Sweet Bytes September 2014

THE PRICK OF A THING ABOUT BLOOD GLUCOSE MONITORS

Helen Edwards

Do you check your blood glucose regularly? I don’t ask in judgement, because we are all different when it comes to diabetes – some of you will check your blood many times a day, others not at all. It all depends on your type and stage of diabetes, management and personal preference. I am asking because I have been thinking a lot lately about how dependent we are on the technology for managing diabetes and how that is both great and not so great.

As a teenager I rebelled against checking my blood, after this replaced urine testing. You would think I would have embraced it as it is far better than checking your pee. But for me it was one change too many in a short space of time. Another thing to learn. Another sign of my diabetes. Another moment of distress in each day. And in those days it was an enormous process! There were many steps and it took a lot longer than the quick machines we have today. It wasn’t the kind of thing you carried with you. I had a testing station in my bedroom and that was where my tests were done.

After a while I mostly stopped checking and made up my results for my parents and the doctors. I could not have cared less about what my blood sugar was doing. I cared far more about being a teenager and having a good time.

This lancet machine (which I still have!) may have been part of the reason I rebelled! It really actually bloody hurt!!

Oh how that has changed. Now I am the complete opposite! I carry my machine everywhere and check up to 20 times a day. We have 5 second machines and virtually painless prickers. If I do not check before driving, eating, exercising, sleeping…..I feel stressed, anxious. I learnt that knowing what my blood glucose is doing gives me power. Power to make adjustments and changes. Power to deal with highs and lows. And peace of mind.

I never go out without it but lately have had a few cases of losing my machine and it was very scary and stressful. I realised how much I rely on this little machine each and every day. The last time I lost one was a few weeks ago. I was an hour away from home and there was nobody to help me. I could not find it anywhere in my bag. I drove home totally stressed about not knowing what my levels were, made worse by the fact I had high levels on arrival at the person I was visiting and had a bolus of insulin, so needed to track the fall. I got home and pulled the house apart to find my back up machine. Later the person I was visiting found it on the road, fallen out from my car.

It was not a case of losing my machine but forgetting it, that caused me more stress this week. I was out for a lunch time run and went to check my levels…..no machine. I NEVER exercise without it and always check during my run as I can drop fast. My parents were away and my husband at work. There was nobody to bring my machine to me. I made the call to cut the run short and head home. Luckily, as I was 4 mmol on arrival at home. It was a stressful run back and it struck me how much it sucks to have type 1 diabetes and not even be able to do a simple thing like going for a run without all this stress…..

Don’t you hate it when diabetes stops you doing something so simple? And the reliance on that machine is both wonderful that we have them, and terrible that we have to be so dependent on them. That’s the prick of a thing about blood glucose monitors.

Have you had a similar experience? Would love to hear

I am off for a finger prick!

Helen

xx

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DIABETES & DISCRIMINATION: WORKPLACE

From David Mapeltoft

Diabetes impacts all aspects of a person life.

Research has found a that diabetes impacts on the daily lives of individuals with diabetes and their family members.

From the DAWN (Diabetes Attitudes Wishes and Needs) these impacts were in the following areas:

Decrease in physical strength – 62%

Worried about hypoglycaemic events – 55%

Emotional wellbeing – 46%

Finances – 44%

High diabetes distress – 45%

Good/very good quality of life – 40%

Medication interference – 39%

Leisure activities – 38%

Work and studies – 35%

Felt supported by others and had stronger relationships with family members – 28%

Discrimination – 19%

Likely depression – 15%

At the DAWN meeting in Holland earlier this year I heard the saddest story of discrimination, and fear of discrimination. The story went something like this:

In China a young woman was asked by her University administration to leave her studies and to leave the university …..because she had diabetes.

Another young woman heard about this story, and decided not to divulge to the university administration that she had diabetes. Sadly, this second young woman died from a hypo that that was not treated: she was afraid to treat for being ‘found out’, and nobody around her knew to treat because they did not know she had diabetes.

If you think you are being excluded, facing barriers or being discriminated against because of your diabetes here’s a few suggestions on what you can do.

Diabetes Australia

Contact your local branch of Diabetes Australia and talk with their advocacy staff. They have experience in this area and also have some information online as a starting point for you. Example https://www.diabetesaustralia.com.au/Living-with-Diabetes/Everyday-Life/Diabetes–Work/

Balancing Safety and Productivity

Diabetes in the Workplace

Often a dilemma: tell my manager or not?

At the present there are no specific laws for people with diabetes. However, people with diabetes are covered by:

• Anti-discrimination legislation in the states and territories.
• The Human Rights and Equal Opportunity Commission Act 1986
• Disability Discrimination Act 1992
• Section 659 of the Workplace Relations Act 1996

It could be in your best interest to share with your employer your diabetes self care plan. This plan could help your employer to identify that you have a team behind your plan; that your plan can be adapted to fit your workplace expectations; and that you are able to put into place safety-nets for any adverse events.

Successful Cases Fighting Discrimination

Example: “The medical evidence of Mr Vickers’ treating endocrinologist confirmed that Mr Vickers had excellent management of his condition and took appropriate precautions to prevent a hypoglycaemic event from occurring. It was therefore unlikely that a hypoglycaemic event would occur at all.” From https://www.humanrights.gov.au/publications/site-navigation-9

If you work in a large organisation, your diabetes self care plan could also act as a guide for policy development within the workplace for current and future colleagues who may have diabetes.

Some people don’t want to tell anyone because they’re afraid they’ll be seen as disabled. Others want to educate their co-workers so that if they are showing signs of a hypo, their co-workers will know their blood glucose may be dropping and provide a carb testament for them.

You’d be surprised how many people live with diabetes or who have family members who have diabetes. When you tell them about your condition, they’re often understanding.

Because people with diabetes have protections under the law, your human resources department could grant the accommodations you request…..but you do need to ask for them. Those accommodations can include:

• A place to rest while your blood glucose returns to normal after a hypo
• Breaks to go to the bathroom and to check your blood glucose levels or eat a snack
• Time off for doctor’s appointments or training / education for better managing diabetes.

You can find some more tips about diabetes in the workplace here

http://www.diabetesqld.org.au/media/42934/daq_employee_guide.pdf

Politicians

If you would like to see changes to the legislation in Australia then you can contact a minister, member of parliament or senator @

Ministry – Cabinet and outer ministry listing.

Members of the House of Representatives – Lists of members’ homepages by alphabet, political party, state/territory and electorate. Homepages include Parliament House and electorate office contact details.

Senators – Lists of senators’ homepages by alphabet, state/territory and senate dates. Homepages include Parliament House and electorate office contact details.

Contacting Members and Senators – Contact lists for senators and members, address label files and CSV files suitable for use as a source file for mail merges. Includes information on how to address senators and members.

Shadow ministry – Shadow (Opposition) ministry listing with links to shadow ministers’ contact details.

Have you some issues relating to workplace discrimination that you might like to share? Positive and negative, we can learn from each other.

Facebook Diabetes Counselling Online Forum – Comments @ 23/9/14:

For those people who read our blogs but are not connected on Facebook, here are some of the discrimination comments other people living with diabetes have made:

“I wasn’t allowed injections on a plane, one airline refused to have me as a passenger many years ago, can’t get life insurance, I went out for dinner once and was attacked by a lady for injecting.. She called me a junkie, I get ridiculed at work when I have sick days and am made to feel guilt for having a disease I didn’t ask for, people have no clue what the disease is and it needs to be well publicised on TV of what it actually is, centrelink ridiculed me once being on a pump and I said ok then.. You wear it for 24 hours and pay all my medical costs and tell me it’s not a disability! They are the worst culprits of all over this disease.. No one should have to pay to have a disease, everything should be free and government funded just like a Methodone program for a junkie!”

“Insurance companies. They just don’t want to know you after you say that you have diabetes”

“I couldn’t get insurance for a personal loan due to diabetes (One of the big four branches). I was young and silly and signed anyway and experienced massive stress until it was paid off. If anything had happened I was financially screwed.”

“I have been driving for 24 year’s with out a blemish to my name but when I wanted to go for my heavy truck license I was told by a license instructor company they wouldn’t be able to help me because I had diabetes so I rang another company and did a corse with out saying I had diabetes and once I had done the test and past I had some paperwork to fill out before going to Vic Roads and 1 of the questions asked if I had diabetes , to which I answered yes ! They then said well you past the test so you’ve got your license but I wouldn’t be aloud to go for a heavier one now they knew ! And ever since Vic Road hassle me every year trying to talk me into giving my license up !!! And because I still use it they force me to see a endocrinologist who doesn’t even really know me and a eye specialist to say I’m safe to drive ……..I can’t just see my own Dr who knows me well ! I costs me a lot to keep it but I’m buggered if I’m giving it up just so they can have taken away my rights ! For the record I have very good control of my diabetes ( not that it’s easy ! ) and I’ve had it for 40 years but I am only 42 !”

“Didn’t get a job once because I mentioned it in the interview. I had all the skills, qualifications and the right passion for the job but didn’t get it”

“The only discrimination I’ve encountered in my 3 years as T2 is people telling me what I can’t eat!”

“Trying to maintain a job is really hard cause once a person mentions that they have T1D,it’s like the employer thinks you’re not capable of the job at hand & then they get rid of you because it’s a liability for them. The biggest problem I’ve found so far is that there are quite a lot of people out there that have no understanding of us people who have diabetes whatsoever & they choose not to, as long as they don’t have it themselves then they really don’t give a hoot.”

“The looks and the comments from staff at work. It put me off doing public injections for years and doing it in the toilet is not hygienic. So I used to try to eat small things that I thought didn’t need injections but that was the early days when I didn’t quite understand about how carbs and diabetes work so my levels would go sky high and I felt terrible for months but I was too ashamed to go to the hospital because I knew they’d tell me off for not injecting but couldn’t face doing it at work so would just ‘survive’ and inject for any meals I had at home.”

“Couldn’t get loan protection on our new car because I’m diabetic, didnt matter if it was diabetic reason for a claim or not, diabetic = untouchable”

“I don’t know why every 12 months I have to get a Vic roads medical done! This year they tried to say I couldn’t drive cause I had a hospital admission, remind me not to go to hospital when I need to as a diabetic cause the next day I may have my licence taken away! It really is getting ridiculous to be treated like absolute crap by everyone who doesn’t have the disease, the fight with this disease isn’t the disease itself it’s the daily struggle to feel like you are a person and are just as valuable or ‘normal’ as the person who doesn’t have diabetes.
I’m a nurse and in all honesty it’s the worst career I chose, understanding is very few and far between and to even fit in the time to check my bgl’s is a challenge.
People need education, they need to live 1 day in our lives in all aspects of it.. The struggle to get out if bed from tiredness, the morning bgl, the bolus or injection, the carb counting, trying to manoeuvre your pump in everything you do including choosing clothes for the day, making sure you have everything to get through a day, wondering if your high of low bgl is ok to drive to work and to bad if your late for work.. The challenges are relentless and an emotional nightmare every second of every day.
It’s not taken seriously at all by anyone and the support is either minimal or non existent!
I may sound negative although I’m not sorry about it, I’m tired of the lack of understanding, lack of support and lack of funding to help those that really desperately need it from the government.
Will chemo or radiation possibly give us a cure? Will medical marijuana help the pain? Will an ice bucket challenge raise money overnight and fund everyone who needs a pump?
We are forgotten and it needs to stop, I’ve had this disease for 16 years and not one member of my own family has any clue about what it even is! My partner of only a few months has educated himself and been a great support to me but he also didn’t know anything about the disease until he was put in a position of no choice but to learn!
An advertisement for TV should be generated as a small movie with the reality of it, no cotton wool.. Pure reality of daily life! And not a fictional non diabetic actor, real people who have real lives! Let’s see the communities reaction after that!

I wish all people with diabetes an amazing life despite all the daily challenge”

 

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HEALTHY D-BAKING WITH GUEST JOAN BAILEY

From Sally Marchini

One of our wonderful Diabetes Counselling Online volunteers, Joan Bailey, has type 2 diabetes. She also has two young daughters who both have coeliac disease. Joan loves to bake them yummy, homemade meals and treats for their lunchboxes. She also works hard to control her blood glucose levels and remain fit so that she’ll be healthy to look after her family in years to come. And she also enjoys the food that she creates for the rest of the family. This means that she needs to consider all the diabetes factors in recipes as well as making them gluten free and delicious.

In today’s blog Joan demonstrates how she does this and explains that often these healthier options are even more delicious than the original recipes. If you’re not gluten free, don’t worry as Joan has included gluten containing options too in her tips for healthier swaps

Over to you Joan:

Thanks Sally. I hope this blog highlights that for those of us who enjoy baking that it is still possible!

Today many low glycemic index (GI) recipes are available but sometimes a family favourite is hard to give up and obviously we still want to enjoy them at the end of the day.

So the only option is to identify the potentially high GI, high fat and high sodium elements within the recipe and swap them for diabetes friendly ingredients.

I personally think that taste-wise the healthier versions can taste even nicer and be more filling and satisfying!

Making the conversion

As we’ve learned through listening to Sally and other dietitians, when converting a recipe for diabetes the main components that should be addressed are the carbohydrate components (the sugars and the flours) as well as the total and saturated fat levels and the salt (sodium) content.

Once you get the proportions correct and the correct substitutions it is easy to do.

It does take a bit of trial and error, so it’s a top idea to write things down as you go. And just like anything you do, the more practice you get, the better you’ll be at making your original ‘guesstimations’ for the substitutions.

Beginning with a Brownie recipe

Let’s start with a basic brownie recipe and look at converting each component. This table shows what a difference the changes can make!

Original recipe	Amount of Nutrient	Substituted with	Amount of nutrient	% Difference
1.5 cups self-raising flour (337g)	Carb = 246g	1.5 cups chickpea (besan flour) plus a teaspoon of baking powder (225g)	Carb = 104.4g	-57.6%
½ cup sugar (225g)	Carb = 224.5g	½ cup Stevia	Carb = 0g	-100%
1 cup water		1 cup water
¼ cup cacao		¼ cup cacao
1 tblspn vinegar		1 tblspn vinegar
60mL full cream milk	Per 100gFat Total = 4.4gSaturated = 2.9	60 mL low fat milk	Per 100gFat Total – 1.2gSaturated 0.8	-73%-72%
1 tsp vanilla essence		1 tsp vanilla essence
6 tblspns sunflower oil	Per 100gFat Total = 100gSaturated = 11g	6 tblspns low fat yogurt	Per 100gFat Total = 0.3gSaturated 0.2g	-99.7%-98%

Now, this table took me a little while to put together, but I think it’s quite an eye opener as to the enormous differences we can make to help our health and wellbeing, just by making a few minor changes to the original recipe. Still looks and tastes as good as the original!

And just to further make the point, I put both recipes through the FSANZ Nutritional Panel calculator (following the directions in a past blog that Sally posted for Diabetes Counselling Online).

First is the original brownie recipe

And here’s my healthier version

Which would you rather have, especially when you know that this one tastes just as good as the original??

Are you amazed at the differences these changes have made?

And the taste also lived up to expectations! My girls certainly enjoyed them – they didn’t last long!

Some other helpful ideas for your recipe conversions

• Instead of icing sugar try low fat Philadelphia cream cheese thinned out with milk and sweetened with Stevia (cocoa – optional)
• For pizza bases/pancakes/crumpets/muffins try swapping the plain white flour with chickpea flour, quinoa flour, buckwheat flour and spelt flour (for those who aren’t gluten intolerant). Coconut flour is also low carb, but I find its flavour spoils the flavour of the finished product.
• Use low fat yoghurt! It makes a great alternative for mayonnaise, sourcream, ordinary cream and can directly replace oil in baking. Here is the link to an articlethat talks more about it.
• Rolled outs and ground seeds also make an excellent substitution for flours. The calorie content does needs to be considered when using ground nuts and seeds. If one cannot have oats rolled quinoa could also be used. Love this Teresa Cutter recipe for Oatmeal Sconesfor when a special treat is in order.
• I have not found a good replacement for syrups. I have tried dissolving Stevia in hot water and letting it cool down. (2tsp stevia to 1 cup water) this can be used in baking but the texture is not the same as syrup.
• Sushi can be made with cauliflower rice or even quinoa if you wanted the low GI carbs
• Quinoa can be substituted for cous cous to provide a lower carb amount (due more protein in the grain).

And now back to our Diabetes Counselling Online social media dietitian, Sally!

Wow Joan! Thanks so much for making such an effort to demonstrate just what a difference a little bit of thinking in your cooking can achieve. Those girls of yours are certainly fortunate to have a Mum who looks after them with good food for their wellbeing too!

Please add your comments below if you have other suggestions/tips that you’ve discovered that might interest some of our readers.

Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a list of all Sally’s Diabetes Counselling Online blogs here.

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CARB COUNTING QUEEN: AM I REALLY GOOD AT MATHS, OR IS IT AN ILLUSION?

from Helen Wilde

I’m always so profoundly moved by what people are so prepared to share with me. Recently I received the following lovely piece of writing from one of the Parents in our ‘Parents of Kids with Diabetes’ group on Facebook. Check out the link if you are the parent, carer or grandparent of someone with diabetes.

Thanks to Maureen Campey for sharing of your thoughts. Fabulous writing Maureen. Yes, the tears come, even if in secret. There are the times we ALL feel like the ‘carb counting Queen’, whether we have a child with diabetes, or have diabetes ourselves! As you say, it helps to be able to see the funny side. I think it also celebrates our confidence in our skills & knowledge, a confidence that we need to stay sane.

Carb Counting?

“Sometimes I feel sad, but there are times when you just have to laugh at the craziness of life as a mum of a Type 1 child. We were at a friend’s bbq recently and when I came home, I started to write this. Do you feel like this too? I’m happy to share this and just give you a laugh. x

The Carb Counting Queen

I am the carb counting queen. No carb is too complex for my capabilities. This title, it has to be said, was totally uncontested. There was no bloody revolution. There is no pretender to the throne.

A Saturday afternoon bbq? Sure, we’d love to come! Watch me as I glide, seemingly effortlessly, towards the buffet. Greeting friends on either side, they are totally unaware of my inner calculations. Think synchronised swimmer – all smiles above the water, craze of activity below. If karma exists, my maths teacher would be rolling about laughing.

Think synchronised swimming

Ok, here we go! Salad, all good: nice and plain. A top ‘filler upper’! Protein, yip: lots of chicken, and sausages. Fine, but wait! Was the chicken marinated? Best stick to sausages! Which carbs though? At least a modicum of healthiness! Bingo! Corn on the cob! One exchange down!

I bet there’s a loaf of bread somewhere, hopefully wholegrain! Always a ‘failsafe’ but so, so boring. Can I check out the pantry without seeming like a crazy lady? Ah look! Potato bake! Now, how did I calculate carbs in that one I made at home? Get the Mobile ‘phone out and have a look. There might be one on the ‘Carb Counter App’ or my faithful knave the ‘Traffic Light Guide’.

Is there a dessert I wonder? Fruit? Maybe iceblocks for the kids? Which brand? Would it be rude to ask? Please let it be at least font size ten on the packaging! So unseemly scrambling about for those newly prescribed glasses.

All that in a ten metre walk! Pass me a glass of bubbly! Now for the rest of the family!”

Maureen Campey