Welcome!

Hi I am Helen, the founder of Diabetes Counselling Online & I have lived with type 1 diabetes since 1979. I have worked as a diabetes educator & specialist in diabetes & mental health for over 15 years. Here at www.diabetescounselling.com.au you will find all you need to know about life with diabetes, as well as our blog, facebook support groups and more. Sign up to our newsletter to get all the best bits of the blog delivered straight to your inbox, as well as updates about what’s happening in diabetes land! Hop into our store for some great e books, children’s Diabetes Dino packs & our gorgeous Diabeadies. We look forward to communicating & connecting xx

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A Day in the Life of

Guest post by Georgia Hall

I work full time, and I also run my own small business with my business partner, but sometimes it feels like I am working 3 jobs. The other day I was working at an event down at the Convention Centre, about a 15 minute walk from my Grenfell Offices. Before I went down there I checked my blood sugar levels and all was okay, I was ready to assist then jet set across town to meet a friend for lunch.

Before leaving the Convention Centre my blood was 8.5mmol – it was on its way down. I stopped to get a snack from the convenience store.

My time frame was
12:45pm: leave convention centre
1:00pm: arrive at work, grab lunch check BGL
1:05pm: leave for Pirie Street

I arrived back at work at 1:00pm (phew, on time), sent an email to confirm lunch, did another check of my BGL (expecting it to have crept up to say 10mmol) to have got an email saying lunch was cancelled, and just as well my blood was 3.7mmol.

Crazy huh, this is what we have to deal with. Alongside whatever else we fill our day with, work, study etc. I’ve discovered that having Type 1 Diabetes is extra-curricular work, work I don’t get any benefits, recognition or paid for. Well maybe self-recognition, but hey that doesn’t pay the bills!

Sure there are some special provisions now and then, but they are few and far between. I’m not looking for any handouts, and I wouldn’t necessarily say I’m complaining, I’m used to it. I’m just saying it how it is, some people may not notice they additional duties and constant awareness we need to have.

The awareness needs to be raised, living with type 1 Diabetes isn’t always easy (well it’s never easy, but it’s not always hard). If you are someone out there, say a teacher or employer or anyone if you are dealing with someone who has diabetes – please be aware.

As the quote goes, ‘everyone is fighting a battle, not everyone knows about it – so be nice’
Auf Wiedersehen

Georgia

Sleep: zzzzzz…. are you sleeping well?

David Mapeltoft, Diabetes Educator

If you have sleep apnoea, your health may be in danger.

People with sleep apnoea have higher chances of traffic accidents and are more likely to develop serious health problems.

Sleep apnoea is a known cause of high blood pressure and can lead to obesity.

Sleep apnoea can also cause relationship problems and depression.

Do I have sleep apnoea?

Usually, people with sleep apnoea find out because a spouse or bed partner noticed them snore or stop breathing during sleep. Other common signs and symptoms include:

• Extreme sleepiness
• Frequent snoring
• Stopping breathing during sleep
• Morning headaches
• Depression
• High blood pressure
• Weight problems

Sleep apnoea is most common among men, people who are overweight and the middle-aged. However, research shows that children and post-menopausal women may also be at risk.

What is treatment like?

There are several treatments available for OSA (obstructive sleep apnoea), however most doctors recommend positive airway pressure (PAP) therapy. PAP therapy is safe, effective and non-invasive. It does not require drugs or surgery.

Alternatives including dental appliances may have some benefits for people with mild OSA. There are invasive surgeries available, however, they have variable success rates, and surgery always has a risk of short and long-term complications.

Of the available treatment options, PAP therapy is the safest and most effective. People on PAP therapy have reduced health risks and more energy to do the things they want to do.

Talk to your doctor about having your sleep pattern assessed

Health risks

Sleep apnoea can be life threatening. People with sleep apnoea have higher chances of serious health problems like diabetes, high blood pressure, heart disease, stroke and obesity.

Treating sleep apnoea can improve these problems, as well as a person’s overall quality of life. It has been shown to lower blood pressure, improve glucose control and increase energy throughout the day in people with diabetes.

The message is simple—if you have sleep apnoea, you need to get treated!

Diabetes

People with sleep apnoea have higher chances of developing insulin resistance, which can lead to Type 2 diabetes. Sleep apnoea is very common in patients that suffer from diabetes. Approximately 60% of Type 2 diabetes patients have sleep apnoea.

Diabetes patients who receive treatment for their sleep apnoea often have an immediate improvement in their diabetic condition.

If you have diabetes and think you might have sleep apnoea, you need to find out. Treating sleep apnoea can help you control your blood sugar levels and may lower your chances of complications, like heart disease.

High blood pressure

The (American)National Institute of Health lists sleep apnoea as a cause of high blood pressure.

Studies show that about 30% of all people with high blood pressure have sleep apnoea. That number increases to 80% for people taking three or more medications to control their blood pressure.

If you have high blood pressure and sleep apnoea, starting treatment may help you lower your levels significantly and improve your heart health.

Heart disease

Untreated sleep apnoea strains the heart and may cause it not to work properly.

Left untreated, sleep apnoea can lead to heart disease and heart failure.

People with sleep apnoea can lower their chances of developing these problems by getting treated. Sleep apnoea treatment can people help control their blood pressure and improve their heart health.

Stroke

Sleep apnoea can increase a person’s chances of stroke. In fact, studies show that more than 60% of patients who have had a stroke also have sleep apnoea. Stroke patients with untreated sleep apnoea may have a harder time recovering after a stroke than others do.

Recovering from a stroke takes much energy and motivation, but the sleepiness that comes from sleep apnoea can make it difficult for a person to follow rehabilitation programs, causing poor recovery.

Stroke patients with untreated sleep apnoea have higher chances of death than patients who receive treatment.

Obesity

About 40% of obese people have sleep apnoea. Overweight people should be particularly concerned because sleep apnoea may make weight loss more difficult.

The sleepiness that comes from sleep apnoea may cause people to overeat, sleep more, and exercise less. Some people, as a matter of habit, will eat to “wake up” when they feel drowsy during the day. That in turn can cause them to gain more weight, which may make their sleep apnoea even worse.

Being treated for sleep apnoea can help obese people gain the energy to exercise more and lose weight.

Sleep well last night?

SLEEP QUIZ

This short quiz is designed to help you to recognize possible sleep apnoea so that you can realise there can be relief for your symptoms.

While awake

• Do you wake up in the morning tired and foggy, not ready to face the day?
• Do you have headaches in the morning?
• Are you very sleepy during the day?
• Do you fall asleep easily during the day?
• Do you have difficulty concentrating, being productive, and completing tasks at work?
• Do you carry out routine tasks in a daze?
• Have you ever arrived home in your car but couldn’t remember the trip from work?

Adjustment and emotional issues

• Are you having serious relationship problems at home, with friends and relatives, or at work?
• Are you afraid that you may be out of touch with the real world, unable to think clearly, losing your memory, or emotionally ill?
• Do your friends tell you that you’re not like yourself?
• Are you depressed?
• Are you irritable and angry, especially first thing in the morning?

Medical, physical condition, and lifestyle

• Are you overweight?
• Do you have high blood pressure?
• Do you have pains in your bones and joints?
• Do you have trouble breathing through your nose?
• Do you often have a drink of alcohol before going to bed?
• If you are a man, is your collar size 17 inches (42 centimetres) or larger?

During sleep and in the bedroom

• Do you snore loudly each night?
• Do you have frequent pauses in breathing while you sleep (you stop breathing for ten seconds or longer)?
• Are you restless during sleep, tossing and turning from one side to another?
• Does your posture during sleep seem unusual? (Do you sleep sitting up or propped up by pillows?)
• Do you have insomnia? (Waking up frequently and without a reason)
• Do you have to get up to urinate several times during the night?
• Have you wet your bed?
• Have you fallen from bed?

What is your score?

If you answered “yes” to any of these questions, you may have sleep apnoea.

However, if you answered “yes” to any of the following especially important four questions, this strongly suggests that sleep apnoea is the problem.

• Are you very sleepy during the day?
• Do you fall asleep easily during the day?
• Do you snore loudly each night?
• Do you have frequent pauses in breathing while you sleep (you stop breathing for 10 seconds or longer)?

Talk to your doctor today. More on sleep and diabetes HERE

Bon nuit / good night

Kind Regards,

David Mapeltoft, Diabetes Educator

Research

FDA OKs New Drug for Diabetes-Linked Eye Condition

Eylea injections appear to ease diabetic retinopathy, studies show

By Robert Preidt

WEDNESDAY, March 25, 2015 (HealthDay News) — The U.S. Food and Drug Administration on Wednesday approved the use of Eylea, an injected drug, to treat diabetic retinopathy in patients with diabetic macular edema.

According to the U.S. Centers for Disease Control and Prevention, diabetic retinopathy is a leading cause of blindness in American adults. A third of those over 40 with diabetes have some form of the eye condition, according to 2008 data, the CDC said.

Overall, more than 29 million people in the United States have type 1 or type 2 diabetes, and diabetes remains the leading cause of new blindness among people aged 20 to 74, the CDC noted.

In some people who have diabetic retinopathy with macular edema, abnormal new blood vessels grow on the surface of the retina. If those new blood vessels break, severe vision loss or blindness can occur.

“The major cause of vision loss occurs when abnormal blood vessels leak, causing retinal swelling also known as macular edema,” explained one expert, Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City.

“Today’s approval [of Eylea] gives patients with diabetic retinopathy and diabetic macular edema another therapy to treat this vision-impairing complication,” Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research, said in an agency news release.

Eylea is given by a doctor as an injection into the eye once a month for the first five injections, and then once every two months. It is meant to be used along with measures to control a patients’ blood sugar, blood pressure and cholesterol levels, the FDA said.

The approval is based on the findings from two clinical trials that included a total of 679 diabetic retinopathy patients with diabetic macular edema. They were randomly assigned to receive Eylea or macular laser photocoagulation, a laser treatment that burns small areas of the retina.

After 100 weeks, patients taking Eylea had significant improvement in the severity of their diabetic retinopathy, compared with those who did not receive the drug, the FDA said.

Another expert said that Eylea is just one of a number of recent advances against the disease. For example, in February, the FDA approved Lucentis (ranibizumab) injections to treat diabetic retinopathy in patients with diabetic macular edema.

“In the last few years, multiple new medications and various surgical methods have become available to treat diabetic retinopathy,” said Dr. Nazanin Barzideh, chief of vitreoretinal surgery at Winthrop-University Hospital in Mineola, N.Y. She said that approved injected medications, “frequently improve vision in the effected diabetics and timely treatment can prevent blindness.” However, Barzideh cautioned that “it is important that new medical and surgical treatments be administered by a retina specialist, as close monitoring is required with all of these new treatments.”

According to the FDA, common side effects with Eylea included bleeding into the tissue that lines the inside of the eyelids and covers the white part of the eyes, eye pain, cataracts, floaters, increased pressure inside the eye, and separation of the interior jelly of the eye from the retina. Serious side effects included infection within the eye and retinal detachment.

Eylea, marketed by Regeneron Pharmaceuticals Inc. in Tarrytown, N.Y., is also approved to treat wet age-related macular degeneration, as well as diabetic macular edema and macular edema secondary to retinal vein occlusions, the FDA said.

SOURCES: Mark Fromer, M.D., ophthalmologist, Lenox Hill Hospital, New York City ; Nazanin Barzideh, M.D., chief, vitreoretinal surgery, division of ophthalmology, Winthrop-University Hospital, Mineola, N.Y.; U.S. Food and Drug Administration, news release, March 25, 2015

HealthDay

Copyright (c) 2015 HealthDay. All rights reserved.

From Helen Wilde, Senior Counsellor

Mindfulness…be fully in the moment. Spend 10 minutes NOW for the sake of your mental health.

Smiling Mind

Clear your mind of the clutter as we get closer to the end of a busy week. It only takes 10 minutes of mindfulness practice to re-focus your mind and get back into the swing of things with a ‪clear and ‪calm mind http://smilingmind.com.au/

Staying well is about more than managing our physical health. How can we make the most of our mental health?

Staying well is an important process in managing anxiety. Recovery can take time and is different for everyone. As well as starting treatment, the person has to find new ways to manage, and live with the changes and challenges of having anxiety. What are your tips on staying well?

Visit http://bb.org.au/staying-well for advice on keeping yourself in check.

Black Dog Institute

Dr Veronica Vatiliotis, Research Assistant at the Black Dog Institute is working on a Rotary funded study in Type 1 Diabetes. The study aims to investigate the feasibility, acceptability and effectiveness of a web and mobile phone-based Cognitive Behaviour Therapy (CBT) intervention for improving mental well-being and reducing psychological and diabetes-related distress in young people with T1D (16 to 25 years).

If you would like to participate, contact Veronica at

University of New South Wales

Hospital Road, Prince of Wales Hospital, Randwick NSW 2031

ph: +61 2 9382 9275

www.blackdoginstitute.org.au | [email protected]

D-discussion on ‘That Sugar Film’

By Sally Marchini, Dietitian, on Mar 22, 2015 03:30 pm
Last week I attended the Newcastle premier of ‘That Sugar Film’, with Damon Gameau as the star. I was there because I was invited to participate afterwards as the ‘nutrition expert’ in the 30 minute Q&A with the audience, numbering 640. I thought my experience worth talking about as, although the film is doing an awesome job at raising awareness of how much sugar is in the foods we eat, it’s really important that people understand that eating well is not all about fearing or avoiding one nutrient (in this case, sugar). I believe that achieving optimum health through eating a well balanced diet, consisting of a variety of real foods, mostly plants, is the most important message to take away from this experience, and I hope that is what I communicated to the audience as a panel member.

In ‘That Sugar Film’ Damon Gameau performs an experiment on just himself. Bearing in mind that we’re all different, and, importantly, that this wasn’t a clinical trial, Damon’s self experiment can form a good reminder to us on some key points of understanding about how added sugars in foods can play havoc with our wellbeing in various ways. Damon has written a blog himself explaining what ‘added sugars’ actually means. He explains, as I have previously done, how and why the term ‘added sugars’ does not include the naturally occurring sugars in fruits and dairy. Natural sugars such as these, and other carbohydrates, including whole grains and legumes, also provide essential nutrients for wellbeing. I encourage you to read his blog on this subject (link above) as it provides a well balanced view.

The Dietitians Association of Australia (DAA), of which I am a member, supports the recommendations of the Australian Dietary Guidelines (ADG) about limiting the intake of foods and drinks containing added sugars. Examples are: confectionery; sugar-sweetened soft drinks and cordials; fruit drinks; vitamin waters; energy drinks; and sports drinks. The DAA believes a healthy, balanced diet involves eating appropriate amounts of a wide variety of nutritious foods, while occasionally being able to enjoy small amounts of ‘discretionary choices’. It’s about taking a balanced approach that is sustainable over the long term.

On that note, remember my recent blog chatting about Dr Rosemary Stanton’s talk on ‘Why so many controversies?’ Here, Dr Stanton reminds us that junk food, containing free sugars, poor quality fats, and high levels of sodium, currently accounts for 36% of the energy intake of adults, and greater than 40% of children’s energy intake. Those are scary figures. Those figures are worth considering when choosing foods and drinks, as are the points about added sugars in ‘That Sugar Film’. Making healthy choices is really about being mindful of what is in the foods we’re eating, choosing to buy and eat fresh foods, learning to read labels, and remembering to eat with moderation.

For us with diabetes, I found this experience to be a really good reminder to be mindful in our food choices. We can consider if we could make a healthier choice where there are options. This is not always possible, so remembering that ‘a little of what you like does you good’, if you make the decision to eat something from our ‘discretionary’ list, then it’s not worth feeling guilty about. Enjoy that choice, try to make it a small amount, and eat slowly and mindfully.

Nourishment and Enjoyment

It is important to appreciate that we eat food for more reasons that just getting the nutrients we need for good health. Eating is also a social activity and most celebrations are based around eating (think weddings, funerals, get-togethers and more). It’s about learning the balance between nourishment and enjoyment.

As APD Dr Joanna McMillan reminds us, it’s important to take pleasure in what you’re eating because that’s the only way you’ll do it for the long term. This is such an important message for us all to remember, especially when we have diabetes because it really is every meal for the rest of our lives. As we often say, ‘it’s all about moderation’ and trying where possible to make healthier choices.

Accredited Nutritionist Catherine Saxelby also reinforces these ideas in her blog on this film where she says, “On a more serious note, I believe the film goes overboard on the need to quit sugar. Are we not capable of moderation? Does it have to be total exclusion?”

Nutrition is a developing science

There is a lot to learn about food and how it affects us. As the dietitian for Diabetes Counselling Online I’ve written over 60 blogs on diabetes and food for Diabetes Counselling Online in an effort to help people with any type of diabetes to get a clear understanding of the nutritional value and health benefits of the food and drinks we choose. There are many more more topics to cover.

I’m constantly reminding people to aim to choose ‘real foods’ from the 5 food groups in the Australian Dietary Guidelines. These guidelines (released in 2013) were developed by real experts who reviewed over 55,000 scientific journal articles. They then translated that evidence into meaningful dietary advice, while reflecting a commitment to best practice standards in health guideline development. This amazing work was done to help all Australians to make better decisions about the foods we choose, to minimise risk of many long term health conditions.

Nutrition science is constantly developing and there are still many discoveries to be made. This is why dietitians constantly study to keep up to date with the latest research so the advice we provide in our medical nutrition therapy is providing you with the safest and most practical advice available.

Some processed foods aren’t all bad

Another point worth making is that ‘That Sugar Film’ demonstrates the large amounts of sugars that can be found in processed foods. It tells us that if you took all the foods off a shelf in a supermarket that contained added sugar, there’d only be about 20% of the foods left there. So this is an exercise for us in learning to read labels, as well as us understanding how to make informed choices of the foods that are there.

Some of these processed foods that are referred to in the film are baked beans, containing the equiv of 1 tsp of sugar per serve. Using baked beans as an example, the beans themselves are highly nutritious and 1 tsp sugar is in the sauce, which also contains nutrients such as lycopene that we need to obtain from cooked tomatoes. That 1 teaspoon of sugar is not enough to spike your BGLs and baked beans do have a low glycemic index, so they’re a good option for us when we need a meal in a hurry.

There are also other processed foods such as tinned and frozen vegetables, some breakfast cereals, some grainy breads and dairy products that as a dietitian I regularly encourage people to use. If these products weren’t being recommended, then chances are that people might inadvertently choose something less nutritious in an effort to have a little less sugar. Learning to label read is so important here. Some of the healthier, lower GI breakfast cereals are really convenient options in our busy lives, as well as containing important nutrients that we need for wellbeing, despite containing some added sugars.

Have you seen it?

If you haven’t seen ‘That Sugar Film’ yet, I encourage a viewing as it will help you to reflect on your own intake of ‘added sugars’, and perhaps help you to understand more about yourself and the food you eat. Just remember to come back and re-read here, so you can refresh your memory about the points I have made in this blog so you’re seeing a balanced perspective.

In the words of Michael Pollan: “Eat food. Not too much. Mostly plants.” This is reinforced by the words of Associate Professor and APD Tim Crowe, “Because there are thousands of natural chemicals present in foods, there is no single food that should be called a ‘superfood’. Instead, think ‘superdiets’ that contain plenty of different plant-based foods as the best way to eat for good health.”

Please feel free to ask questions either in the space provided following this blog, or on our closed Facebook group ‘Diabetes and Food – let’s celebrate it!”. I believe food really should be celebrated, not feared.

Sally

Member’s Story

Our guest poet, Maureen Campey, has written another great poem about Parenting a child with diabetes. This time, Maureen has written about her teenage son starting a new year of High School, one of those momentous hurdles that we all face as parents.

Here are Maureen’s wise words.

Sending our kids back to school always brings its own set of worries and frustrations. My T1 14yr old has gone back to a new set of teachers. He seems pretty cool with it all. My ‘coping mechanism’ seems to have become, Writing Poetry! Weird, I know but it helps me get it out of my system. I hope you don’t mind if I share!

Dear Teacher

Hi, hello, it’s me again.
Please don’t roll your eyes!
I’m not a helicopter parent,
I come in peace!

I need to explain
That my child will be carrying an invisible pancreas.
You won’t even know it’s there.
He will carry it with him wherever he goes.
He will do its job and look after it
But sometimes he may grow a little weary.
Your help may be needed as he mustn’t let go of this tiresome load.

Scared? Don’t be!
Imagine how he feels all day, every day
Yet he keeps on going.
Your job is small and help is at hand for you.

My child must calculate many things at the same time.
He must think like a pancreas.
Can you imagine?
As well as trying to learn,
He must anticipate the effect of every action and piece of food
Whilst travelling from class to class, and teacher to teacher.
No mean feat!

I will make sure you are given the knowledge you need.
I ask that you are willing to accept your role.
Let him be and don’t become a helicopter teacher.
He is not perfect.
Do not expect gratitude,
There will be no immediate reward for what you do
But know that he will go on to live a full life
Having learnt from you that this burden can be shared.

You will never know the gift you have given my child
But please know that I will be forever in your debt.

Maureen Campey

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