweight exercises. Being creative, we came up with a number of substitutes for hand weights, kettlebells, or weight bags. These included garden bricks, a couple of wine bottles, and a childrenâ&#x20AC;&#x2122;s schoolbag filled with books. But the most popular items (mainly because almost everyone had them) were milk bottles. And they proved to be very versatile.

HOW TO START YOUR MILK-BOTTLE WORKOUT

Fill one or two empty milk bottles with water, stones, or sand. The great thing about using milk bottles is that you can fill or empty them to suit your ability. One litre of water is approximately 1 kg of weight, but you can to change the weight of the bottle to anything you like. Just ensure that the top of the bottle is securely closed. Some exercises involve holding a bottle above your head, and nobody wants an impromptu shower. Do three sets of 12 to 15 repetitions of these exercises. If you find them easy, add more weight or increase the repetitions.

WEIGHTED SQUAT

Stand with your feet shoulder-width apart and parallel to each other. If you have one bottle, hold the bottle close in at your chest. If you have two, hold a bottle in each hand with your arms by your side. Slowly squat down and then push through your heels to rise back up again. Think of it as if you are going to sit down on the toilet. The secret to a good squat is making sure that you keep your weight in your heels and trying not to let your knees move forward past your toes.

DIABETES WELLNESS | Spring 2020

WITH 1 BOTTLE

CURLS

Hold one or two bottles and stand comfortably with soft knees. Keeping your upper arms still and stable at the side of your body, slowly bend your elbows and raise the bottle(s) to shoulder height. Then lower back to the starting position. A good curl uses only your arms, not your back. There should be no swing in your back to get the weight lifted, and your movements should be controlled.

WITH 2 BOTTLES

OVERHEAD TRICEP EXTENSION

This can be done either standing or seated. If you’re seated, make sure your feet are flat on the floor. Start with your arms straight up above your head. (And bottles securely closed!) Keep your arms close to your head and lower the bottles behind you, then raise them back to the starting point. WITH 1 BOTTLE

WITH 2 BOTTLES

WITH 1 BOTTLE

OVERHEAD PRESS

WITH 2 BOTTLES

As with the overhead tricep extension, this can be done either seated or standing. If you’re standing, be sure to keep your knees soft. This helps to maintain the natural arch of your back. Start with your milk-bottle weights at shoulder level, and push them upwards in a slow, controlled manner. Keep the weights in line – don’t bring them together above your head. Return to the start.

DIABETES WELLNESS | Spring 2020

WITH FEET RAISED

RUSSIAN TWIST

Sit on the ground, and hold one bottle with both hands at your chest. Slowly lean backwards using your abdominal muscle to support your weight. Slowly twist your body from side to side, touching the bottle on the ground before moving to the other side. To begin with, try leaving your feet on the ground. As you feel more confident, try raising your feet off the ground. This is an abdominal exercise, so you should feel it in your tummy and sides. If you feel it in your back, then lower your feet to the ground.

LUNGES

The classic lunge can be upgraded with hand weights. Hold one bottle at your chest or hold a bottle in each hand with your arms by your side. Start with your feet shoulder-width apart, then take a step forward. Lower your body straight down, then raise it back up again. Make sure that both legs are bending. Try to get them to 90 degrees and then push through your heels when coming up.

DIABETES WELLNESS | Spring 2020

WITH FEET ON THE GROUND

WITH 1 BOTTLE

WITH 2 BOTTLES

WEIGHTED LUNGES WITH A TWIST

Try this one if you’re feeling adventurous. It’s like the weighted lunge, but when you reach the bottom of your lunge, twist your body towards the leg which is forward. Then twist back to face forward and rise up to the start position. This is a great core exercise and also a test of balance.

STAY SAFE

EXTRA FITNESS TIP Try holding the bottles in your hands as you walk up and down stairs.

There are any number of fitness experts on social media who offer at-home workouts, but be sure to check their credentials before following their latest core-busting, booty-building, or leg-burning exercise plans. A discount code on the range of yoga pants they are promoting is no substitute for the knowledge of a real fitness professional. It’s also vital to remember that, if you have any pain in your knees, back, or anywhere else while attempting any of the exercises, then stop that exercise. If necessary, chat to your healthcare professional.

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Move

Make walking a habit – with your doctor’s help A new study shows that, when someone needs to be more physically active, having a GP write a “walking prescription” may be one of the best ways to stay motivated.

alking improves cardio-metabolic health, and, for people with type 2 diabetes, walking after eating can play a big role in preventing bloodsugar spikes. Walking is not only good for us; but it’s also cheap and accessible. For many people, it can be done more easily and regularly than, say, going to the gym. Because of this, healthcare professionals often recommend it. But whether we, as patients, follow the recommendation can be another matter. Enter a New Zealand research team who wanted to find out whether a formal prescription for a set amount of walking would be a motivator for people with type 2 diabetes, and, more to the point, what would help or hinder people in following the prescription? The Royal New Zealand College of General Practitioners has just published the study, and the findings are illuminating.

“To actually prescribe exercise is a really interesting way of doing it” – Dr Bryan Betty, Director of The Royal New Zealand College of General Practitioners HOW THE STUDY WORKED

Twenty-eight adults with type 2 participated in the study. Each was prescribed a regular walking routine that involved walking for 10 mintes after breakfast, 10 minutes after lunch, and 10 minutes after dinner, every day for three months. Participants were contacted briefly every two weeks to check in and remind them of the walking prescription. Most participants reported that, after receiving the walking prescription, they walked more than they had before and they felt healthier. Detailed interviews with each participant explored what kept them walking and what prevented them.

DIABETES WELLNESS | Spring 2020

WHAT KEPT PEOPLE WALKING

Some themes emerged as important motivators for the study participants: • establishing a set walking routine • having family or a partner’s support for the new walking regimen • regular monitoring by a healthcare professional • experiencing health benefits that they attributed to the walking, such as improved self-esteem, feelings of wellbeing, better sleep, better digestion, and improved blood-sugar control. Some participants reported weight loss and/or eating less at meal times in order to feel more comfortable while walking. WHAT PREVENTED PEOPLE WALKING

Injuries and sore muscles hindered some participants’ walks, while a small number of participants found walking hard to prioritise over other activities. Several women in the study found after-dinner walks were hard to maintain, as it was often dark by then. Unease about walking after dark was a major obstacle. Walking in bad weather was a deterrent for some participants as well. Several participants lived alone or didn’t have family support, and this negatively affected their adherence to the walking prescription. THE ROLE OF THE HEALTHCARE PROVIDER

The study suggests that patients need “purpose, reward, and incentive” to maintain a walking practice. A key finding of this and other related research is that the formalised researcher–particpant relationship plays an important part in motivating the participant. This suggests that, in real life, the relationship between a patient and the healthcare provider who writes their prescription is also crucial. The study makes the point that healthcare providers need to understand their own role when it comes to motivating the patient. Working with the patient to set realistic goals, formally documenting physical activity prescriptions, and checking in with the patient about the prescription at follow-up are all vital. The

healthcare provider can also help by encouraging family participation, reinforcing the positive health benefits of walking, enquiring about any obstacles to walking, and helping the patient figure out ways to get round them. Dr Bryan Betty, Medical Director of The Royal New Zealand College of General Practitioners says an example of this would be, if the patient is uneasy walking alone at night, they could join with others for a night-time walking group. Or perhaps their healthcare provider could help them find another activity to do at night that has the same benefits as walking. Dr Betty says, “We know that housework is actually really good exercise ... vaccuming for example.”

ACCU-CHEK® LANCING SYSTEMS

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WHY A PRESCRIPTION?

At his practice in Cannons Creek, Porirua, Dr Betty often uses the Green Prescription system. This is an initiative administered by the Ministry of Health, that allows patients to be prescribed a programme of physical activity that can be done at home and in their community. However, Dr Betty says, “You don't have to do the whole green prescription.” There’s no reason why GPs or other healthcare professionals shouldn’t use a written prescription as a tool for encouraging something more modest but still incredibly beneficial, such as walking. “The way a patient structures their day is incredibly important in terms of where you slot changes in to their routine. To actually prescribe exercise is a really interesting way of doing it. “Saying, ‘Do more exercise,’ is vague and generic, and can be easily dropped. But writing a prescription to actually say, for example, ‘Do 10 minutes here, and 10 minutes there,’ is a way of formalising the conversation. It’s like an agreement. “With any prescription, whether it be for medication or something else, you always move towards a point of agreement where both patient and the medical professional are agreed on what things look like going forward. “In practice, a lot of GPs tend to do this. With the patient, we’ll agree what we're trying to achieve over the next two to three months and then, at the end of that time, review it with the patient. “Having clear structure and clear guidance that both the clinician and the patient can agree to is a really good way to go.” Dr Betty thinks the new study on walking prescriptions is valuable. “Having this sort of research which backs up the prescription approach gives you an extra impetus to do it.” You can read the full report in the Journal of Primary Healthcare: www.publish.csiro.au/HC/HC20023.

Reference: 1. Kocher, S, et al., Comparison of Lancing Devices for Self-Monitoring of Blood Glucose Regarding Lancing Pain J Diabetes Sci Technol 2009; 3(5):1135-1143. FOR PEOPLE WITH DIABETES. ALWAYS READ THE INSTRUCTIONS FOR USE. CONSULT YOUR HEALTHCARE PROFESSIONAL FOR ADVICE. Accu-Chek lancing devices are for single patient use only. The same device must not be used by multiple patients. CLIXMOTION, ACCU-CHEK and FASTCLIX are trademarks of Roche. All other trademarks are the property of their respective owners. ©2020 Roche Diabetes Care. Roche Diabetes Care Australia Pty Ltd, 24-32 Lexington Drive, Bella Vista NSW 2153 Australia. ABN 69 602 140 278. Distributed in New Zealand by USL Medical, 494 Rosebank Road, Avondale, Auckland. 0800 658 814. TAPS: NA 12110. AU-684. RDC7032. Date of preparation July 2020.

Last word

ONCE A DIABETES NURSE ALWAYS A DIABETES NURSE After more than 25 years in the role, Wellingtonian Lorna Bingham has reduced her nursing hours to follow her dream of opening a bookshop. However, she’s as passionate as ever about caring for the diabetes community.

fter a busy work week, Lorna would leave hospital on a Friday evening and wish there was a bookshop to pop in on her way home. The wish coalesced into a dream, and in late 2018 she turned it to reality, opening Another Chapter Bookshop across the road from Wellington Hospital. Here, locals and other healthcare workers drop by to browse and buy, as well as out-of-town visitors after gifts for patients. Lorna loves chatting with them, and the conversation often turns to wellness, although Lorna never offers healthcare advice when she has her bookseller hat on. BEGINNINGS

Lorna’s interest in diabetes began in the early 90s when she worked as a pharmaceutical representative promoting insulin. With a degree in human biology, she was interested in nutrition and exercise, and when she met diabetes teams and saw the supportive educational role of the health professionals she knew that was what she wanted to do. “I was lucky to get a part-time job in Wellington working alongside Dr Bob Smith and Louise Farmer, which grew to a full-time specialist role and then to nurse practitioner.”

DIABETES WELLNESS | Spring 2020

WORKING WITH YOUNG ADULTS AND THEIR PARENTS

Lorna currently works with the young adult team – supporting people between 18 and 25. They’re transitioning from the adolescent clinic, where they’re closely supported, to adult care, where they manage their condition largely independently. “Issues for that age are similar to those of their peers: often around alcohol, relationships, drug use, sex, finding work ….” Confidentiality is paramount, and the diabetes team takes this seriously. The young people know they can be open and honest in relation to their lifestyle which means the team can support them effectively. “It’s also a time of transitioning to being independent adults.” Lorna acknowledges this time of letting go is stressful for parents. “Myself, I’ve got a 22 year old and a 19 year old, and I’m sure if either of them had diabetes the team would be trying to work out how to do a ‘parentectomy’ on me! “We talk with parents about how the clinic philosophy is about supporting young people to transition safely into adulthood. We might still see the parent at the end of a consultation if the young person is ok with that, and they’re always welcome to let us know if they have concerns, but patient confidentiality is vital.” HELPING THE HELPERS

Health professionals also develop diabetes, and Lorna says they too need support. “It’s important sometimes to remind health professionals if they work in, say, a hospital setting that many people with diabetes manage effectively in the community and never require hospitalisation. In hospital, we see

the tip of the iceberg, where people may have complications of diabetes. I often remind people that other people’s stories are not theirs! They can rewrite the script. “As we all know, diabetes can impact on body systems, but if you have concerns it’s best to talk them over with a knowledgeable person and take action sooner rather than later. Where possible, improving your food intake can make a big difference to diabetes control. Regular physical activity helps and, of course, taking medication as it’s prescribed. Tweaking these things can have a positive impact on living a healthy life – with diabetes well controlled most of the time!” GETTING THE MOST FROM YOUR DIABETES NURSE

Lorna says, “Health professionals are in this job because we want to make a difference. Remember we’re on your side. The most important thing is that we work together. People with diabetes are the experts on their lives, and we work to help them fit their diabetes around their lifestyle. To provide optimum support, we need to know what’s going on, warts and all. For example, if they’re missing some daily injections, we need to know they struggle with that. Then we have an accurate starting point and can look at options together. Where your diabetes control is today doesn’t have to be where it is tomorrow or next week. There are always options. “Most of us have dreams, so sort out your diabetes with your team if it’s not going too well and then there’s no reason why you can’t live your dream. Taking action is the key to making dreams a reality.” Lorna knows this first hand.

Smartphone enabled glucose monitoring1

WITH YOUR PHONE1,2

With a digitally connected FreeStyle Libre system, you can now manage your glucose levels anytime, anywhere with your smartphone1,2. Download the FreeStyle LibreLink app today!

Visit FreeStyleLibre.co.nz to learn more

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC. The FreeStyle Libre Flash Glucose Monitoring System is indicated for measuring interstitial fluid glucose levels in people (aged 4 and older) with insulin-dependent diabetes. The indication for children (age 4 - 17) is limited to those who are supervised by a caregiver who is at least 18 years of age. Always read the instructions for use. The sensor must be removed prior to Magnetic Resonance Imaging (MRI). 1.The FreeStyle LibreLink app and the FreeStyle Libre Reader have similar but not identical features. 2. The FreeStyle LibreLink app is compatible with NFC enabled phones running Android 5.0 or higher, or with iPhone 7 or higher, running iOS 11 or higher. FreeStyle, Libre, and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. Information contained herein is for distribution outside of the USA only. For more information call Customer Service on 0800 106 100. Mediâ&#x20AC;&#x2122;Ray New Zealand, 53-55 Paul Matthews Road, Albany, Auckland 0632 www.mediray.co.nz NZBN 9429041039915 ADC-16457 v1.0

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FLASH GLUCOSE MONITORING SYSTEM

HELPING TO MANAGE YOUR DIABETES

Diabete-Ezy Accessories

FreeStyle Optium Blood Glucose and Blood Ketones Testing • FreeStyle Optium Meter Kit • FreeStyle Optium Blood Glucose Test Strips 50’s • FreeStyle Optium Blood Ketones Test Strips 10’s

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Frio Cooling Wallets

MedActive Carry Cases

• • • • •

A selection of convenient carry cases for medical supplies. • Easy Bag Single • iCool Prestige • Easy Bag Classic • iCool MediCube • iCool Weekender

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Keeps Insulin cool and safe Refrigeration not required Simply activate with cold water Reusable, light and compact Available in five sizes and six colours

Ezy-Fit Carry Case (Blue, Pink & Green) Multi-Fit Carry Cases (Black & Red) Test Wipes Starter Pack Test Wipes Refills Comfy Pump Belts Diabete-ezy™

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Hypo-Fit Glucose Gel

Dextro Energy Glucose Tablets

• Two flavours – Orange and Tropical • 18gram sachets, 13.4grams Carbohydrates • Gluten-Free

• 24 sticks per carton (12 tablets per stick) • Available in four flavours Orange, Blackcurrent, Lemon, Tropical • All with added Vitamin C

HYPO-FIT D I R E C T- E N E R G Y

Order Online: www.mediray.co.nz Freephone: 0800 106 100 Address for Correspondence: PO Box 303205, North Harbour, Auckland, New Zealand