KO E ngaahi mE'a - Australian Diabetes Council

KO E SUKÁKo e ngaahi me’a ‘oku totonu ke ke ‘ilo ki ai1ENGLISH/TONGAN

ContentsChapterIndexForewordIntrodion1 What is diabetes2 Types of diabetesType 1 diabetesType 2 diabetesGestational diabetes3 Risk factors4 The Diabetes Health Care Team5 Annual Cycle of Care6 Healthy Eating for Diabetes7 What’s in food?8 Common Questions about Food and Diabetes9 Diabetes and Alcohol10 Physical activity11 Oral Medications12 Insulin13 Blood Glucose (Sugar) Monitoring14 Short Term Complications – Hypoglycaemia15 Short term complications – high blood glucose (sugar) level (hyperglycaemia,DKA, HONK/HHS, and sick days)16 Chronic complications17 Diabetes and your feet18 Diabetes and Pregnancy19 Diabetes and Your Emotions20 Diabetes and Driving21 Diabetes and Travel22 Need an Interpreter?23 National Diabetes Services Scheme (NDSS)24 Australian Diabetes Council2

Ngaahi me’aTōpikiFakahokohokoTalamu’omu’aTalateu1 Ko e hā ‘a e suka2 Fa’ahinga suka kehekeheSuka Fa’ahinga 1Suka Fa’ahinga 2Suka Lolotonga Feitamá3 Ngaahi Me’a Tu’unga Fakatu’utāmaki4 Ko e Timi Tauhi Mo’ui Leleí ‘o e Suká5 Ko e Siakale ‘o e Tauhi Fakata’ú6 Ko e Kai Fakamo’ui lelei ma’ae Suká7 Ko e hā ‘a e ngaahi me’a ‘oku ‘i he me’akaí?8 Ngaahi Fehu’i ‘oku fa’a ‘eke fekau’aki mo e Me’akaí mo e9 Suká mo e ‘Olokaholό10 Ngaungaue‘a e Sinό11 Ngaahi Faito’o ‘oku Inu pē Folo12 ‘Inisulini13 Ko hono Siofi mo Tokanga’i ‘a e Kulūkousi (Suka) ‘i he Totό14 Ngaahi Faingata’a Fuonounou - Hypoglycaemia15 Ngaahi faingata’a fuonounou – tu’unga ‘o e kulūkousí (suka) he totό(hyperglycaemia, DKA, HONK/HHS, mo e ngaahi ‘aho puke)16 Ngaahi mahaki tauhi mo hono ngaahi faingata’a17 Suká mo ho Va’é18 Suká mo e Feitamá19 Suká mo ho ngaahi Ongo Fakaelotό20 Suká mo e faka’ulí21 Suká mo e Fefolau’akí22 Fiema’u ha Tokotaha Fakatonulea?23 Ko e Polokalama Fakafonua ‘o e ngaahi Ngāue ki he Suká (NDSS)24 Kosiliō Suka ‘a ‘Aositelēliá3

ForewordDiabetes –What you need to know has been written for people with diabetes and for peoplewho would like to learn more about the condition.Health professionals with skills and knowledge in a variety of specialised areas havecontributed to the content and presentation.This book has been reviewed by diabetes educators, dietitians and exercise physiologists.Australian Diabetes Councilabn 84 001 363 766 CFN 1245826 Arundel Street, Glebe, NSW 2037GPO Box 9824, Sydney, NSW 2001email: info@australiandiabetescouncil.comwebsites: www.australiandiabetescouncil.comwww.diabeteskidsandteens.com.au© 2012 Copyright Australian Diabetes CouncilThis article/ resource has copyright. Apart from any fair dealing for the purposes of private study, research, criticismor review permitted under the Copyright Act 1968, no part may be stored or reproduced by any process withoutprior written permission from Australian Diabetes Council.4

TALAMU’OMU’ASuká – Kuo fa’u ‘a e fakamatala fekau’aki mo e ngaahi me’a ‘oku totonu ke ‘ilo ki ai ‘a e kakai ‘okusuká pea ma’ae kakai ‘oku nau fie ‘ilo ange ki he mahaki ni.Na’e kau mai ki hono fa’u ‘a e ngaahi fakamatala ni mo hono fokotu’utu’ú ‘a e kau mataotao‘oku nau taukei mo ‘ilo ki he mo’ui leleí ‘i ha ngaahi va’a taukei kehekehe.Kuo ‘osi fai hano fakamatala fakaanga ‘a e tohi ni ‘e he kau mataotao he ako ki he mahaki suká,kau taukei ki he fakafuofua e ma’u me’atokoní mo e taukei fakamālohisino faka-fisiōlosisi.Australian Diabetes Councilabn 84 001 363 766 CFN 1245826 Arundel Street, Glebe, NSW 2037GPO Box 9824, Sydney, NSW 2001‘Imeili: info@australiandiabetescouncil.comUepisaiti: www.australiandiabetescouncil.comwww.diabeteskidsandteens.com.au© 2012 Copyright Australian Diabetes Council‘Oku malu’i ‘a e totonu kotoa ‘o e ‘atikolo/ma’u’anga fakamatala ko ‘ení. Tukukehe ‘o ka ngāue’aki ‘a e founga totonuki he taumu’a ako fakafo’ituitui, fakatotolo, fakafehu’i –mo-vakili pē ha fakamatala fakaanga ‘oku fakangofua ‘i heLao ki he Tatau-Totonu 1968, ‘oku tapu ke tauhi pē hiki ha fa’ahinga tatau ‘o ha konga ‘o e tohi ni kae’oua kuo ma’uha ngofua mei he Kosiliō Mahaki Suka ‘a ‘Aositelēlia.5

IntroductionOne in four people in Australia have either diabetes or are at high risk of diabetes.Diabetes prevalence is considerably higher in Aboriginal and Torres Strait Islander and certainculturally and linguistically diverse (CALD) groups.So far there is no cure for diabetes but with proper management most people can lead a fulland active life and delay or prevent long term complications. To ensurebest possible health, people with diabetes and their families need to understand a great dealabout diabetes.Being diagnosed with diabetes can be frightening and overwhelming. It’s a lot easierwhen you understand it and develop a lifestyle plan to manage it. For this reason it is veryimportant to have information about food, medicines, exercise, community resources anddiabetes self care.This book has been produced by Australian Diabetes Council. It has been written in Englishand several other languages to explain what you need to know about diabetes.6

1What is diabetes?Diabetes is a condition where the amount of glucose (sugar) in the blood is too high.Glucose is your body’s main energy source but when blood glucose is too high over longperiods it can damage certain organs.Glucose comes from carbohydrate foods that are broken down and released into thebloodstream. Carbohydrate foods include bread, rice, potatoes, fruit and milk.The pancreas, a part of the body that is found behind the stomach, releases a hormonecalled insulin into the blood stream. Insulin allows the glucose to move from the bloodstream into certain cells of the body, where it is changed into energy. We use this energy towalk, talk, think, and carry out many other activities.Diabetes occurs when there is either no insulin, not enough insulin or the insulin that isproduced is not working properly to move the glucose out of the blood. .Currently there is no cure for diabetes.Symptoms of high blood glucose (sugar)21. Frequent urination (both night and day)2. Thirst / dry mouth3. Tiredness / lack of energy4. Blurred vision5. Slow healing of wounds6. Infections e.g. urine and skin7. Tingling sensation in feet8. Itchy skinTypes of diabetesThe most common types of diabetes include:• Type 1 diabetes• Type 2 diabetes• Gestational Diabetes (GDM)8

Fa’ahinga suka kehekehe – hoko atuSuka fa’ahinga 1‘Oku fa’a hoko ‘a e fa’ahinga suka ko ‘ení ‘i he fānaú iikí mo e tamaiki lalahí, ka ‘e lava ‘o hoko ‘iha fa’ahinga ta’u motu’a pē. ‘I he suka fa’ahinga 1, kuo hanga ‘e he fa’unga (malu’i) ‘o e sinό ‘ofaka’auha ‘a e ngaahi nāunāu fa’ungame’á (cells) ‘oku nau ngaohi ‘a e ‘inisuliní. Ko hono olá he‘ikai leva ke ngaohi ‘e he ‘ate pilí ha ‘inisulini.‘Oku ‘IKAI kau ‘a e filingamo’uí (lifestyle) ki hono fakatupu e suká hangē ko e fu’u lahi e kai suká,si’isi’i ‘a e fakamālohisinό pē fu’u sino.‘Oku fa’a ‘asi vave ‘a e ngaahi faka’ilonga ‘o e suka fa’ahinga 1 ‘o kau ai ‘a e:• Ongo’i fieinua ‘aupito• Lahi ‘a e tu’uofí• Fakatu’upakē ‘a e holo e pāuní (neongo ‘oku lelei ‘a e u’á mo lahi ange)• Hela’ia• Ongo kovi fakalūkufua• Langa ‘a e koná, tokotokakovi mo e lua• Feliliuaki ‘a e fakakaukaú mo e ongό.Kapau ‘e tuai hono ‘ilό, ‘e ma’olunga ‘aupito ‘a e tu’unga ‘o e kulūkousí ‘i he totό. ‘O ka si’isi’i honoma’u ‘e he sinό ‘a e kulūkousi mei he totό ke ne ngāue’aki ko ha ivi ‘e kamata leva ke ne veteki‘a e ngakό. Ka lahi hono veteki ‘e he sinό ‘a e ngakό, ‘e tupu leva ‘a e kitouni. ‘Oku mātu’akifakatu’utāmaki ‘aupito ‘a e ma’olunga e tu’unga ‘o e ketones mo e ma’olunga ‘a e kulūkousí hetotό pea ‘oku fiema’u ke faito’o ‘i he vave taha.Kapau ‘e ‘ikai faito’o, ‘e puke lahi ‘a e tokotaha ni pea ‘e lava ke:• Vave pē hō’aki e mānavá• Si’i ‘a e vai he sinό mo e lua ‘o hoko ai ‘a e• Mole ‘a e ngaahi ongo kotoa he sinό mo e ‘atamaí (Coma).Ko e faito’o ki he suka fa’ahinga 1 ko e ‘inisulini pea ke kamata ‘i he vave tahá pea ke tauhi ma’uia ‘i he toenga ‘o e mo’uí. ‘Oku kau ‘i hono leva’i e suká ‘a e:• Tauhi ke hōhoa tatau ‘a e fakamālohisinό, me’akaí mo e ‘inisuliní• Toutou siofi ‘a e tu’unga ‘o e kulūkousi he totό• Filingamo’ui ‘oku fakamo’uilelei.11

Types of diabetes - continuedType 2 diabetesThis type of diabetes is usually diagnosed in people over 40 years of age. However it is nowbeing diagnosed in younger people, including children. Poor lifestyle choices are a majorreason for this increase in young people .Inactivity and poor food choices can result in weight gain, especially around the waist.This prevents the body from being able to use insulin properly (insulin resistance) so bloodglucose levels rise. Type 2 diabetes has a slow onset.Type 2 diabetes runs in families so children and grandchildren are at risk. The good news isthat type 2 diabetes can be delayed or prevented when healthy lifestyle choices that focuson increasing physical activity, healthy food choices and weight loss are made. For this reasonit is important to know your risk for type 2 diabetes.Symptoms of type 2 diabetes may include frequent urination, thirst, blurred vision, skininfections, slow healing, tingling and numbness in the feet. Often, there are no symptomspresent, or symptoms are not recognised.Once diagnosed, it is very important to maintain good blood glucose (sugar) levels as soonas possible to avoid complications.Management should begin with healthy food choices and regular physical activity. However,diabetes is a progressive disease and over time, oral medications and/or insulin may be needed.12

Fa’ahinga suka kehekehe – hoko atuSuka fa’ahinga 2‘Oku fa’a ma’u ‘a e fa’ahinga suka ko ‘ení ‘i he kakai ‘oku laka honau ta’u motu’á ‘i he 40. Ka ‘okulolotonga ‘asi ‘i he ngaahi sivi fakatoketā hono ma’u ‘a e tamaikí ‘o kau ai mo e fānau iikí. ‘Okutupu ‘eni mei he kovi ‘a e filingamo’ui ‘oku fai ‘e he to’utupú.‘Oku lava ke fakasino, ‘o fakatautefito ki he kongalotό ‘o kapau ‘oku si’isi’i ‘a e fakamālohisinόmo kovi ‘a e fili me’akaí. ‘E fakatupu leva mei ai ‘a e ta’ofi ‘e he sinό hono ngāue totonu’aki ‘a e‘inisuliní (ta’ota’ofi e ‘inisuliní) ‘o tupu mei ai ‘a e hiki ‘a e tu’unga ‘o e kulūkousí ‘i he totό. ‘Okumāmālie ‘a e hoko mai ‘a e suka fa’ahinga 2.‘Oku tukufakaholo ‘a e suká ‘i he ngaahi familí ‘o ala a’u ‘a e fānaú mo e makapuná ki hatu’unga fakatu’utāmaki ke nau ma’u e mahaki ni. Ka ‘e ala toloi pē ta’ofi ‘a e suka fa’ahinga 2‘o ka fai ‘a e filí ki he filingamo’ui fakamo’ui lelei ‘a ia ‘oku fakatefito e tokangá ke lahai ange ‘ae fakamālohisinό, fili ‘a e me’akai fakamo’ui lelei mo holoki e sinό. Koe’uhi ko e ‘uhinga ko ‘ení‘oku mahu’inga ke ‘ilo’i ‘a e tūkunga ‘oku malava ke ma’u ko e ‘e he suka fa’ahinga 2.Ko e ngaahi faka’ilonga ‘o e suka fa’ahinga 2 ‘oku ala kau ai ‘a e fa’a tu’uofí, fieinuá, nenefu ‘a esiό, mahaki’ia ‘a e kilí, tuai ‘a e mo’ui e ngaahi lavelaveá, mofisifisi mo mamate ‘a e va’é.’Oku ‘i aie taimi ‘oku ‘ikai ‘asi ha ngaahi faka’ilonga ia, pē ‘ikai fakatokanga’i ‘a e ngaahi faka’ilongá.Hili hono sivi kuo ma’u e suká, ‘oku mahu’inga ‘aupito ke tauhi ke lelei ma’u pē ‘a e tu’unga ‘o ekulūkousi (suka) ‘i he totό ‘o fai ‘eni ‘i he vave tahá ke taliteke’i ha ngaahi faingata’a.‘Oku mahu’inga ke kamata ‘a hono leva’i ‘aki ‘a e fili ki he ngaahi me’akai fakamo’ui lelei mo efa’a ngaungaue ‘a e sinό.Ka ko e suká ko ha mahaki ‘oku fakutuutu ange ‘ene tupú pea ‘i ha taimi ‘amui ange, ‘e fiema’uke folo fo’i’akau pe inu ha faito’o pea mo fiema’u mo e ‘inisulini.13

Types of diabetes - continuedType 2 Management Plan• Be physically active (e.g. walking) – aim for 30 minutes of moderate physical activity everyday of the week. Check with you doctor first• Adopt a healthy eating plan• Lose weight or maintain a healthy weight• Reduce salt intake• Drink plenty of water• See your diabetes health care team for regular health checks –, blood glucose levels,blood pressure, cholesterol, kidneys and nerve function, eyes and dental health• Take care of your feet - check daily• Stop smoking• Regular dental care to avoid teeth and gum problems.Encourage your family to adopt a healthy lifestyleSmoking and diabetesTobacco has many unhealthy effects, especially for people with diabetes. People withdiabetes who smoke are three times more likely to die of heart disease or stroke than peoplewith diabetes who do not smoke.Smoking raises blood glucose levels, reduces the amount of oxygen reaching the body’stissues, increases fat levels in the blood, damages and constricts blood vessels and increasesblood pressure. All of these contribute to the risk of heart attack and stroke. Smoking can alsoworsen blood supply to feet.For those who quit smoking, more frequent monitoring of blood glucose levels is important.This is because blood glucose levels may get lower when they quit smoking and can requirechanges to medication doses.It is advisable that people with diabetes discuss with their doctor, the products and servicesavailable to help them quit smoking.14

Fa’ahinga suka kehekehe – hoko atuPalani Leva’i ‘o e Fa’ahinga• Ke sino longomo’ui (hangē ko e luelué) – taumu’a ke lahilahi e fakamālohisinό ‘i ha miniti ‘e30 he ‘aho kotoa ‘o e uiké.’Uluaki vakai’i ki ho’o toketā.• Fetongi ki ha palani kai fakamo’ui lelei• Holoki e sinό pe feinga ke tauhi ha sino ‘oku mo’ui lelei• Fakasi’isi’i ‘a e kai māsimá• Inu ke lahi• Toutou ‘alu ma’u pē ki ho timi tauhi mo’ui lelei e suká ‘o sivi -, tu’unga ‘o e kolūkousí he totό,toto ma’olunga, lahi ‘o e cholesterol he totό, kofuuá mo e ngāue ‘a e neavé, matá mo emo’ui lelei ‘a e nifό• Tokanga’i ho va’é – vakai’i faka’aho• Tuku e ifí• Tokanga ma’u pē ke tauhi lelei e nifό ke ta’ofi ‘a e ngaahi palopalema ki he nifό mo e te’enifό.Poupou’i ho familí ke nau ohi ‘a e to’onga filingamo’ui ‘oku fakamo’ui lelei.Ifí mo e suká‘Oku lahi ‘aupito ‘a e kau kovi ‘a e tapaká ki he mo’ui leleí, tautefito ki he kakai ‘oku nau suká.‘Oku liunga tolu ke ala mate ‘i he mahaki mafú pē pā kalavá ‘a e kakai suka ‘oku nau ifí ‘iatekinautolu ‘oku ‘ikai ke nau ifí.‘Oku hanga ‘e he ifí ‘o hiki ki ‘olunga ‘a e tu’unga ‘o e kulūkousī ‘i he totό, fakasi’isi’i ‘a e lahi ‘o e‘okisiseni ‘oku a’u ki he ngaahi tisiu ‘o e sinό, hiki hake ‘a e tu’unga ‘o e ngakό ‘i he totό, mamau’imo fakafāsi’i ‘a e ngaahi kālava fetuku totό pea mo hiki hake ‘a e fua e totό. ‘Oku kau kotoa ‘ae ngaahi me’a ni ki hono fakalahi e tu’unga fakatu’utāmaki ‘o e mahaki mafú mo e pā kalava.‘Oku kau kovi ‘a e ifí ki hono ‘ave ‘a totό ki he va’é.Ko kinautolu kuo ‘osi tuku ifí, ‘oku mahu’inga ke lahilahi ange hono vakai’i ‘a e tu’unga ‘o ekulūkousí ‘i he totό. ‘Oku mahu’inga ‘eni koe’uhi ‘e ala holo ‘a e tu’unga ‘o e kulūkousí ‘i he totό‘o ka ta’ofi ‘a e ifí pea ‘e malava ke liliu ‘a e lahi ‘o e faito’o pē fo’i’akau ‘oku folό.‘Oku taau ke ‘alu ‘a e kakai ‘oku nau suká ‘o talanoa mo ‘enau toketā, ki he ngaahi me’a mo engāue ‘oku ‘atā ke tokoni kiate kinautolu ke tuku ‘enau ifí.15

Types of diabetes - continuedGestational DiabetesThis type of diabetes occurs during pregnancy and usually goesaway after the baby is born.In pregnancy, the placenta produces hormones that help the babyto grow and develop. These hormones also block the action of themother’s insulin. As a result, the need for insulin in pregnancy istwo to three times higher than normal. If the body is unable toproduce enough insulin to meet this extra demand, gestationaldiabetes develops.Screening for gestational diabetes occurs around the 24th to 28thweek of pregnancy. Gestational diabetes may re-occur at the nextpregnancy.Blood glucose (sugar) levels that remain above target range mayresult in bigger babies, which can make birth more difficult. It canalso increase the risk to the baby of developing diabetes in later life.What do you need to do if you have been diagnosed with gestational diabetes?It is necessary to see a diabetes educator, dietitian, endocrinologist and obstetrician.The management includes healthy eating for the mother, moderate exercise plus regularmonitoring of blood glucose levels.It is a good idea to have small frequent meals throughout the day that are nutritious foryou and your baby, rather than three big meals. This will ease the insulin demand on thepancreas.Those most at risk for developing gestational diabetes are:• Women over 30 years of age• Women with a family history of type 2 diabetes• Women who are overweight• Aboriginal or Torres Strait Islander women• Certain ethnic groups, in particular Pacific Islanders, people fromthe Indian subcontinent and people of Asian origin• Women who have had gestational diabetes during previouspregnancies.Women who have had gestational diabetes are at increased risk of developing type 2diabetes. It is strongly recommended to have a follow up Oral Glucose Tolerance Test 6-8weeks after the baby is born, then every 1-2 years.16

Fa’ahinga suka kehekehe – hoko atuSuka Lolotonga Feitamá‘Oku hoko ‘a e fa’ahinga suka ko ‘ení ‘i he taimi feitamá pea fa’a pulialeva ia hili hono fā’ele’i ‘a e pēpē.Lolotonga ‘o e feitamá, ‘oku hanga ‘e he fonuá ‘o ngaohi ‘a e ngaahihormones ke tokoni ki he tupu mo e fakalaka kimu’a ‘a e pēpē.‘Oku toe hanga ‘e he ngaahi hormones ko ‘ení ‘o fakafe’atūngia’i ‘a engāue e ‘inisulini ‘ae fa’é. Ko e me’a leva ‘e hokό, ko hono feima’u ‘a e‘inisuliní ke liunga ua pē tolu ‘i he fiema’u totonu ‘a e sinό lolotonga‘o e feitamá. Kapau ‘e ‘ikai lava ‘e he sinό ‘o fakatupu ha ‘inisulinife’unga mo e fiema’u makehe ko ‘ení, ‘e tupu leva ‘a e suká lolotonga‘a e feitamá.‘Oku fai ‘a e sivi suka lolotonga feitamá ofiofi ki he uike 24 ki he28 ‘o e feitamá. ‘E toe lava ke hoko ‘a e suká lolotonga feitamá ‘i hefeitama hoko maí.Ka kei ma’olunga ‘a e tu’unga ‘o e kulūkousi (suka)‘i he totό ‘i he tu’unga ‘oku totonu ke ‘i aí ‘eala fakatupu ha ngaahi pēpē ‘oku lalahi ange, pea ‘e faingata’a hono fāele’i maí. ‘E lava foki kefakalahi ‘a e tu’unga fakatu’utāmaki ki he pēpē ke ne ma’u ‘a e suká ‘amui ange.Ko e hā ‘a e me’a te ke faí kapau kuo sivi fakatoketā koe ‘o ma’u ‘oku puke ‘i he sukálolotonga feitamá?‘Oku mahu’inga ke ke sio ki ha tokotaha fakahinohino suka, tokotaha tokoni fakafuofua kai,endocrinologist (toketā taukei ki he hormones) mo e toketā taukei feitamá.‘Oku kau ‘i he polokalama leva’í ‘a e kai fakamo;ui lelei ‘a e fa’é, fakamālohisino fakafe’unga mohono siofi ma’u pē ‘a e tu’unga ‘o e kulūkousí ‘i he totό.‘Oku lelei kapau ‘e toutou fai ha fanga ki’i kai lolotonga e ‘ahό ‘a ia ‘e fakamo’ui lelei kiate koemo e pēpē, ‘o ‘ikai ko ha kai lalahi ‘e tolu. ‘E tokoni ‘eni ki hono feau ‘a e fiema’u ‘inisulini mei he‘atepilí.Ko e tu’unga fakatu’utāmaki lahi taha ‘e ala fakatupu ai ‘a e suka lolotonga feitamá ko e:• Kakai fefine ‘oku laka honau ta’u motu’á ‘i he 30• Kakai fefine ‘oku ‘i ai e hisitōlia ‘o e suka fa’ahinga 2 ‘i honau fāmilí• Kakai fefine sino mamafa• Kakai fefine tupu’i ‘Apolisinale pē ‘Out Motu Torres Strait• Ni’ihi ‘o e ngaahi matakali, tautefito ki he kakai ‘o e ‘Otu Motu Pasifikí, kakai mei hekonitinēniti si’i ‘o ‘Initiá mo e kakai tupu’i ‘Esiá• Kakai fefine na’a nau ma’u ‘a e suka lolotonga feitamá ‘i he’enau ngaahi feitama kimu’á.‘Oku lahi ange ‘a e tu’unga fakatu’utāmaki ‘oku ‘i ai ‘a e kakai fefine na’a nau suka lolotongafeitamá ke nau ma’u ‘a e suka fa’ahinga 2. ‘Oku fai ‘a e tapou mālohi heni ke fai ha Muiaki Sivi‘i he Ngutú‘o e Tu’unga Matu’uaki ‘o e Kulūkousí hili ha uike ‘e 6-8 ‘o hono fā’ele’i ‘a e pēpē, peahoko atu fakata’u 1-2.17

3Risk FactorsRisk factors for developing type 2 diabetes include:• Family history of diabetes• Overweight and over 45 years of age• Heart disease, heart attack or stroke• High blood pressure and over 45 years of age• Anyone over 55 years of age• High blood cholesterol• High blood glucose levels during pregnancy (gestational diabetes)• Higher than normal blood glucose levels• Aboriginal, Torres Strait Islander, Pacific Islanders, Indian sub-continent or Chinese culturalbackground• Women with Polycystic Ovarian Syndrome.The Australian Diabetes Risk Assessment Tool (AUSDRISK) should be used to identify your riskof developing type 2 diabetes. You can get this risk assessment tool from your doctor or fromwww.health.gov.au. Discuss your results with your doctor.Children and adolescents who are overweight, experiencing increased thirst, urinaryfrequency, tiredness and/or who may have a family history of diabetes should also betested for diabetes.One of the main risk factors for developing diabetes is a family (hereditary) link. This meansthat if a person has diabetes, there is an increased risk that other members of their family (e.g.brother, sister, children, grandchildren) will develop diabetes.Your family needs to be aware of the importance of a healthy lifestyle to delay or preventtype 2 diabetes. Regular physical activity and healthy food choices will help reduce the riskof developing type 2 diabetes.PREVENTION - THE TIME TO ACT IS NOWPeople at high risk of type 2 diabetes should be tested by their doctor every year to check forthe possible onset of diabetes.18

3Ngaahi Me’a Tu’unga Fakatu’utāmaki‘Oku kau ‘i he Ngaahi me’a ‘oku tu’unga fakatu’utāmaki ‘o ne fakatupu ‘a e suka fa’ahinga 2 ‘a e:• Hisitōlia ‘o e suká ‘i he fāmilí• sino mo laka e ta’u motu’á he 45• mahaki’ia ‘a e mafú, mahaki mafu pē pā kālava• toto ma’olunga pea laka hake ‘a e ta’u motu’á ‘i he 45• taha pē ‘oku laka hake ‘a e ta’u motu’á ‘i he 55• ma’olunga ‘a e cholesterol he totό• ma’olunga ‘a e tu’unga ‘o e kulūkousí ‘i he totό lolotonga e feitamá (suka lolotonga feitamá)• ma’olunga ange he tu’unga totonú ‘a e tu’unga ‘o e kulūkousí he totό• Kakai mei he ngaahi tupu’anga ‘Apolisinalé, ‘Otu Motu Torres Strait, ‘Otu Motu Pasifikí, fonualahi ‘o ‘Initiá pē Siainá• Kakai fefine ‘oku nau ma’u ‘a e Polycystic Ovarian Syndrome.‘Oku totonu ke ngāue’aki ‘a e nāunau founga sivi Australian Diabetes Risk Assessment Tool(AUSDRISK) ke ne ‘omai ‘a e founga ke ‘ilo’i ai pē ‘oku ke ‘i he tu’unga fakatu’utāmaki ke tupu‘iate ko e ‘a e suka fa’ahinga 2. Te ke lava ‘o ma’u ‘a e nāunau founga sivi ni mei ho’o toketā pēmei he www.health.gov.au. Talanoa mo ho’o toketā ki he ola ‘o ho’o siví.‘Oku totonu ke sivi suka ‘a e fānau iiki mo e fānau lalahi ‘oku nau sinό, lahi ange ‘enauongo’i fieinuá, toutou tu’uofi, hela’ia pea/mo ‘i ai ‘a e hisitōlia ‘o e suka ‘i he fāmilí.Ko e taha ‘o e ngaahi me’a tu’unga fakatu’utāmaki ki hono fakatupu ‘a e suká ko e fetu’utakifakafāmili (tukufakaholo). ‘Oku ‘uhinga ‘eni ka ‘i ai ha taha ‘oku ma’u ‘e he suká, ‘e lahi ange ‘ae tu’unga fakatu’utāmaki ‘e ala ma’u ‘e he ngaahi mēmipa kehe ‘o honau fāmilí (hangē ko etokoua, tuofefine, fānau, makapuna) ‘e he suká.‘Oku totonu ke ‘ilo ‘e ho’o fāmilí ‘a e mahu’inga ‘o e filinga ki he mo’ui leleí ke toloi pē ta’ofi ‘a e hokomai ‘a e suka fa’ahinga 2. ‘E tokoni ki hono holoki ‘a e tu’unga fakatu’utāmaki ‘o e suká fa’ahinga 2kapau ‘e tauhi ke longomo’ui ma’u pē ‘a e sinό mo fili ‘a e ngaahi me’akai fakamo’ui lelei.FAKAALAALA – KO E TAIMI ‘ENI KE FAI ‘A E NGĀUE KI AIKo e kakai ‘oku nau tu’u ‘i he tu’unga fakatu’utāmaki ma’olunga ke nau ma’u ‘a e suka fa’ahinga2 ‘oku totonu ke sivi fakata’u kinautolu ke vakai’i na’a ala ma’u kinautolu ‘e he suká.19

4The Diabetes Health Care TeamDiabetes is a lifelong condition. Your health care team is available to support, advise and answeryour questions.The most important member of this team is you!You are the one who will be at the centre of your diabetes management. Your family, friendsand co-workers might also be part of your team.The Diabetes Health Care Team includes:• Your family doctor who looks after your diabetes and refers you to other healthprofessionals as needed. Your family doctor is responsible for organising your diabetes tests.• An Endocrinologist is a specialist in diabetes. Many people with type 1 diabetes see anendocrinologist. People with type 2 diabetes may see an endocrinologist if they are havingproblems with their diabetes management or wheninsulin therapy is needed.• A Diabetes Educator is usually a registered nursewho has done special training in diabetes. Educatorscan assist with teaching you about diabetes inmany of the important areas such as blood glucosemonitoring, medications, insulin, sick days, travel andstress.• A Dietitian can answer questions about healthyeating for you and your family.• An Exercise Physiologist can help to develop aphysical activity plan suitable for you - regardless ofage, ability or disability.• An Optometrist will do a diabetes eye check anda vision check. Some people with diabetes needto see an Ophthalmologist, a doctor with specialtraining in diseases and problems with the eye.• A Podiatrist is a health professional who deals with the feet. Many podiatrists have advancedtraining in caring for the ‘diabetic foot’.• A Dentist will check your teeth and gums.Sometimes people with diabetes have trouble coping with the day to day burden of theirdisease. Social workers and psychologists can help in this area. Your family doctor ordiabetes educator can often refer you to these services.Other specialists are sometimes needed. Children and adolescents with diabetes should seea paediatric endocrinologist or a paediatrician.Women with diabetes who are planning a pregnancy, who are pregnant or womenwho develop gestational diabetes should see an obstetrician and endocrinologist. Ifcomplications of diabetes are present, referral to other health professionals may be required.Pharmacists are also very important in your diabetes management. They have specialknowledge of how medicines work and which medications may interact with each other.Ask your doctor or diabetes health care team about any structured diabetes educationclasses/programs in your area. Diabetes education programs, either individual or as part ofa group, will help you set some healthy lifestyle goals and assist you with managing yourdiabetes.20

4Ko e Timi Tauhi Mo’ui Leleí ‘o e Suká‘Oku hoko ‘a e suká ko ha mahaki ‘oku tolonga ki he ngata e mo’uí. ‘Oku ‘atā ‘a ho’o timi tauhi mo’ui leleí ke tokoni,fale’i mo tali ha’o ngaahi fehu’i. Ko e mēmipa mahu’inga taha ‘i he timí ko koe!Ko koe pē ‘oku ‘i he senitā ‘o hono leva’i lelei ho suká. ‘E ala kau atu ki ho timí ‘a ho fāmilí, kaungāme’á mo ho kaungāngāué.‘Oku kau ‘i he Timi Tauhi Mo’ui Lelei ‘o e Suká ‘a:• Toketā fakafāmilí ‘a ia ‘oku ne tokanga’i ho suká mo ne fakahoko koe ki ha kau mataotao kehe ‘o ka fiema’u. Ko efatongia ia ‘a ho’o toketā fakafāmilí ke ne alea’i ho’o ngaahi sivi suká.• Ko ha ‘Enitōkilonisisi (Endocrinologist) ko e mataotao ia ‘i he mahaki suká. ‘Oku tokolahi ‘a e kakai ‘oku nau ma’u ‘a esuká fa’ahinga 1 ‘oku nau ō ‘o sio ki ha ‘Enitōkilonisisi. ‘E lava ‘a e kakai suka fa’ahinga 2 ke nau sio ki ha ‘enitōkilonisisikapau ‘oku ‘i ai ha’anau ngaahi palopalema fekau’aki mo hono pule’i honau suká pē ka fiema’u ha palani faito’o‘inisulini.•‘Oku fa’a hoko ha neesi lesisita kuo ‘osi fai ‘ene ako makehe ki hemahaki suká ko ha Faiako Fakahinohino Suka. ‘E ala tokoni ‘a ekau faiako ni ki hono ako’i kiate koe ‘a e ngaahi me’a mahu’ingakehekehe hangē ko hono siofi ‘a e kulūkousí ‘i he totό, ngaahifaito’ό, ‘inisuliní, ngaahi ‘aho puké, fe’alu’akí mo e hoha’á.•‘E ala tali ‘e ha Tokotaha Fale’i Fakafuofua Kai ‘a e ngaahi fehu’ifekau’aki mo e kai fakamo’ui lelei kiate koe mo ho fāmilí.•‘E ala tokoni ha Taukei Fakamālohisino (Physiologist) ki honofokotu’u ha palani fe’unga mo koe ki he ngaungaue ‘a e sinό –tatau aipē pe ko e hā ho ta’u motu’á, me’a ‘oku ke malava ‘o faí pēfaingatā’ia fakasino.•‘E fai ‘e ha Mataotao Mata (Optometrist) ‘a e sivi mata mo e siofekau’aki mo e suká. Ko e kakai suka ‘e ni’ihi ‘e fiema’u ke nau sioki ha Taukei ‘Ofalomosisi (Ophthalmologist), ko ha toketā ‘oku nemataotao ‘i he ako ki he ngaahi mahaki mo e palopalema ‘o ematá.•Ko ha Potaiatulisi (Podiatrist) ‘a e tokotaha taukei ‘i he mo’ui leleí‘oku ne tokanga’i ‘a e va’é. ‘Oku lahi ‘a e kau potaiatulisi ‘oku nau‘osi ma’u ‘a e taukei ako makehe ki hono tokanga’i ‘a e ‘va’e suká’.•‘E sivi ‘e ha Tokotaha Ta’akinifo (Dentist) ho nifό.‘Oku fa’a faingatā’ia ‘a e kakai ‘oku nau ma’u ‘a e suká ‘i he’enau fetakai faka’aho mo e mafatukituki ‘o honaumahakí. ‘E ala tokoni ‘i he tafa’aki ko ‘ení ‘a e kau Ngāue ki he sōsialé (Social workers) mo e kau Mataotao ki he‘atamaí. ‘E ala fakahoko koe ki he ngaahi ngāue ni ‘e ho’o toketā fakafāmilí pē faiako suká.‘Oku fa’a fiema’u he taimi ‘e ni’ihi ha kau mataotao kehe. ‘Oku totonu ke sio ‘a e fānau iikí mo e tamaiki lalahíki ha toketā mataotao ki he suka ‘i he fānaú (paediatric endocrinologist) pē ha toketā mataotao ki he fānaú(paediatrician).‘Oku totonu ke sio ‘a e kakai fefine suka ‘oku nau palani ke nau feitamá, ‘a kinautolu ‘oku feitamá pē kakai fefine ‘okuma’u ‘e he suka lolotonga feitamá ki he toketā mataotao ki he feitamá (obstetrician) mo e ‘enitōkilonisisí. Kapau ‘ehoko ha ngaahi faingata’a felāve’i mo e suká, ‘e ala ‘ave kinautulu ki ha kau mataotao fakamo’ui lelei kehe.‘Oku mahu’inga foki mo e kau Hu’ivaí (Pharmacists) ‘i he polokalama pule’i ‘o ho suká. ‘Oku nau ma’u ‘e kinautolu‘a e ‘ilo makehe ki he anga ‘o e ngāue ‘a e ngaahi faito’ό mo e anga ‘o e fengāue’aki ‘a e ngaahi faito’ό kehekehé.‘Eke ki ho toketā pē ki he timi tauhi mo’ui lelei ‘o e suká pē ‘oku ‘i ai ha fokotu’utu’u pau ‘o ha ngaahi kalasi/polokalama ako mo fakahinohino ki he suká. ‘E tokoni ‘a e ngaahi polokalama ako ki he suká, tatau pē ‘efakafo’ituitui pē ha konga ‘o ha kulupu, ki hono fokotu’u ha ngaahi taumu’a filingamo’ui lelei mo tokoni’i koe kihono pule’i ho suká.21

5Annual Cycle of CareWhat regular health checks are recommended?Regular health checks help to reduce your risk ofdeveloping diabetes complications.The recommended health checks are:What needs to be checked? How often? Who do you need to see?Blood pressure Every visit to your doctor Your family doctorWeight, height and waist circumferenceBody Mass Index (BMI): if required – thishelps determine if you have a problemwith your weightFeetKidneys: a blood and urine test, to makesure your kidneys are working wellHbA1c: this blood test shows youraverage blood glucose level over thepast 2 - 3 monthsLipids: blood fatsEyesEvery six months/ moreoften if requiredDaily self check andSix monthly healthprofessional checkupsOnce a year/ more often ifrequiredAt least six monthly or moreoften if not on targetOnce a year/ more often ifrequiredAt diagnosis and at leastevery two years/ moreoften if requiredYour family doctorPodiatrist or family doctorYour family doctorYour family doctorFamily doctorOptometrist / OphthalmologistHealthy eating plan Once a year DietitianPhysical activityMedicationOnce a yearOnce a year/ more often ifrequiredYour family doctor / exercisephysiologistYour family doctorReview self care education Once a year Diabetes educatorReview smoking status Once a year Your family doctorYour family doctor, with the help of your health care team, should develop a care planto manage your diabetes. This will allow you to access additional Medicare services forpeople with chronic conditions.22

5Ko e Siakale ‘o e Tauhi Fakata’úKo e hā ‘a e ngaahi sivi mo’ui lelei tukupau ‘oku taauke faí?‘Oku tokoni ‘a e toutou sivi mo’ui leleí ki hono fakasi’isi’i etupu ‘a e ngaahi faingata’a fakamahaki kehe fekau’aki mo e‘o e suká.Ko e ngaahi sivi mo’ui lelei ‘oku taau ke faí ko e:Ko e hā e me’a ke siví?Sivi e fua e totόFua mamafa, ma’olunga mo e lōloatakatakai ho kongalotόFua ‘o e Body Mass Index-(BMI): ‘o kafiema’u – ‘oku tokoni ‘eni kapau ‘oku ‘i aiha palopalema mo ho fua mamafáVa’eOngo Kofuuá: ‘ai ha sivi toto mo e sivitu’uofi, ke fakapapau’i ‘oku ngāue lelei ‘a eongo kofuuáHbA1c: ‘oku hanga ‘e he sivi toto ko ‘ení‘o fua ‘a e ’avalisi ‘o e tu’unga e kulūkousí‘i ho totό’i he māhina ‘e 2-3 kuo ‘osíLipiti: ngako ‘i he totόMatáTu’ofiha?‘I he ‘a’ahi kotoa pē ki hotoketāFakamāhina ono/lahi ange‘o ka fiema’uSivi faka’aho ‘e kita mo e sivimo’ui lelei fakamāhina onomo e kau taukeíTu’o taha he ta’u/lahi ange ‘oka fiema’uFeinga ke fakamāhina ‘e onopē tu’olahi ange kapau ‘oku‘ikai ‘i he tu’unga totonuTu’otaha he ta’u/ lahi ange ‘oka fiema’u‘I he taimi sivi fakatoketā ‘o‘ilo ai e mahakí pea feingake fakata’u ua/lahi ange kafiema’uKo hai ‘oku tonu ke ke sioki aí?Ho toketā fakafāmilíHo toketā fakafāmilíToketā Mataotao Va’é pē toketāfakafāmilíHo toketā fakafāmilíHo toketā fakafāmilíHo toketā fakafāmilíHa Mataotao Mata (Optometrist)/Taukei ‘Ofalomosisi(Ophthalmologist)Palani kai fakamo’ui lelei Tu’o taha he ta’u Tokotaha Fale’i Fakafuofua KaiNgaungaue ‘a e sinόFaito’oToe vakai’i ‘a e ako ki hono tokanga’i ‘ekita kitáTu’o taha he ta’uTu’o taha he ta’u/lahi ange ‘oka fiema’uTu’o taha he ta’uHo toketā fakafāmilí/ TaukeiFakamālohisino (Physiologist)Ho toketā fakafāmilíFaiako sukaToe vakai’i ‘a e tu’unga ‘o e ifí Tu’o taha he ta’u Ho toketā fakafāmilí‘Oku tonu ke hanga ‘e ho’o toketā fakafāmilí, ‘i he tokoni ki ai ‘a ho’o, timi tauhi mo’ui leleí,‘o fokotu’u ‘a e palani tauhi ke ne pule’i ‘a ho suká. ‘E fakangofua koe ke ke ma’u ‘a e ngaahitokoni fakalahi ‘a e Medicare fekau’aki mo e kakai ‘oku nau mo’ua ‘i he ngaahi mahaki tauhi.23

6Healthy eating for diabetesEating does more than just provide food and building materials for the body. Eating is apleasurable and social experience.Diabetes should not stop you from enjoying food and eating with friends and family. Youcan still enjoy special occasions such as family, social, school and religious festivals. Tell yourdietitian, diabetes educator and doctor what you eat and when. Your food and diabetesmedications can be adapted to suit your lifestyle and normal family routine. However youmay need to make changes to your eating habits to keep your diabetes under control andstay healthy.Why is healthy eating important?A healthy diet is one of the most important parts of diabetes management.Eating well can help to manage your blood glucose (sugar) levels, cholesterol and bloodpressure. Eating well can also help you to maintain a healthy body weight. Being overweightmakes it harder to manage your diabetes. It is therefore important to have a healthy diet tohelp you lose excess weight and improve your diabetes management.It is important that any dietary advice is tailored to your needs. That is where your dietitian ishelpful.24

6Ko e Kai Fakamo’ui lelei ma’ae Suká‘Oku ‘ikai ngata pē ‘a e kaí ‘i hono ‘ave ‘a e me’akaí ki he sinό mo hono langa haké. ‘Oku ma’u ‘ae ifό ‘i he kaí pea ko e taha ia ‘o e me’a ‘oku fai ‘i he fakafeohi fakasōsialé.‘Oku ‘ikai totonu ke ta’ofi ‘e he suká ‘a e fakamānako ‘o e kaí mo e kai fakataha mo e ngaahikaungāme’á mo e fāmilí. ‘Oku lava pē ke ke kei fiefia ‘i ho’o kau ki he ngaahi fakataha makehehangē ko e ngaahi kātoanga fakafāmilí, fakasōsialé, fakaakό mo e fakalotú. Tala ki ho tokotahafale’i fakafuofua kaí, faiako fakahinohino suká mo e toketā ‘a e ngaahi me’akai ‘oku ke kaí mo etaimi ‘oku ke kai aí.‘E lava ke liliu ‘a ho’o me’akaí mo e ngaahi faito’o suká ke fe’unga mo ho filinga mo’uí pea mo enofo fakafāmili faka’ahό. Kā ‘e lava ke fai ha ngaahi liliu ki ho’o kaí angamahení ke leva’i lelei hosuká mo ke kei mo’ui lelei foki.Ko e hā ‘oku mahu’inga ai ‘a e kai fakamo’ui leleí?Ko e taha ‘o e ngaahi me’a mahu’inga ki hono pule’i lelei ‘o e suká ko e fai ‘a e to’onga kaifakamo’ui lelei.‘Oku tokoni ‘a e kai fakapotopotό ki hono leva’i ‘a e tu’unga ‘o e kulūkousí (suka) ‘i he totό,cholesterol mo e fua e totό. ‘E toe tokoni ‘a e kai fakapotopotό ki hono tauhi ke tu’unga lelei ‘ae fua mamafa ‘o e sinό.‘E faingata’a ange hono pule’i ‘a e suka ‘o ka sino. Ko ia ai ‘oku mahu’inga ke ke tauhi e kaífakamo’ui lelei ke tokoni ki ho’o fakaholό mo fakalakalaka ‘a hono leva’i ho suká.‘Oku mahu’inga ke fakafua ‘a e fale’i kai kotoa pē ke fakafe’unga mo ho ngaahi fiema’ú. Ko etaimi ‘eni ‘e tokoni ai ‘a e tokotaha fale’i fakafuofua kaí.25

Healthy eating for diabetes - continuedWhat is healthy eating for diabetes?Healthy eating for diabetes is the same as healthy eating for everyone. A healthy eatingpattern encourages:• High fibre cereals including wholegrain breakfast cereals, wholemeal or grainy breads,wholemeal pasta and brown rice• Two serves of fruit and five or more serves of vegetables every day (e.g. banana, paw paw,mangoes, breadfruit, pineapples, kumara, yam and taro). Include legumes such as bakedbeans, kidney beans, chick peas, split peas and lentils• One to two serves of lean meat, fish, skinless poultry or alternatives each day (e.g. fresh fish,tin fish and sashimi). Alternatives include legumes, eggs, nuts and seeds• Dairy foods (e.g. milk, cheese and yoghurt) that are low fat or skim for everyone over theage of two. Soy products fortified with calcium are a good alternative for those who cannothave dairy• Limit saturated fat (e.g. coconut cream or milk based food and drinks, fatty mince, cornedbeef, pork crackling, sausages, mutton flaps, turkey tails, butter, cream and pastries)• Have a low–moderate fat intake• Avoid adding salt to food. Choose low salt or reduced salt foods. Limit salty foods such assoy sauce, tinned corned beef, povi masima (salted beef brisket), packet noodles, takeawayfoods and chips• Eat only moderate amounts of sugars and limit or avoid foods high in added sugars (e.g.lollies, sweet pies, puddings, ice cream, fausi (baked taro or pumpkin with caramelizedcoconut cream), fruit juices and soft drinks)• Drink plenty of water• If you drink alcohol, limit your intake to 2 standard drinks a day. It will also be a good ideato include alcohol free days each week.How can I keep my blood glucose (sugar) levels in the healthy range?It is very important that people with diabetes aim to keep their blood glucose levels in targetrange with regular physical activity, healthy eating and appropriate treatment (medicationsand/or insulin if required). (Refer to Chapter 13 on Blood Glucose Monitoring.You can help to do this by spreading your food intake out over the day, not overdoing yourserve sizes and choosing mostly high fibre, low fat and lower glycemic index carbohydrates.Regular reviews with your dietitian are important to help you get the balance right betweenyour blood glucose levels, the food you eat, exercise and your diabetes medication, if youtake them. A dietitian may suggest you make changes to the types of food you eat and howmuch you eat to help keep you healthy. Your dietitian will try to work within the foods andcooking methods that you traditionally use.26

Kai fakamo’uilelei ma’a suká – hoko atuKo e hā ‘a e kai fakamo’ui lelei ma’ae suká‘Oku tatau ‘a e kai fakamo’ui lelei ma’ae suká mo e kai fakamo’ui lelei ma’ae tokotaha kotoa pē.‘Oku faka’ai’ai ‘e he sīpinga kai leleí ‘a e:• Ngaahi me’akai fakapongipongi (cereals) fonu ‘i he faipa kau ai ‘a e cereals fakapongipongingaohi mei he tenga’i uité, mā momosi mei he uité pē mā tenga’i uite, pasta momosi meihe uité mo e laise lanu melomelo• Hikinga fo’i’akau ‘e ua mo e hikinga ‘e nima pē lahi ange ‘o e vesitapolo ‘i he ‘aho kotoa(hangē ko e siaine, lesi, mango, mei, fainā, kumala, ‘ufi mo e talo)Fakakau ‘a e fa’ahinga tenga’i ‘akau legumes hangē ko e piini ta’o, piini fuo-kidney, piisichick,piisi – split mo e lentils (tenga’i ‘akau kai)• Hikinga ‘e ua ‘o e kakano’i manu (‘ikai ha ngako), ika, moa (‘ikai ha kili) pē ha ngaahi kikikehe he ‘aho kotoa (hangē ko e ika fo’ou, kapaika mo e sashimi). Fakafetongi’aki ‘a elegumes, fua’imoa, nati mo e tenga’i ‘akau• Ngaahi me’akai dairy (hangē ko e hu’akau, siisi mo e yoghurt) ‘oku ma’ulalo ‘a e ngakό pē‘ikai ha ngako ma’ae tokotaha kotoa ‘oku lahi hake he ta’u uá. ‘Oku lelei ki he ni’ihi ‘oku ‘ikaike nau kai e me’akai dairy ke fakafetongi ‘aki ‘a e ngaahi me’akai ngaohi mei he soy ‘a ia kuotānaki ki ai ‘a e calcium• Fakasi’isi’i e me’akai fonu ngutungutu ‘i he ngakό (hangē ko e kilimi mei he niu taufua pēme’akai pē me’ainu ngaohi mei he hu’akau, pulu kilisi ngako, pulu fakamāsima, tu’a’i puaka,sōsisi, kapakau’i sipi, mui’i pīpī, pata, kilimi mo e me’akai ngaohi mei he pastries)• Kai ‘a e me’akai ‘oku ma’ulalo-talotoloto ‘a e ngakό• Faka’ehi’ehi mei hono ngāue’aki ‘a e māsimá ‘i he me’akaí. Fili ‘a e ngaahi me’akai ‘oku si’isi’i ‘ae māsimá pē me’akai ‘oku holoki ‘a e māsimá. Faka’ehi’ehi hono ngāue’aki ‘a e ngaahi me’akaimāsimá hangē ko e soy sauce, kapapulu, povi māsima (pulu māsima), kofukofu nūtolo,me’akai takeaway mo e chips• Kai fakafuofua pē ‘a e ngaahi me’akai suká pea fakangatangata pē faka’ehi’ehi mei hengaahi me’akai kuo tānaki ki ai ‘a e suká (hangē ko e lolé, ngaahi pai melie, puteni, ‘aisi kilimi,fausi (talo pē hina ta’o ‘aki ‘a e niu lolo’i), ngaahi inu melie (juice mo e soft drinks)• Inu ‘a e vaí ke lahi• Kapau ‘oku ke inu ‘olokaholo, fakangata ho’o inú ki ha ipu fua fe’unga ‘e 2 ‘i he ‘aho. ‘E kaulelei kapau te ke fakakau ha ngaahi ‘aho tuku inu ‘olokaholo he uike kotoa.‘E anga fēfē ‘eku tauhi ‘a e tu’unga ‘o e kulūkousi (suka)‘i hoku totό ‘i he tu’unga ‘okufakamo’ui leleí?‘Oku mahu’inga ‘aupito ke tauhi ‘e he kakai suká ‘a e tu’unga ‘o e kulūkousi ‘i honau totό kenofo ‘i he feitu’u ‘oku tāketi’i ‘i he’enau fa’a ngaungaue, kai fakamo’ui lelei pea mo tauhi ‘a engaahi faito’o pau (ngaahi fo’i’akau pea/pē ‘inisulini ‘o ka fiema’u).Te ke ala tokoni kapau te ke vahevahe taimi ki ho’o kaí ‘i he ‘aho, ‘o ‘oua tōtu’a ‘a e lahi e me’akaí‘i ha houa kai, pea fili ‘a e me’akai ‘oku lahi ‘a e faipa (fibre), ma’ulalo e ngakό mo e me’akaisuka-sitaasi (carbohydrates) ‘oku ma’ulalo ‘a e fua ‘o e sitaasí/suka moe anga ‘ene uesia ‘a ekulūkousi ‘i he totό (lower glycemic index).‘Oku mahu’inga ‘a e toutotu ‘a’ahi ki ho’o tokotaha fale’i fakafuofua kaí ke ne tokoni’ikoe ke tauhi ke palanisi totonu ‘a e tu’unga ‘o e kulūkousí ‘i ho totό, me’akai ‘oku ke kaí,fakamālohisinό pea mo ho’o faito’o suká, ‘o kapau ‘oku ke folo.‘E ala fokotu’u atu ‘e ha tokotahafale’i fakafuofua kaí ke liliu ‘a e fa’ahinga me’akai ‘oku kaí mo e lahi ‘o e me’akai ‘oku ke kaíke tokoni ke tauhi koe ke ke mo’ui lelei. ‘E feinga ho’o tokotaha fale’i fakafuofua kaí ke nengāue’aki ‘a e ngaahi me’akai mo e founga ngaohi kai tuktufakaholo ‘oku ke anga ki aí.27

7What’s in food?You may have heard about:• Carbohydrates• Fibre• Protein• Fat• Vitamins and Minerals.These are called nutrients and they help your body to work properly and stay healthy. A nutrientis a substance found in food. You can find more information on each of these nutrients below.CarbohydratesCarbohydrates are the best energy source for your body. When they are eaten theybreakdown to form glucose in the bloodstream. Eating regular meals and spreading yourcarbohydrate foods evenly over the day can help to maintain your energy levels withoutcausing blood glucose levels to go too high or too low.Carbohydrate foods include:• Cereals and breads (e.g. scones, all types of bread, crepes, rice including sweetened rice,sago, noodles and pasta)• Milk and yoghurt (e.g. sweetened condensed milk)• Fruit (e.g. banana, mango, pineapple, paw paw, papaya, watermelons and breadfruit).• Starchy vegetables and legumes (e.g. taro, potatoes, sweet potatoes, kumara, cassava,manioke (tapioca), yam and corn).• Sugar and sugary foods (e.g. puddings, tapioca puddings, sweetened rice, sweet pies, otai(watermelon & pineapple drink), coconut buns and tea with more than 3 spoons of sugar).Most of these foods, except sugar and sugary foods, also provide other important nutrientsto help keep you healthy. It is important to include these foods every day.Eating a large serve of carbohydrate (e.g. a large plate of pasta or rice served with potatoesand dahl) may cause your blood glucose levels to rise too high. Also, eating too much foodall the time, even if it is healthy food, will cause you to put on weight. Being overweightmakes it harder to manage your blood glucose levels.As everyone is different, talk to your dietitian about the amount of carbohydrate food youneed to eat.Sometimes testing your blood glucose level two hours after a meal can help you to work outif you ate too much carbohydrate at a meal. If this happens a lot speak to your dietitian ordiabetes educator who can give you advice on what to do. Cutting down carbohydrates isnot always the answer.Glycemic IndexAll carbohydrate foods will breakdown to form glucose. Some carbohydrates break down toglucose fast and some break down slowly. The Glycemic Index (GI) is a way of measuring howfast or slow a carbohydrate food affects blood glucose levels.Low glycemic index foods raise your blood glucose levels more slowly than high glycemicindex foods. Eating mostly low glycemic index foods may help people with diabetes to reduce28

7Ko e hā ‘a e ngaahi me’a ‘oku ‘i he me’akaí?Mahalo kuo ke ‘osi fanongo ki he ngaahi me’a fekau’aki mo e:• Ngaahi sitaasí• Faipa• Protein• Ngako• Vaitamini mo e Minerals.‘Oku ui e ngaahi me’a ni ko e nutrients pea ‘oku nau tokoni’i ho sinό ke ngāue lelei mo tauhi kemo’ui lelei. Ko e nutrient ko ha me’a ia ‘oku ma’u ‘i he me’akaí. Te ke lava ‘o toe ma’u ha ngaahifakamatala ‘o lalo fekau’aki mo e nutrient takitaha.Ngaahi carbohydrates‘Oku ‘i he ngaahi me’akai carbohydrates ‘a e ma’u’anga ivi lahi taha ma’a ho sinό. ‘I he taimi ‘okukai ai iá’oku veteki ia ‘o fakatupu mei ai ‘a e kulūkousi ‘i he halanga totό. ‘Oku tokoni hono tauhi ‘iha tu’unga lelei ho iví ‘o ka ke tauhi ho’o taimi kaí pea vahevahe tatau ho’o kai e ngaahi me’akaicarbohydrates ‘i he ‘aho ke ‘oua na’a fu’u tō lalo pē tō ‘olunga ‘a e tu’unga kulūkousi ‘i ho totό.‘Oku kau ‘i he me’akai carbohydrates ‘a e:• Me’akai pongipongi ko e cereals mo e mā (hangē ko e sekoni, mā kehekehe, keke vai, laisekau ai ‘a e laisa fakamelie, sago, nūtolo mo e pasta)• Hu’akau mo e yoghurt (hangē ko e hu’akau melie)• Fua’i’akau (hangē ko e siaine, mango, fainā, lesi, meleni mo e mei).• Vesitapolo sitaasi mo e legumes (hangē ko e talo, pateta, kumala, manioke (tapioca), ‘ufi moe koane).• Suka mo e me’akai suka (hangē ko e puteni, puteni manioke, laise fakasuka, pai melie, ‘otai(inu meleni & fainā), pani ngaohi mei he niu mo e tī fakasuka’aki ‘o laka hake he sēpuni ‘e 3).Ko e lahi ‘o e ngaahi me’akai ni, tukukehe ‘a e me’akai suka mo melié, ‘oku nau ‘oatu ‘a e ngaahima’u’anga ivi mahu’inga ke tauhi koe ke ke mo’ui lelei. ‘Oku mahu’inga ke ke fakakau ‘a engaahi me’akai ni ‘i he ‘aho kotoa.‘O ka ke kai ha hikinga lahi ‘o e me’akai carbohydrate (hangē ko ha peleti pasta lahi pē laise‘oku ‘omai ‘aki ‘a e pateta mo e dahl) ‘e ala hiki ‘o ma’olunga ‘a e tu’unga kulūkousi ‘i ho totό. Pea‘oku kau ai mo efa’a kai lahí, ‘o tatau ai pē pe ko ha me’akai fakamo’ui lelei, ‘e fakasino kiate koe.‘Oku faingata’a ange ke te tauhi ke lelei ‘a e tu’unga kulūkousi ho totό ‘o ka ke fu’u sino.Koe’uhi ‘oku kehe ‘a e tokotaha kotoa, talanoa mo ho’o tokotaha fale’i fakafuofua kaí fekau’akimo e lahi ‘o e me’akai carbohydare ‘oku totonu ke ke kaí.‘Oku fa’a hanga ‘e he sivi ‘o e tu’unga e kulūkousi ho totό ‘i ha ‘osi ha houa ‘e ua mei ho’o kaí ‘otokoni ki hono ‘ilo’i pē na’e lahi ho’o kai ‘a e me’akai suka-sitaasí ‘i ha houa kai. Kapau ‘oku hokotātu’olahi ‘a e me’a ni talanoa ki ho’o tokotaha fale’i fakafuofua kaí pē ki he faiako suká ke ‘oatuha fale’i ma’au ki he me’a ke faí. ‘Oku ‘ikai ko e talí pē ‘a e holoki ‘o e suka-sitaasí.Ko e Fua ‘o e sitaasí/suka mo e anga ‘ene uesia ‘a e kulūkousi ‘i he totό (GI)‘E veteki ‘a e ngaahi me’akai carbohydrates kotoa pē ‘o fakatupu ai ‘a e kulūkousí. ‘Oku ‘i ai ‘ae ngaahi carbohydrates ‘e ni’ihi ‘e vave ‘ene vete ‘o hoko ko e kulūkousí pea tuai e ni’ihi. ‘Okuhanga ‘e he Glycemic Index (GI) ‘o fua ‘a e vave pē tuai ‘a hono uesia ‘e ha me’akai carbohydrate‘a e tu’unga ‘o e kulūkousí ‘i he totό.29

Ko e hā ‘a e me’a ‘i he me’akaí – hoko atu‘Oku hanga ‘e he ngaahi me’akai ‘oku ma’ulalo e glycemic index ‘o fakatuai’i hono hiki hake ‘atu’unga ‘o e kulūkousí ‘i ho totό ‘o fakatatau ki he ngaahi me’akai ‘oku ma’olunga e glycemicindex. ‘E tokoni ki he kakai suká ‘o ka lahi ange ‘a e kai e me’akai ‘i he fa’ahinga ‘oku ma’ulaloe glycemic index ki hono holoki ‘o e tu’unga kulūkousi ‘i he totό, fakasi’isi’i e ngako’i totό mohiki hake ‘a e cholesterol fakamo’ui leleí. Te nau toe tokoni ke ke ongo’i mākona fuoloa ange‘o ala tokoni ki hono tokanga’i e tupu ho pāuní. ‘Oku kei mahu’inga pē ke ‘oua ‘e tōtu’a ‘a lahi eme’akai te ke kaí.‘Oku ‘ikai fakamo’ui lelei kotoa ‘a e me’akai ‘oku ma’ulalo e glycemic index. ‘Oku totonu ke ke keivakai’i pē ‘oku kau ‘i he ngaahi me’akai fakamo’ui lelei na’e lisi atu kimu’á. Feinga ke lahi angeho’o kai ‘a e me’akai ‘oku ma’olunga ‘a e faipā kae ma’ulalo e ngakό mo ma’ulalo e glycemicindex. ‘Oku lelei ka kamata fakakau e me’akai ‘oku ma’ulalo e glycemic index ‘i he houa kaikotoa.Ko e ngaahi me’akai fakamo’ui lelei ‘oku ma’ulalo e glycemic index ‘oku kau ai legumes (hangēko e piini ta’o, piisi ta’o mo e lentils), pasta, cereals ngaohi mei he mahoa’a melomelo (polisi),koane, hu’akau ‘oku si’isi’i e ngakό mo e yoghurt, ngaahi fua’i’akau lahi mo e ngaahi mā ngaohimā tenga’i uite ‘oku lahi ai e faipá.‘Oku fa’a kau ‘a e laisé ‘i he me’akai ‘oku ma’olunga ‘a e glycemic index tautefito ki he laisepikipikí/laise fatú mo e laise sesimaní. Ka ‘oku ‘i ai ‘a e fa’ahinga laise ‘oku ma’ulalo ange ‘a eglycemic index. ‘Oku kau ai ‘a e laise Basmati mo e Doongara.Kae fēfē ‘a e Suká?Ko e carbohydrate mo e suká. ‘E ‘ikai uesia ho suká ‘o ka to’oto’o si’isi’i pē ho’o kaí, hangē ko esēpuni tī suka ‘e 1-2 ‘i ho ipu tī pē ha siamu ‘oku vali manifi ‘i ho’o tousí.‘Oku fakamo’ui lelei ‘a e ngaahi me’akai ‘e ni’ihi ‘oku ‘i ai ‘a e suká. Hangē ko e fua’i’akaú mo ehu’akaú ‘oku ‘i ai fakanatula pē ‘a e suká. ‘Oku ‘i ai ‘a e ngaahi me’akai fakamo’ui lelei kekehe ‘okutānaki ki ai e suka si’isi’i pē (hangē ko e me’akai pongipongi ko e cereals ‘oku lahi ai ‘a e faipamo e yoghurts.Kā ko e kai pē inu lahi ‘a e ngaahi me’akai ‘oku ma’olunga ‘aupito ai ‘a e suká (hangē ko engaahi inu kasá, kōtiolo, inu fakalanú, sokoleti, hu’akau melie mo e hu’akau fakalanu) ‘e lavake ne ke hiki ‘o fu’u ma’olunga ‘a e tu’unga kulūkousi ho totό. ‘E lava ke fakasino. ‘E sai tahákapau ‘e kai fakasi’isi’i ‘a e fa’ahinga me’akai ko ‘ení. Fili ‘a e ngaahi inu kasa mo e kotiolo ‘okufakafuofua ai e suká ‘o ‘ikai fili e ngaahi me’a inu tukupaú.Kapau ‘oku ke ngāue’aki ha suka ‘i ho’o ngaohi me’akaí, fakakaukau ki he lahi ‘o e suka te kefakaiku ‘o kaí. Kapau ‘oku lahi ‘aupito ‘a e suka ‘i he me’akai ‘e ngaohí pea te ke kai ha hikingalahi ai, feinga’i ke fakasi’isi’i ‘a e lahi ‘o e suká, ‘ai ha’o hikinga ‘oku si’i ange pē fakafetongi ‘a esuká ‘aki ha me’a fakamelie kehe. Feinga ke fili ‘a e ngaahi me’akai te ke ngāue’akí ‘oku si’isi’i engakό (tautefito ki he me’akai fonu ngutungutu ‘i he ngakό) mo ‘i ai ha faipa.Faipa‘Oku mahu’inga ‘a e faipá ki he taha kotoa pē, ‘o kau ai e kakai suká. ‘E ala tokoni ‘a e faipa kihono tauhi ke mo’ui lelei ‘a e ngaahi ‘okani ‘oku ne momosi e me’akaí ‘i ho sinό pea ne ta’ofi ‘a efaingata’a e tu’u mama’ό.‘Oku mahu’inga foki ‘a e faipá ki he kakai ‘oku nau suká. ‘E ala tokoni ki hono holoki ‘a echolesterol “koví” ‘a ia ‘e tokoni ki hono tauhi ho mafú ke mo’ui lelei. Pea ko e ngaahi me’akailahi ‘oku ma’olunga ai ‘a e faipá ‘oku nau ma’ulalo he glycemic index. Ko hono ‘uhingá ‘oku lava‘e he fa’ahinga faipa ‘e ni’ihi ‘o fakamāmālie’i ‘a hono fakatoka lelei ‘a e me’akaí ‘i he sinό. ‘E lavafoki ‘e he ngaahi me’akai faipá ‘o tauhi koe ke ke ongo’i mākona (he kaí) ‘o lava ai ke ala tauhike lelei ho fua mamafá.31

What’s in food? - continuedFatFat is an essential nutrient. However many of us eat too much fat or eat the wrong types of fat.Fat is high in kilojoules. Eating too much fat can cause you to put on weight or make it harderfor you to lose weight.Some fats (saturated fats and trans fats) can increase your risk of heart disease and make itharder to manage your diabetes. Avoid these types of fats (e.g. coconut oil, lard, butter, palm oil,full fat dairy foods, fatty meats and fried foods).Polyunsaturated fats (e.g. oily fish, safflower and sunflower oils) and monounsaturated fats(e.g. avocado, canola and olive oils) can help reduce your risk of heart disease. They are betterchoices than saturated fat. Both of these fats have benefits for your health so vary betweenthem. These fats are still high in kilojoules, so if you are overweight, eat them in moderation.To help you get the right type of fat and avoid eating too much fat;Choose:• Meat trimmed of fat or lean meats (e.g. goats meat)• Chicken trimmed of fat and skin• Low fat cooking methods such as umu, boiling, barbequing, grilling, dry frying, baking,steaming or poaching• Low fat dairy foods• To eat more fish including oily fish (e.g. tuna, salmon, mackerel, herring, sardines)• Olive, canola, sesame, peanut, corn, safflower or sunflower oils for cooking, marinades anddressing• Margarines made from olive, canola, safflower orsunflower oils• Alternatively, use a plant sterol enriched margarine(i.e. Proactive and Logicol), but speak to your dietitianand/or doctor about it before you decide to use it• To include small amounts of avocado, unsalted nuts andseeds in your diet• To cook soups, curries and other dishes with lightevaporated milk with coconut essence or Carnation light and creamy coconut flavouredevaporated milk rather than coconut milk or cream• Use low fat yoghurt in curries instead of cream.Limit/avoid:• Fatty or processed meats (e.g. sausages, salami, corned beef, pork cracklings, mutton flaps,lamb and pork belly and fried meat)• High fat cooking methods such as frying or roasting in fat• Full fat dairy foods• Butter, ghee, lard, vegetable shortening, cream, coconut oil, coconut milk and coconutcream• Sauces or dishes made up with coconut milk or coconut cream• Fried fish or chicken• Fried foods, cakes, pastries, biscuits, donuts, crisps and high fat crackers• Sweet pies, coconut based desserts, puddings, fast foods.32

Ko e hā ‘a e me’a ‘i he me’akaí – hoko atu‘Oku fakakau ‘i he ngaahi me’akai faipá ‘a e ngaahi fua’i’akau fuakakato (‘ikai ko e huhu’a inufua’i’akau), vesitapolo (hangē ko e talo mo e manioke), ngaahi legumes, nati mo e ngaahitenga’i ‘akau, mā tengai’i uite mo e mā uite mo e ngaahi cereals ‘oku ma’olunga ‘a e faipá.NgakόKo e me’a fakatupuivi mahu’inga ‘a e ngakό. Kā ‘oku tokolahi ‘iate kitautolu ‘oku fu’u lahi ‘etau kaingakό pē kai e ngaahi ngako ‘oku halá.‘Oku ma’olunga ‘aupito ‘a e kilojoules ‘i he ngakό. ‘E lava ke fakasino ‘a e kai ngako lahí pēfaingata’a ange ke ke fakaholo.‘Oku ‘i ai e fa’ahinga ngako (saturated fat mo e trans fat) ‘oku lava ke ne fakalahi ‘a e tu’ungafakatu’utāmaki ‘o e mahaki’ia ho mafú pea fakatupu ai ‘a hono faingata’a ke pule’i lelei ho suká.Faka’ehi’ehi mei he fa’ahinga ngako ko ‘ení (hangē ko e lolo niu, ngako, pata, lolo paame, ngaahime’akai ngaohi mei he ngako’i hu’akau dairy, ngaahi me’akai ngakongako mo e ngaahi me’akaifakapaku.‘Oku lava ke tokoni ‘a e ngaahi me’akai ngako polyunsaturated (hangē ko e lolo ‘o e iká, safflowermo e ngaahi lolo safflower) mo e ngaahi ngako monosaturated (hangē ko e ‘avoka, canola, moe lolo ‘olive) ki hono holoki ‘a e tu’unga fakatu’utāmaki ‘o e mahaki’ia ‘o e mafú. ‘Oku sai angehono fili ‘ení ‘i he ngaahi me’akai ngako saturated. ‘Oku ‘i ai e ngaahi lelei fakatou’osi ‘o e ongongako ni ko ia ai fetongitongi hona ngāue’akí. ‘Oku kei ma’olunga ‘a e kilojoules ‘i he ngaahingako ko ‘ení, pea kapau ‘oku ke sino mamafa, kai fakafuofua kinautolu.To help you get the right type of fat and avoid eating too much fat;Ko e tokoni ke ke ma’u ‘a e fa’ahinga ngako lelei mo faka’ehi’ehi mei he kai ngako lahí;Fili ‘a e:• Kakano’i manu kuo to’o e ngakό pē kakano’i manu ‘oku si’isi’i ai e ngakό (hangē ko ekakano’i kosi)• Moa kuo to’o e ngakό mo e kilí• Founga ngaohi me’akai ‘oku si’i hono ngāue’aki ‘a e ngakό hangē ko e ‘umu, haka vai,pāpākiu, tunu, fakapaku ta’engako, ta’o, hakamao pē fakapaku vai.• Me’akai ‘oku ma’ulalo ai ‘a e me’akai ngaohi mei hengako’i hu’akaú• Ke lahi ange hono kai ‘o e ika kau ai ‘a e lolo ika (hangēko e tuna, salamoni, mackerel, herring mo e sātini)• Ngaahi lolo ‘olive, canola, sesame, pinati, koane,safflower pē sunflower ki he ngaohi kaí, marinades mo edressing• Masalini ngaohi mei he ‘olivé, canolá, safflower pēngaahi lolo sunflower• Me’a kehe, ngāue’aki ‘a e masalini ‘oku fakalahi ki ai ‘a e kemikale sterol mei he ‘akau (‘a ia koe Proactive mo e Logicol ), kā ke talanoa ki ho tokotaha fale’i fakafuofua kaí pea/pē ki hotoketā kimu’a pea ke fakakaukau ke ke ngāue’aki ia• Ngaahi kongokonga iiki ‘o e ‘avoka, nati ta’e māsima mo e ngaahi tenga’i ‘akau ‘i ho’o kaí• Hu’akau evaporated ma’ama’a hu’i ‘aki e vanila niu pē Carnation ma’ama’a pē hu’akaukilimi fakaifo me’akai niu evaporated ki hono ngaohi ‘a e supό, kalé mo e ngaahi me’akaikehé kae ‘oua ngāue’aki ‘a e kilimi niú pē kilimí• Ngāue’aki ‘a e yoghurt ‘oku si’isi’i e ngakό ‘i he ngaahi kalé ‘o ‘ikai ko e kilimi.33

What’s in food? - continuedProteinProtein is essential to your body everyday to repair old or damaged parts. Most people livingin Australia already eat enough protein and do not need to eat more.Choose protein foods that are also low in fat. Foods that are a good source of low fat proteinare lean meat, poultry without the skin, fish and seafood, eggs, low fat dairy products,unsalted nuts, legumes (dried beans, dried peas and lentils) and soy products such as tofu.Speak to your dietitian if you are not sure if you are eating enough protein.Vitamins and mineralsVitamins and minerals are important for a healthy body. Eating a wide variety of foods fromall five food groups will help you get all the vitamins and minerals your body needs.The food groups are:• Breads and cereals• Vegetables• Fruit• Dairy foods• Meat or meat alternatives (e.g. poultry, seafood, eggs, legumes, nuts and seeds).34

Ko e hā ‘a e me’a ‘i he me’akaí – hoko atuFaka’ehi’ehi /Fakasi’isi’i ‘a e:• Kakano’i manu ngako pē processed (hangē ko e sōsisi, salami, pulu māsima, paku’i puaka,kapakapa’i sipi, sipi mo e kete’i puaka mo e kiki fakapaku• Ngāue’aki ‘a e fa’ahinga ngaohi kai ‘oku fakapaku pē ta’o ‘i he ngakό• Ngaahi me’akai ‘oku ngaohi kakato mei he ngako’i hu’akau• Pata, fa’ahinga ngako ko e ghee, fa’ahinga ngako ko e lard, ngako mei he vesitapolό, kilimi,lolo niu, huhu’a niu mo e kilimi niu• Ngaahi soosi pē me’akai ngaohi’aki e niu lolo’i pē niu kilimi• Ika fakapaku pē moa fakapaku• Ngaahi me’akai fakapaku, keke, pastries, pisikete, tounati, crisps mo e mā pakupaku ‘oku lahie ngakό• Ngaahi pai melie, hikingaua ngaohi mei he niu, puteni mo e me’akai fakatau.Protein‘Oku mahu’inga ‘a e protein ki ho sinό ‘i he ‘aho kotoa ke ne fakafo’ou ‘a e ngaahi konga ‘okumotu’a pē maumaú. Ko e tokolahi ‘o e kakai nofo ‘Aositelēlia ‘oku fe’unga ‘enau kai protein pea‘ikai ke fiema’u ke nau toe kai ke lahi ia.Fili ‘a e ngaahi me’akai protein ‘oku toe ma’ulalo ai ‘a e ngakό. Ko e ngaahi me’akai ‘oku leleihono ma’u mei ai ‘a e protein ka ‘oku ma’ulalo ai e ngakό ko e kakano’i manu ‘oku si’i e ngakό,moa/pato ta’e kili, ika mo e me’akai tahi, fua’imoa, me’akai ‘oku si’i ai ‘a e ngako’i hu’akaú, natita’emāsima, ngaahi legumes (piini mōmoa, piisi mōmoa mo e lentils) mo e ngaahi me’akaingaohi mei he soy hangē ko e tofū.Talanoa ki ho tokotaha fale’i fakafuofua kaí kapau ‘oku ‘ikai te ke fakapapau’i pē ‘oku fe’ungaho’o kai protein.Vatamini mo e minalolo‘Oku mahu’inga ‘a e vaitaminí mo e minalolό ki ha sino mo’ui lelei. ‘E tokoni ho’o kai ‘a engaahi me’akai kehekehe mei he ngaahi kulupu me’akai ‘e nimá ki hono ma’u atu ‘a e ngaahivaitamini mo e minalolo ‘oku fiema’u ‘e ho’o sinό.Ko e ngaahi kulupu me’akaí ‘a e:• Ngaahi mā mo e cereals• Ngaahi vesitapolo• Fua’i’akau• Ngaahi me’akai ngaohi mei he hu’akau• Kakano’i manu pē ngaahi kiki kehe (hangē ko e moa/pato, me’akai tahi, fua’imoa, nati mo etenga’i ‘akau).35

8Common Questions about Food andDiabetesHow often should people with diabetes eat?It is important for all people with diabetes to eat regular meals over the day. This helps tospread food intake out and prevent blood glucose levels going too high or low.Some people with diabetes take tablets or insulin to help manage their diabetes. Thesemedications may mean that you need to eat at certain times, eat a small snack betweenmeals or have a snack before bed. Discuss with your dietitian, diabetes educator or doctorwhether you need to eat at certain times or need to eat snacks.If you keep irregular hours (or you do shift work) it is important to discuss this with yourdietitian, diabetes educator or doctor as your medications may need to be adjusted to fit inwith when you are able to eat. It is important that you do your best to have a regular eatingpattern from day to day.Why is it important to manage my weight?Being overweight can make it harder to control your blood glucose levels. Carrying too muchfat around your middle is especially bad for diabetes and heart disease. If you are overweight,ask your dietitian for advice on how to adjust your food intake to lose weight. Also speak toyour doctor or an exercise physiologist about exercise.Can I eat fruit? What type of fruit can I eat and how much?Yes, people with diabetes can eat fruit. Fruit is an excellent source of fibre, vitamins andminerals. All fruit can be included as part of a healthy diet for people with diabetes. Fruitcontains natural sugar therefore it is important to spread fruit over the day.The recommendation for fruit is the same as the general population. That is, two servings offruit each day. 1 serve of fruit equals:• 1 medium piece of fruit (e.g. 1 apple or 1 orange or 1 pear)• 2 smaller pieces of fruit (e.g. 2 plums or 2 kiwifruit)• 1 cup chopped or canned fruit (not in syrup)• 1 tablespoon of sultanas or 4 dried apricots*• 1 small banana or ½ large banana• ½ cup of tin pineapples• 1 small mango (flesh only)• 1½ cups of watermelon or rockmelon• 1 ½ cups of diced papaya or pawpaw.Fruit juice is high in kilojoules and does not contain fibre. It is much better to eat the wholefruit rather than drink the juice. Drinking too much juice raises blood glucose levels and maycontribute to weight gain. If you must drink juice, limit to a maximum of 1 small glass a day.*Dried fruit contains a lot of natural sugar. If you eat dried fruit limit to a small quantity e.g. 1tablespoon of sultanas, 2 dried figs or 4 pitted dates.36

8Ngaahi Fehu’i ‘oku fa’a ‘eke fekau’aki moe Me’akaí mo e‘Oku tonu ke kai tu’ofiha ‘a e kakai suká?‘Oku mahu’inga ki he kakai kotoa pē ‘oku suká ke tauhima’u ‘enau kaí lolotonga ‘o e ‘ahό. ‘Okutokoni ‘eni ki hono vahevahe lelei ‘a e me’akai ‘oku kaí mo ta’ofi ‘a e hiki ‘o ma’olunga pē holo kilalo ‘a e tu’unga ‘o e kulūkousí he totό.Ko e kau suka ‘e ni’ihi ‘oku nau folo fo’i’akau suka pē ‘inisulini ke tokoni’i hono leva’i honau suká.‘Oku mahino mei ho’o folo e ngaahi faito’o ko ‘ení ‘oku fiema’u ke ke kai ‘i he taimi pau, kai haki’i me’akai fakaneifua ‘i he vaha’a taimi kaí pē ko e kai ha’o fakaneifua kimu’a pea ke mohé.Tālanga’i mo ho tokotaha fale’i fakafuofua kaí, faiako suká pē toketā pē ‘oku fiema’u ke ke kaihe ngaahi taimi pau pē ke kai me’akai fakaneifua.Kapau ‘oku ke tauhi ha ngaahi houa ‘oku fetō’aki (pē ke ngāue shift) ‘oku mahu’inga ke ketālanga’i mo ho tokotaha fale’i fakafuofua kaí, faiako fakahinohino suká pē toketā koe’uhi‘e alaliliu si’i ‘a ho’o ngaahi faito’ό ke fe’unga mo e taimi ‘oku lava ai ke ke kaí. ‘Oku mahu’inga ke kefeinga ‘i ho lelei tahá ke ke kai he taimi pau ‘i he ‘aho ki he ‘aho.Ko e hā ‘a e me’a ‘oku mahu’inga ai ke tokanga’i hoku pāuni mamafá?‘Oku lava ke faingata’a ange hono pule’i ‘a e tu’unga e kulūkousí ‘i ho totό ‘o ka ke sinomamafa. ‘Oku kau kovi lahi ki he suká mo e mahaki’ia ‘a e mafú ‘o kapau ‘e fu’u lahi ‘a e ngakό ‘iho kongalotό. Kapau ‘oku ke sino, ‘eke ki ho tokotaha fale’i fakafuofua kaí ha fale’i fekau’aki moe founga ‘e lava ke liliu ai ‘a e lahi ho’o kaí ke fakaholo ho sinό. Pea ke talanoa ki ho toketā pētaha fakamālohisino fisiolosīi fekau’aki mo e fakamālohi sinό.‘Oku ngofua ke u kai fua’i’akau? Ko e hā e fa’ahinga fua’i’akau ‘oku tonu ke u kaí mohono lahí?‘Io, ‘oku sai pē ke kai fua’i’akau e kakai suká. ‘Oku lelei ‘aupito ‘a e faipa, vaitamini mo e minalolo‘oku ma’u mei he fua’i’akaú. ‘Oku lava ke fakakau ‘a e fua’i’akau kotoa pē ki ha polokalama kaifakamo’ui lelei ma’ae kakai ‘oku suká. ‘Oku ma’u ‘i he fua’i’akaú ‘a e suka fakanatula ko ia ai ‘okumahu’inga ke vahevahe tatau ‘o hono kaí ‘i he lolotonga ‘o e ‘ahό.Ko e poupou ki hono kai ‘a e fua’i’akaú ‘oku tatau pē mo ia ‘oku fai ki he kakaí fakalūkufua. ‘A ia,ko e hikinga fua’i’akau ‘e ua ‘i he ‘aho. Ko e fua ‘o e hikinga fua’i’akau ‘e taha ‘oku tatau ia mo e:• konga’i fua’i’akau lahilahi fe’unga (hangē ko e fo’i’apele ‘e 1 pē fo’i moli ‘e 1 pē fo’i pea ‘e 1)• ongo konga fua’i’akau iiki hifo ‘e 2 (hangē ko e palamu ‘e 2 pē kiwifruit ‘e 2)• ipu fua’i’akau tofitofi ‘e 1 pē fua’i’akau kapa (‘ikai ‘i ha huhu’a melie)• sēpuni lahi ‘e 1 fuamelie pē apricot fakamōmoa ‘e 4• fo’i siaine si’isi’i ‘e 1 pē ½ siaine lahi• ½ ipu fainā kapa• fo’i mango si’isi’i ‘e 1 (kakanό pē)• ipu ‘e 1 ½ meleni pē rockmelon• ipu ‘e 1 ½ lesi tofitofi.‘Oku ma’olunga ‘a e kilojoules ‘i he inu fua’i’akaú pea ‘ikai ha faipa ai. ‘Oku sai ange ke kai ‘ae fua’i’akau fuá ‘i hono inu ‘a hono huhu’á. ‘Oku hiki ki ‘olunga ‘a e tu’unga ‘o e kulūkousí hetotό ‘i hono inu ‘o fu’u lahi ‘a e juice pea ‘e ala fakasino foki. Kapau ‘oku ke fiema’u ke inu juice,fakangatangata pē ki ha ipu sio’ata si’isi’i ‘e 1 he ‘aho.*’Oku lahi ‘aupito ‘a e suka fakanatula ‘oku ma’u ‘i he fua’i’akau fakamōmoá. Kapau ‘oku ke kaifua’i’akau fakamōmoa pea ke fakafuofua pē ke si’isi’i hangē ko ha sēpuni fuamelie lahi ‘e 1, fikifakamōmoa ‘e 2 pē ha dates ‘e 4 kuo to’o e tengá.37

Common questions about food and diabetes - continuedCan I eat unlimited vegetables?Vegetables provide an excellent source of fibre, vitamins and minerals. Recommendationsfor vegetables are five or more servings a day. One serve of vegetables is equal to ½ cupcooked vegetables or 1 cup salad or 1 medium potato* or ½ cup cooked legumes*. Mostvegetables have very little impact on blood glucose levels and weight (i.e. salads, cabbagesand broccoli). These vegetables are referred to as free foods and can be included in unlimitedquantities.*Starchy vegetables (that is, potato, sweet potato, kumara, taro, cassava, corn and legumes)do contain carbohydrate. This means they are broken down into glucose to provide the bodywith energy. Starchy vegetables can be included as part of a healthy eating plan in moderateamounts to help manage blood glucose levels.Are “diet” foods suitable?Not all diet foods or foods marked “suitable for people with diabetes” are useful for peoplewith diabetes. Often they can be quite high in kilojoules or may have a lot of fat in them. Alsothey can often be quite expensive.Diet foods that you should avoid are:• Diabetic chocolate. These are usually high in fat.• Diet or low carbohydrate beer. These beers are still high in alcohol. It is the alcohol that ismore of a problem than the carbohydrate content.Some diet foods are fine for people with diabetes. These are foods that normally may behigh in added sugar. Replacing the sugar with a sweetener such as Equal, Splenda andSugarine means you do not have to worry that they will raise your blood glucose level toohigh. These include:• Diet soft drinks• Diet cordials.• Diet jellies.What foods can I eat if I am always hungry?If you are often hungry, make sure you are not overly restricting how much you eat just tokeep your blood glucose levels down. This is especially important for children, adolescentsand the elderly. Speak to your dietitian about what is the right amount of food for you.If you are eating the right amount of food and are still hungry, try to include high fibre, lowfat and low glycemic index foods in your meals and snacks. They can help to keep youfeeling fuller for longer.Some foods can be eaten without affecting your blood glucose level or body weight. Theseare the kind of foods you should aim to eat if you are still hungry. These foods are oftencalled “free” foods. They include:• Most vegetables except the starchy vegetables (legumes, potato, sweet potato, kumara,corn, taro and cassava), avocado and olives.• Some fruits e.g. lemon, lime, cumquats, loquats, passionfruit, berries and rhubarb.• Black or green tea* (without milk or sugar).• Clear broth• Tomato Juice• Fresh lemon juice• Diet jelly• Herbs and spices38

Ngaahi fehu’i ‘oku fa’a ‘eke fekau’aki mo e me’akai mo e suká – hoko atu‘Oku sai ke u kai ta’efakangatangata ‘a e vesitapolό?‘Oku lelei ‘aupito ‘a e faipa ‘oku ma’u ‘i he vesitapolό, vaitaminí mo e minalolό.‘Oku lelei ‘aupito ke kai ha hikinga ‘e nima pe lahi ange he ‘aho. Ko e hikinga vesitapolo ‘etahá ‘oku fe’unga ia mo e ½ ipu vesitapolo moho pē ipu ‘e taha sālati pē fo’i pateta talotoloto‘e 1 * pē ½ ipu legumes*. ‘Oku ‘ikai ke loko ‘i ai ha kaunga ‘a e vesitapolo lahi ki he tu’unga‘o e kulūkousi he totό mo e fua mamafá (hangē ko e salati, kapisi mo e broccoli). ‘Oku ui ‘ae ngaahi vesitapolo ko ‘ení ko e me’akai kai ta’efakangatangata (free foods) pea ala ke alafakakau ke ta’efakangatangata hono lahí.*’Oku ma’u ‘i he ngaahi me’akai sitaasí (hangē ko e pateta, kumala, talo, manioke, koane moe legumes) ‘a e carbohydrate. Ko hono ‘uhingá ‘oku veteki e ngaahi me’akai ni ‘o ma’u ai ‘a ekulūkousí ‘o ne fakatupu leva ‘a e ivi ‘i he sinό. ‘Oku ala fakakau ‘a e ngaahi vesitapolo sitaasí ‘iha palani kai fakamo’ui lelei kae fakafuofua pē hono lahí ke tokoni ki hono pule’i ‘a e tu’unga ‘oe kulūkousi ‘i he totό.‘Oku lelei nai ‘a e ngaahi me’akai “diet”?‘Oku ‘ikai ‘aonga ki he kau suká ‘a e ngaahi me’akai “diet” ‘e ni’ihi pē ngaahi me’akai ‘oku tohi ai“fe’unga ki he kakai suká”. ‘Oku fa’a lahi ai ‘a e kilojoules pē ala lahi ai e ngakό. Pea ‘oku nau fa’amamafa ange.Ko e ngaahi me’akai diet ‘oku tonu ke ke faka’ehi’ehi mei aí:• Sokoleti ki he suká. ‘Oku fa’a lahi ‘a e ngakό ai• Pia diet pē ma’ulalo ‘i he carbohydrate. ‘Oku kei lahi pē ‘a e ‘olokaholό ‘i he ngaahi pia ko ‘ení.‘Oku lahi angé ‘a e palopalema ‘o e ‘olokaholό ‘o ‘ikai ko e lahi ‘a e carbohydrate.‘Oku ‘i ai e ngaahi me’akai diet ‘e ni’ihi ‘oku sai pē ki he kakai suká. Ko e ngaahi me’akai ‘eni‘oku fa’a ala lahi ‘a e suka ‘oku tānaki atu ki aí. ‘E ‘ikai te ke hoha’a pe ‘e hiki hake ki ’olunga ‘a etu’unga kulūkousi ‘i ho totό kapau te ke fetongi hono ngāue’aki e suká ‘aki ‘a e ngaahi me’afakamelie hangē ko e Equal, Splenda and Sugarine . ‘Oku kau heni ‘a e:• Inu kasa diet• Kotiolo Diet• Seli Diet.Ko e hā ‘a e ngaahi me’akai ‘oku taau ke u kai kapau ‘oku ou fiekaia?Kapau ‘oku ke fa’a fiekaia, ‘oua te ke fu’u fakangatangata ‘a e lahi ho’o kaí koe’uhi pē ko ho’o fietauhi ke ma’ulalo ‘a e tu’unga kulūkousí. ‘Oku mahu’inga fau ‘eni ma’ae fānaú, tamaiki lalahí moe kau vaivaí. Talanoa ki ho tokotaha fale’i fakafuofua kaí ki he lahi ‘o e me’akai ‘oku taau ma’aú.Kapau ‘oku ke kai e me’akai totonu ka ‘oku ke kei fiekaia pē, feinga ke ke fakakau ke lahi ange‘a e faipá, meakai mo e fakaneifua ‘oku ma’ulalo e ngakό mo e glycemic index. ‘E lava ke tokoni‘eni ki ho’o ongo’i mākona ke fuoloa ange.‘Oku ‘i ai e ngaahi me’akai ‘e ni’ihi ‘e ala kai kae ta’euesia ‘a e tu’unga ‘o e kulūkousi ho totό pēho fua mamafá. Ko e ngaahi me’akai ‘eni ‘oku totonu ke ke taumu’a ke kai kapau ‘oku ke keifiekaia. ‘Oku fa’a ui e ngaahi me’akai ko ‘ení ko e me’akai “tau’atāina”. ‘Oku kau ai a e:• Ngaahi vesitapolo lahi ka ‘ikai kau ai e ngaahi vesitapolo sitaasí (legumes, pateta, kumala,koane, talo mo e manioke), ‘avoka mo e ‘olive.• Ngaahi fua’i’akau hangē ko e lemani, laimi, cumquats, loquats, vaine pāsione,berries, rhubarb.• Tī ta’ehu’akau pē tī lanumata* (ta’ehu’akau pē ta’esuka).• Tī herbal• Kofi* (ta’ehu’akau pē ta’esuka)• Vai kau ai ‘a e vai sota mo e vai minalolo ta’efakalanu39

• Herbal teas.• Coffee* (without milk or sugar).• Water including soda water and plain mineral water• Diet soft drinks and cordials• Clear broth• Tomato Juice• Fresh lemon juice• Diet jelly• Herbs and spices.* It is best to limit tea and/or coffee to 4 cups a day.What can I add to food to give it more flavour?It is important to limit salt and foods containing salt. This is because a high salt intake cancause high blood pressure.Herbs, spices, chilli, garlic, lemon, lime and vinegar can all be used to add flavour to foodwithout affecting blood glucose levels or blood pressure. Use your traditional herbs andspices to maintain the traditional flavour of meals (e.g. curry powder).Why should I see a dietitian?An Accredited Practising Dietitian is a health professional who can help you manage foodand diabetes. Make an appointment to see a dietitian when you are first diagnosed withdiabetes. You will need a referral from your doctor. When you are first diagnosed, yourdietitian will need to see you a few times. Continue to see a dietitian once or twice a yearfrom then on.Your doctor might also suggest you see a dietitian if you are prescribed with medications orchange your medications. This is because medications can affect the balance between foodand your blood glucose levels.Call Australian Diabetes Council on 1300 342 238 for more information.If you cannot speak English well, call the free Telephone Interpreter Service (TIS) on 131 450and ask them to help you to speak to a dietitian from Australian Diabetes Council..40

• Inu kasa diet mo e kotiolo• Supo vai• Inu huhu’a temata• Inu huhu’a lemani fo’ou• Seli diet• Ngaahi ‘akau iiki namukakala mo e sipaisi.*Ko e sai tahá ‘a hono fakangatangata e inu tī mo e/pē kofí ki he ipu ‘e 4 he ‘ahoKo e hā ‘a e ngaahi me’a fakaifo te u ala tānaki ki he me’akaí?‘Oku mahu’inga ke fakasi’isi’i ‘a e māsimá mo e ngaahi me’akai ‘oku ‘i ai ‘a e māsimá. Ko hono‘uhingá ‘e ala fakatupu ‘e he lahi ‘o e kai māsimá ‘a e toto ma’olungá.‘Oku ala tānaki ‘a e ngaahi ‘akau iiki namukakala, sipaisi, polo, kāliki, laimi mo e vinika kihe me’akaí ke fakaifo ‘o ta’euesia ‘a e tu’unga kulūkousi ‘i he totό mo e toto ma’olungá.Ngāue’aki ho’o ngaahi ‘akau iiki namu akakla mo e ngaahi sipaisi ke tauhi ‘a e ifo ‘o e me’akaitukufakaholό (hangē ko e kalé).Ko e hā ‘a e ‘uhinga ‘oku tonu ai ke u sio ai ki ha Tokotaha Fale’i Fakafuofua Kai?Ko e Tokotaha Ma’u Fakamo’oni Ngāue Fale’i Fakafuofua Kai ko ha taukei ‘i he mo’ui leleí ‘eala tokoni kiate koe ki hono pule’i ‘a e me’akaí mo e suká. ‘Ai ha’o ‘apoinimeni ke ke sio ki hatokotaha fale’i fakafuofua kai ‘i he taimi na’e fuofua sivi fakataoketā koe ‘o ma’u koe ‘e he suká.‘E fiema’u ha tohi mei he toketā. ‘I he taimi ko ē hono fuofua sivi fakatoketā ai koé ‘o ma’u esuká, ‘e fiema’u ‘e he tokotaha fale’i fakafuofua kaí ke toutotu sio kiate koe. Hokohoko atu pēho’o sio ki he tokotaha fale’i fakafuofua kaí tu’otaha pē ua he ta’u.‘E lava ke talaatu ‘e he toketā ke ke sio ki ha tokotaha fale’i fakafuofua kai kapau ‘oku tohi’i atu‘a e ngaahi tu’utu’uni fakatoketā ki he ngaahi faito’o pē liliu ‘a e ngaahi faito’o ‘a’aú. ‘Oku fai’enikoe’uhi ‘e lava ‘e he ngaahi faito’ό ‘o uesia ‘a e palanisi ‘o e me’akaí mo e tu’unga ‘o e kulūkousího totό.Tā ki he Kosiliō Suka ‘a ‘Aositelēliá ‘i he 1300 342 238 ki ha toe fakamatala.Kapau ‘oku ‘ikai lelei ho’o lea fakapapālangí, tā ki he Ngāue Fakatonulea Fakatelefoni (TIS)ta’etotongi ‘i he 131 450 pea ke kole kiate kinautolu ke nau tokoni’i koe ke ke lea ki hatokotaha fale’i fakafuofua kai mei he Kosiliō Suka ‘a ‘Aositelēliá..41

9Diabetes and AlcoholToo much alcohol is harmful for everyone, including people with diabetes. However, peoplewith diabetes may still drink some alcohol. If you drink alcohol, drink in moderation and beaware of the following:• Alcohol can increase body weight, blood pressure and some blood fats. This can make itharder to manage your diabetes and increases your risk of heart disease.• People who use insulin or take some diabetes tablets can have a very low blood glucoselevel (hypoglycaemia) after drinking alcohol. Always eat carbohydrate food when drinkingalcohol. Ideally drink alcohol with a meal but if this is not possible snack on carbohydratefoods like low fat crackers, pretzels or bread.• The symptoms of drunkenness and hypoglycaemia are similar. People may not offeryou help if they think that you are just drunk. Let the people with you know that you havediabetes and what to do if you have hypoglycaemia.Drink alcohol in moderationModerate drinking means no more than 2 standard drinks for both women and men per day.A standard drink is a 285 ml of full strength beer, 375 ml mid-strength beer, 425 ml of lightbeer (less than 3% alcohol), 100ml wine, 60 ml sherry or 30ml spirits (incl. whisky and brandy).It’s a good idea to include alcohol free days each week.To help reduce how much alcohol you drinktry diluting it by adding water, soda water ordiet soft drink. You could also try alternatingbetween alcoholic and non-alcoholic drinks.42

9Suká mo e ‘Olokaholό‘Oku fakatu’utāmaki ‘a e lahi ‘o e ‘olokaholό ki he taha kotoa, kau ai mo e kakai suká. Ka neongoia, ‘oku sai pē ke ki’i inu ‘olokaholo si’isi’i pē ‘a e kakai suká. Kapau te ke inu ‘olokaholo, pea keinu fakafuofua pē pea ke fakatokanga’i e ngaahi me’a ‘oku hā ‘i lalό:• ‘Oku lava ke fakatupu fakasino ‘a e ‘olokahoό, toto ma’olungá mo e ngaahi ngako ‘i he toto‘e ni’ihi. ‘E lava ‘eni ke fakafaingata’a hono pule’i lelei ho suká pea ne fakatupu ke lahi ange ‘ae tu’unga fakatu’utāmaki ke ke mahaki mafu.• ‘E lava ‘o holoki ke ma’ulalo ‘aupito ‘a e tu’unga kulūkousi ‘i he totό (hypoclycaemia) ‘ihe kakai ‘oku nau ngāue’aki ‘a e ‘inisuliní pē folo ha ngaahi fo’i’akau suka hili ha’anau inu‘olokaholo. Kai ma’u pē ‘a e me’akai sitaasi ‘i he taimi ‘oku ke inu ‘olokaholo aí. ‘E sai tahákapau te ke inu ‘olokaholo lolotonga e kai me’akaí kā ‘o kapau ‘e ‘ikai lava ia kai ha ngaahime’akai sitaasi iiki hangē ko e māpakupaku, pretzels pē mā.• ‘Oku angatatau ‘a e ngaahi faka’ilonga ‘o e konā mo e hypoglycaemia. Kapau ‘e pehē ‘e hekakaí ia ‘oku ke konā pe, he ‘ikai te nau fie tokoni’i koe. Tala ki he kakai ‘oku ke ‘ilo’í ke nau ‘ilo’i‘oku suka and mo e me’a ke nau fai kapau te ‘e ma’u koe ‘e he hypoglycaemia.Inu fakafuofua ‘a e ‘olokaholό‘Oku ‘uhinga ‘a e inu fakafuofuá ke ‘oua laka ‘a e inú ‘i ha ipu fe’unga ‘e 2 ‘i he ‘aho ‘o tatau kifafine mo tangata. Ko e fua ‘o e inu fe’unga ‘oku mililita 285 pia mālohi tahá, mililita ‘e 375‘a e pia mālohi talotolotό, mililita ‘e 425 ‘a e pia ma’ama’á (si’i ange ‘a e pēseti ‘olokaholό ‘i he3%), milimita uaine ‘e 100, milimita ‘e 60 sherry pē milimita sipiliti ‘e 30 (kau ai ‘a e uasikē mo epalanite). ‘Oku lelei ‘aupito ke fakakau ha ngaahi ‘aho ta’e inu ‘olokaholo ‘i he uike kotoa.‘E tokoni ki hono fakasi’isi’i ho’o inu ‘olokaholό‘aki hano fakavaivai’i ia ‘o tānaki ha vai, vai sota pēinu kasa diet ki ai.’Ahi’ahi’i foki hono fetongitongihono inu ‘a e ‘olokaholό mo e ngaahi inuta’e’olokaholό.43

10Physical activityDaily physical activity is an important part of maintaining a healthy lifestyle. Everybodyreceives great benefits from exercise, but for people with diabetes; there are some extra,more significant benefits as well.Why it is good for youRegular physical activity can:• Lower your blood glucose (sugar) levels and improve your blood glucosecontrol• Help make your tablets and/or insulin work better• Help you to manage your weight or reduce your weight• Lower blood pressure and blood fats such as cholesterol• Improve the health and strength of your heart• Reduce stress and anxiety• Reduce your risk of developing diabetes complications• Help you sleep better• Improve your balance and coordination• Make you feel great!What should I be aiming for?Regular physical activity plays a large part in helping you to manage andcontrol your diabetes. The amount of activity you should be doing is thesame as everybody else!Following these four simple guidelines can help put you on the path to good health:• Think of physical activity as an opportunity, rather thanan inconvenience• Be active in as many ways as you can.Create opportunities for activity within your day. Forexample, walk to the shops instead of driving, take thestairs over the lift, or get off the bus one stop early andwalk the extra distance.It is also important to make these changes withinthe workplace. Try walking the longer way to thephotocopier, visiting a colleague rather than emailing,stand up when talking on the phone or going for awalk during the lunch break.• Put together at least 30 minutes of moderate intensity physical activity every day.Guidelines suggest we aim to do a minimum of 30 minutes every day of physical activity;but remember these don’t have to be all at once. 30 minutes can be divided into 15 or10 minute blocks, and they have the same effect. Try exercises that use your whole bodyin the movement, such as brisk walking, swimming, dancing or cycling. These activitiesshould be performed at a level that makes you breathe harder but that you can still talk.• If possible, do some regular vigorous exercise for extra health and fitness.Vigorous means that you are now exercising at a level that makes you huff and puff. Onlydo this type of activity if you have your doctor’s okay and are managing your currentexercises well.44

10Ngaungaue‘a e Sinό‘Oku mahu’inga ‘a e ngaungaue faka’aho ‘a e sinό ki hono tauhi ke mo’ui lelei ‘a e filingamo’uí. ‘Oku ma’u ‘e he tahakotoa pē ‘a e ngaahi lelei mei he fakamālohisinό, ka ki he kakai suká; ‘oku toe tānaki atu ha ngaahi lelei kehe foki.Ko e hā ‘oku sai ai ia kiate aú?‘E lava ‘e he toutou ngaungaue‘a e sinό ‘o:• Holoki ‘a e tu’unga ‘o e kulūkousí (suka) ‘i ho totό mo fakalelei’i ‘a hono leva’i ‘o e kulūkousi‘i ho totό• Tokoni ke ngāue lelei ange ‘a ho’o ngaahi fo’i’akaú pea/pē ‘inisuliní• Tokoni’i koe ke ke leva’i lelei ho fua mamafá pē holoki ho fua mamafá• Holoki ‘a e toto ma’olungá mo e ngaahi ngako he totό hangé ko e cholesterol• Fakalakalaka ‘a e mo’ui lelei mo e mālohi ‘o ho mafú• Fakasi’isi’i ‘a e hoha’a mo e puputu’ú• Fakasi’isi’i ‘a ho’o a’u ki ha tu’unga fakatu’utāmaki koe’uhi ko ha tupu ha ngaahi mahakifekau’aki mo e suká• Tokoni ke ke mohe lelei ange• Fakalakalaka ho’o palanisí mo e coordination• ‘Ai ke ke ongo’i lelei ‘aupito!Ko e hā ‘a e me’a ke u fakataumu’a ki aí?‘E tokoni lahi ‘a e toutou ngaungaue ‘a e sinό ki hono pule’i mo leva’i ho suká. ‘Oku totonu ketatau ‘a e lahi ‘o ho ngaungaué mo e kakai kehé!‘E tokoni ‘a e ngaahi tefito’i fakahinohino ko ‘ení ki hono ‘ave koe ‘i he hala ki he mo’ui leleí:• Fakakaukau ma’u pē ko e faingamālie ‘a e fakamālohisinό, ‘o ‘ikai ko ha me’a fakahela.• Ngaungaue ma’u pē ‘i he me’a kehekehe ‘oku ke faí.Fokotu’u ha ngaahi founga ke ke ngaungaue ai lolotonga ‘o e‘ahό. Hangē ko e lue ki he falekoloá kae ‘oua ‘e faka’uli, kaka hesitepú kae ‘oua heka he lift, pē ko ho’o hifo ‘i ha tau’anga pasikimu’a pea ke toki lue ai.‘Oku mahu’inga foki ke fai e ngaahi liliu ni ‘i ho feitu’u ngāue’angá.Feinga ke ke lue takai ke lōloa ange ho’o ‘alu ki he misini hikitataú (photocopier), ‘a’ahi ki hao kaungāngāue ‘o ‘ikai fetu’utakifaka-‘imeili, tu’u ‘o lue takai lolotonga ho’o talanoa telefoní pē koho’o lue lolotonga ho’o mālōlō kai ho’atá.• Fokotu’u ha miniti ‘e 30 pē ofi ki ai ha taimi fakamālohisino ‘okuki’i faingata’a angé ‘i he ‘aho kotoa.‘Oku fokotu’u atu ke ke taumu’ fakamālohisino ‘o ‘oua si’i hifohe miniti ‘e 30 ‘i he ‘aho kotoa; ka ke manatu’i ‘oku ‘ikai ‘uhinga ‘eni ke fai faka’angataha. ‘E lava ke vahevahe‘a e miniti ‘e 30 ki he poloka taki miniti ‘e 15 pē 10, pea te nau ma’u ‘a e ola tatau. ‘Ahi’ahi’i ‘a e ngaahifakamālohisino ‘oku ngaue kotoa e sinό, hangē ko e lue vave, kakau, tau’olunga pē ‘aka pasikala. ‘Okutotonu ke fai ‘a e ngaahi fakamālohisino ni ‘i he tu’unga ‘e a’u ‘o hōhō ho manavá ka ke kei lava pē ‘o lea.• ‘O ka lava, toutou fai ha ngaahi fakamālohisino ‘oku longomo’ui angé ke toe mo’ui lelei mo fakamo’uileleiange.‘Oku ‘uhinga ‘a e longomo’uí ‘o e fakamālohisinό ko e a’u ki ha tu’unga ‘e hoko ai ha’o hōhō.lahi ange.Fai ‘a e fa’ahinga fakamālohisino ko ‘ení kapau ‘oku faka’atā ‘e ho’o toketā pea ‘oku ke leva’i lelei pē ho’ofakamālohisinό.45

Physical activity - continuedWhat about Resistance Training?You should also aim to include some kind of weight or resistance training during the week.Resistance training means any exercise or activity where you use your body to lift somethingor to work against a weight, force or gravity. Resistance training is great for helping you tokeep active and independent for longer and has additional benefits for people with diabetes.Resistance training can:• Improve the way your body uses and stores insulin• Increases your muscle mass. This increases how much energy you burn which helps withweight loss/ management and improving blood glucose control.• Decrease your risk of falling and the risk of fractures• Improve strength, power, balance and coordinationHow much resistance training do I need to be doing for good health?• Try to lift weights (e.g. cansof food, hand weights) two -three times a week• Include exercises thattarget all of your largemuscle groups includingyour arms and legs• Aim to do each exerciseeight - twelve times(repetitions), and performtwo - three lots (sets) ofeach exercise• Start at a light weight till you learn the correct technique. After you have mastered thisweight, try lifting a heavier weight• Ideally, aim to lift a weight that only allows you to do eight - twelve repetitions each time.Precautions to take before initiating an exercise program:If you plan to start an exercise program for the first time, or you are doing something new,visit your doctor for medical clearance before you begin.It is also important to understand how your medications work together with physicalactivity. Exercise works like insulin and lowers your blood glucose levels (sugar). In peoplewho are taking insulin or some oral medications the combined effect with exercise cancause hypoglycemia. To avoid this, it is important to regularly test your blood glucose levels(sugars) before, sometimes during, immediately after and again a couple of hours afterexercise, so you understand how your body responds to different activities. If you find thatyour blood glucose is falling too low, you may need to alter your diabetes medication or eatextra carbohydrates to account for this effect. However, consult with your doctor, diabeteseducator or dietitian before making these changes.There are also some times when you should avoid exercise; if your blood glucose levels(sugars) are above 15 mmol/L, if you are feeling unwell or lightheaded (dizzy) or if you areunsure how to perform an exercise correctly.Most important!Enjoy the activities you chose. Be active in as many ways as you can, every day and rememberyou don’t have to take it seriously, just regularly.Always speak with your doctor before beginning a new physical activity program. If yourequire more guidance or advice about exercising with diabetes, speak with an accreditedexercise physiologist.46

Fakamālohisino – hoko atuFēfē ‘a e Fakamālohisino Hiki pē Fusi Me’amamafá?‘Oku tonutonu foki ke ke fakakau ‘a e fakamālohisino ‘oku kau ai ha hiki me’amamafa pē fusi ha me’a mamafa.Ko e fusi me’amamafá ‘oku ‘uhinga ia ki ha fa’ahinga fakamālohisino pē ngaue ‘a e sinό ‘a ia ‘oku ke ngāue’aki hosinό ke ne hiki ha me’a pē ke ngāue’aki ki hano teke’i ha me’a mamafa, ivi pē kalāvite. ‘Oku lelei ‘aupito ‘a e fusime’amamafá ki hono tauhi koe ke ke ngaungaue mo tau’atāina ke fuofuoloa ange pea toe tānaki atu ki ai ‘a engaahi lelei ki he kakai suká.‘Oku hanga ‘e he fakamālohisino hiki pe fusi me’amamafá ‘o:• Fakalelei’i ‘a founga ‘oku ngāue’aki ‘e he sinό ‘a e ‘inisuliní mo hono tauhí• Fakalahi ‘a e ho uouá. ‘Oku ne fakalahi ‘a e ivi ‘oku ke ngāue’aki ‘a ia ‘e tokoni ‘eni ki he fakaholό/pule’i e fuamamafá mo leva’i a e tu’unga kulūkousi ‘i he totό• Holoki ‘a e tu’unga fakatu’utāmaki ‘i ha’o tō mo e tu’unga fakatu’utāmaki ‘o ha ngaahi fasi.• Fakalelei’i ‘a e ivi, mālohi, palanisi mo e coordination.Ko e hā hono lahi ‘eku fakamālohisinohiki/fusi me’a mamafá ke fakamo’ui lelei?• Feinga ke ke hiki me’a mamafa (hangē koe ngaahi kapa me’akai, me’a hikihiki iiki)tu’o ua –pē tolu he uike.• Fakakau e ngaahi fakamālohisino ‘oku nengāue’i ‘a e ngaahi kulupu lalahi ho uouakau ai mo ho nimá mo e va’é.• Fakataumu’a ke ke fai ‘a e fo’ifakamālohisino takitaha tu’ovalu ki he tu’otahaua (fefoki’aki), pea ke fai ‘a e fo’i seti fakamālohisino tu’oua kihe tu’otolu.• Kamata’aki ha me’ahiki ma’ama’a kae’oua kuo ke ako ‘a e founga totonú.• Ko e sai tahá, kapau ‘oku ke taumu’a hiki ‘a e me’a mamafa ‘oku ke ala hikí ke fefoki’aki tu’o valu ki he tu’o tahaua.Ngaahi me’a ke fakatokanga kimu’a pea toki kamata ha polokalama fakamālohisino:Kapau ko ho’o ‘uluaki palani ‘eni ke kamata ha polokalama fakamālohisino, pē ko ho’o fai ha me’a fo’ou, ‘uluaki‘a’ahi ki ho’o toketā ke ne ‘oatu ha’o tohi faka’atā mo’ui lelei pea ke toki kamatá.‘Oku toe mahu’inga foki ke mahino kiate koe ‘a e anga ‘o e ngāue faktaha ‘a ho’o ngaahi faito’ό mo efakamālohisinό. ‘Oku hangē ‘a e ngāue ‘a e fakamālohisinό ko e ‘inisuliní, ‘oku ne holoki ‘a e tu’unga ‘o e kulūkousi‘i ho totό (suka). ‘I he kakai ‘oku nau ngāue’aki ‘a e ‘inisuliní pē ha faito’o ‘oku folo pē inu ‘e lava ke nau fengāue’aki‘o fakatupu ‘a e hypoglycemia. ‘E lava ke ta’ota’ofi ‘a e hoko ‘a e me’a ni ‘i hono sivi ‘a e tu’unga ‘o e kulūkousí ‘iho totό (suka) kimu’a, ‘i ha taimi lolotonga, mo e ‘osi pē ‘a e fakamālohisinό pea toe sivi’i ha ngaahi houa meihe taimi na’e ‘osi ai ‘a e fakamālohisinό, koe’uhi ke mahino kiate koe ‘a e anga ‘o e ngāue ‘a ho sinό pea mo ‘enefekau’aki mo e ngaahi ngāue kehekehe ‘oku ke faí. Kapau ‘oku ke vakai hifo ‘oku tōlalo ‘a e kulūkousí ‘i ho totό,‘e ngali tonu ke ke liliu ‘a ho faito’o suká pē kai ke lahi ange ‘a e carbohydrates ke ne tau’i ‘a e me’a ‘oku hokό. Kāneongo ia, faka’eke ki ho’o toketā, faiako suká pē tokotaha fale’i fakafuofua kaí kimu’a pea ke fai ‘a e ngaahi lilu ni.‘Oku ‘i ai foki mo e ngaahi taimi ‘oku tonu ke ‘oua te ke fakamālohisino ai; kapau ‘oku ma’olunga ‘i he 15 mmol/L ‘ae tu’unga kulūkousi ‘i ho totό, kapau ‘oku ‘ikai ke ke ongo’i sai pē ongo’i ma’ama’a ho ‘ulú (ninimo) pē kapau ‘oku‘ikai ke mahino kiate koe ‘a e anga totonu ‘o hono fai ha fakamālohisino.Me’a mahu’inga tahá!Ke ke ongo’i fiefia ‘i he ngaahi ‘ekitivitī ‘oku ke faí. Feinga ke ke ngaungaue ‘i he ngaahi me’a kehekehe ‘oku kemalava ke faí ‘i he ‘aho kotoa, pea ke manatu ke ‘oua te ke fu’u hoha’asi ia, kā ke fai ia ‘i he ngaahi taimi pau.Talanoa ma’u pē ki ho’o toketā kimu’a pea ke kamata ha polokalama fakamālohisino fo’ou. Kapau ‘oku kefiema’u ha poupou pē fale’i fekau’aki mo e fakamālohisino mo e suká, talanoa ki ha tokotaha taukei (fisiolosia)fakamālohisino kuo lesisita.47

11Oral MedicationsType 2 diabetes is a progressive disease. Even though you can be doing all the right thingsto manage your diabetes, it may be necessary to start medication to keep healthy bloodglucose (sugar) levels.When starting new medication you need to ask your doctor and pharmacist:• How many tablets you should take• How often you should take your tablets• What time of the day you should take your tablets -whether before food, with food or after food• How your tablets work• The side effects• How your tablets affect or are affected by othermedications you are taking.Over time your medications may not work as well.For this reason it is recommended to have yourmedications reviewed by your doctor every year.Your local pharmacist can also help you understandyour medications.Do not stop, decrease or increase your medication without first discussing it with your doctoror diabetes educator.Do not share your medications with anyone else.Certain diabetes medication can increase the risk of a low blood glucose level(hypoglycaemia). It is essential to know how to recognise and treat low blood glucose orhypoglycaemia. Ask your doctor, pharmacist or diabetes educator if this applies to you.If you are having frequent episodes of hypoglycaemia it is very important to speak with yourfamily doctor or diabetes health care team.Further assistance with your medications:Home Medication Review:If you are taking five or more different medicines, talk to your doctor about arranginga home medication review by your local pharmacist.National Prescribing Service:For information over the phone regarding the expert use of any of your medicationsyou can contact the National Prescribing Service consumer enquiry line “MedicinesLine” on 1300 633 424.48

11Ngaahi Faito’o ‘oku Inu pē FoloKo e suka fa’ahinga 2 ‘oku fakautuutu ‘ene tupú. Neongo ‘oku ke fai totonu e me’a kotoa kihono leva’i ho suká, ‘e ala hoko mai ‘a e taimi ‘oku totonu ke kamata ho’o ngāue’aki ha faito’oke ne tauhi ke mo’ui lelei ‘a e tu’unga kulūkousi ‘i ho totό (suka).‘Oku fiema’u ke ke ‘eke ki ho’o toketā mo e tokotaha hu’ivaí ’o ka ke kamata ha faito’o fo’ou:• Ko e hā ‘a e lahi ‘o e fo’i’akau te ke folό• ‘E tu’ofiha ho’o folo ‘a e fo’i’akaú• Ko fē ‘a e taimi he ‘ahό ‘oku tonu ke ke folo ai ho’ofo’i’akaú – kimu’a he kaí, lolotonga ‘a e kaí pē ‘i he ‘osi‘a e kaí• Anga ‘o e ngāue ‘a ho’o fo’i’akaú.• Ko e ngaahi me’a kehe ‘e ala hokό• Ko e founga ‘e ala uesia ai ‘e he fo’i’akau ‘oku ke folόē uesia ‘e he ngaahi faito’o kehe ‘oku ke folό ‘a ho’ofo’i’akaú ‘oku ke lolotonga folό.‘Oku lava ke ta’engāue lelei ‘a ho ngaahi faito’ό ‘i havaha’a taimi. Koe’uhi ko e ‘uhinga ko iá ‘oku taau kevakai’i fakata’u ho’o ngaahi faito’ό ‘e he toketā.‘E tokoni’i koe ‘e he tokotaha hu’ivai ‘i he feitu’u ‘oku kenofo aí ke fakamahino’i kiate koe ho ngaahi faito’ό.‘Oua ‘e tuku, holoki pē fakalahi ho faito’ό ka ke ‘uluaki talanoa mo ho toketā pē faiako suká.‘Oua te ke ‘oange ho faito’ό ki ha taha kehe ke ne folo.Oku ‘i ai ‘a e ngaahi faito’o suka ‘e ni’ihi ‘oku nau lava ke nau hiki’i ‘a e tu’unga fakatu’utāmaki ‘oe ma’ulalo e kulūkousi he totό (h). ‘Oku fiema’u ‘aupito ke ke ako ke ke ‘ilo’i mo hono faito’o ‘ae ma’ulalo e kulūkousi he totό pē hypoglycemia. ‘Eke ki ho toketā, tokotaha hu’ivaí pē faiakosuká kapau ‘oku fekau’aki ‘eni mo koe.Kapau ‘oku ke fa’a ongo’i ‘oku ke haipkalaisīmia ‘oku mahu’inga fau ke ke talanoa ki ho toketāfakafāmilí pē ki he timi tauhi mo’ui lelei e suká.Ko ha toe ngaahi tokoni fekau’aki mo ho’o ngaahi faito’ό:Vakai’i ‘a e Faito’o ‘i ‘Apí:Kapau ‘oku ke folo ha fo’i’akau kehekehe ‘e nima pē lahi ange, talanoa ki ho toketā kene alea’i ha founga ki hono vakai’i ‘e he tokotaha hu’ivaí ‘a e faito’o ‘i ‘apí.National Prescribing Service:Fetu’utaki ki he laine faka’eke’eke fakatelefoni ma’ae consumer ko e “Medicine Lines” ‘ihe National Prescribing Service ‘i he 1300 633 424 ki ha fakamatala ‘i he telefonífekau’aki mo e taukei ki hono ngāue’aki ho’o ngaahi faito’ό.49

12InsulinThe pancreas is a part of the body situated behind the stomach that produces a hormonecalled insulin.Without insulin, the cells in our bodies would not be able to use the glucose (sugar) to provideenergy.In type 1 diabetes the pancreas does not make any insulin andglucose levels build up in the blood. Insulin by injection or byinsulin pump is required for life. A person with type 2 diabetes orgestational diabetes may also require insulin to keep their bloodglucose levels within the recommended range.Your doctor may decide that insulin is needed as well as oralmedications, or that insulin may be better than oral medications.This does not mean that you have failed in your diabetesmanagement. It has been decided that insulin is necessary tomaintain good diabetes management.All insulins lower blood glucose levels. Low blood glucose orhypoglycaemia can be a side effect of insulin treatment. It isessential to know how to recognise and treat low blood glucose ora hypoglycaemic episode.There are many types of insulins available, you and your doctorwill discuss which is right for you. If you have any questions orconcerns about starting on insulin you can also contact yourdiabetes educator.Key points to know are:• Type and amount of insulin to be used• Time to take your insulin and when to eat• The time your insulin has it’s greatest effect and how long it stays in your body• When to test your blood glucose (sugar) level• When to contact your doctor or diabetes health care team.Tell your doctor or diabetes educator of any changes in your lifestyle, workinghours, physical activity or meal times. They will advise you if you need to changeyour insulin treatment .50

12‘Inisulini‘Oku tu’u ‘i mui ‘i he keté ‘a e konga ‘o e sinό ko e ‘atepilí ‘a ia ‘oku ne fakatupu ‘a e hormone ko e‘inisuliní.Ka ‘ikai ha ‘inisulini, ‘e ‘ikai lava ‘e he ngaahi cells ‘i hotau sinό ‘o ngāue’aki ‘a e kulūkousí (suka) kene fakatupu ‘a e iví.‘I he suka fa’ahinga 1 ‘oku ‘ikai ngaohi ‘e he ‘atepilí ia ha ‘inisulinipea fakatupu ai ‘a e lahi ange ‘a e tu’unga ‘o e kulūkousí ‘i he totό.‘Oku fiema’u leva ke huhu ‘a e ‘inisuliní pē pamu ‘a e ‘inisuliní kema’u ‘a e mo’ui. Ko e tokotaha ‘oku ne ma’u ‘a e suka kalasi 2 pēsuka lolotonga ‘a e feitamá ‘oku ala ke ne fiema’u ‘a e ‘inisulini ketauhi ‘a e kulūkousí ‘i ha tu’unga ‘oku fakafiemālie.‘E ala fakakaukau’i ‘e he toketā ‘oku fiema’u ‘a e ‘insulini ke tānakiatu ki he ngaahi faito’o kehe ‘oku folo, pē na’a ‘oku sai ange ‘a e‘inisulini ‘i he ngaahi faito’o ko ia. ‘Oku ‘ikai ‘uhinga ‘eni na’e ‘ikaike lelei hono leva’i ho suka. Kuo ne fakakaukau ‘oku fiema’u ‘a e‘inisulini ke hokohoko atu hono tauhi ke lelei ‘a e leva’i ho suka.‘Oku hanga ‘e he ‘inisulini ‘o holoki ‘a e tu’unga fakatu’utāmaki ‘oe kulūkousi ‘i ho toto. Ko e taha ‘o e ngaahi me’a ‘e ala uesia koe ‘ihono ngāue’aki ‘a e faito’o ‘inisulini ko hono holoki ‘a e tu’unga ‘o ekulūkousi ‘i ho toto pē fakatupu ‘a e haipokalaisīmia. ‘Oku mahu’ingake ke ako ke ‘ilo’i pea mo hono faito’o ‘a e tōlalo ‘a e tu’unga ‘o ekulūkousi he toto pē hoko ‘a e hypoglycaemia.‘Oku lahi ‘a e fa’ahinga ‘insulini ‘oku ala ma’ú pea te mo talanoa mo ho toketā pē ko fē ‘a e me’a‘oku fe’unga mo koé. Kapau ‘oku ‘i ai hao ngaahi fehu’i pē tāla’a fekau’aki mo ho’o kamata e‘inisuliní ‘e lava ke ke toe fetu’utaki ki ho’o faiako suká.Ngaahi me’a tefito ke ke ‘ilo ki ai:• Fa’ahinga ‘inisulini mo hono lahi ke ngāue’akí.• Taimi ke ke folo pē huhu ai ho’o ‘inisuliní pea mo e taimi kaí.• Ko e taimi ‘oku ‘aonga taha ai ho’o ‘inisuliní pea mo e lōloa ‘ene nofo ‘i ho sinό.• Taimi ke sivi ai ‘a e tu’unga ‘o e kulūkousí (suka) ‘i ho totό.• Taimi ke ke fetu’utaki ai ki ho toketā pē timi tauhi mo’ui lelei ‘a e suká.Tala ki ho toketā pē faiako fakahinohino suká ‘o ka ai ha ngaahi liliu ki hofilingamo’uí, ngaahi houa ngāué, fakamālohisinό pē ngaahi houa kaí. Te nau fale’ikoe ki he taimi ‘oku fiema’u ai ke liliu ho’o faito’o ‘inisuliní.51

Sharps disposalWhat are “community sharps”?Community sharps are medical devices that penetrate the skin andare used in the home.They include:• Needles – used to give injections, draw blood or insert insulinpump tubing• Syringes (even if needle removed)• Pen needles for insulin pens• Blood glucose or finger pricker lancets.Your used sharps must be secured in a strong puncture resistantcontainer, Australian Standard Sharps containers (available from theAustralian Diabetes Council and some pharmacies) or a punctureresistant plastic container with a screw top lid are suitable.Sharps must NOT be placed in any rubbish or recycling bins.How do I dispose of my community sharps?Place sharps in an appropriate container. Dispose of containers only into community sharpsdisposal facilities found at:• Public hospitals• Participating pharmacies• Community sharps disposal bins• Needle and syringe program outlets.For a list of sharps disposal facilities in your area contact your local council or phone theAustralian Diabetes Council on 1300 342 238.52

Ko hono li’aki ‘a e ngaahi me’a māsiláKo e hā ‘a e “ngaahi me’a māsila fakakomiunitī”?Ko e ngaahi me’a māsila fakakomiunitī ko ha ngaahi nāunaufakaemahaki ‘oku hoka’i ki he kilí pea ‘oku ngāue’aki ‘i ‘api.‘Oku fakakau heni ‘a e:• Ngaahi hui – ngāue’aki ki he huhú, ke to’o toto pē ke fakahū ki hetiupi pamu ‘inisuliní• Ngaahi me’ahuhu (kau aipē ‘a e ngaahi me’a kuo ‘osi to’o e huí)• Ngaahi hui peni ki he ‘u peni ‘inisuliní• Ngaahi hui sivi kulūkousi pē hui ‘oku hoka’i he louhi’i nimá.‘Oku pau ke tauhi malu ‘i ha koniteina ‘oku ‘ikai ke mafahi ngofua‘a ho ngaahi me’a māsilá, ngaahi container Ngaahi Me’amāsilaTukupau ‘Aositelēlia (ma’u atu mei he Kosilio Suka ‘a ‘Aositelēlia mo engaahi fale hu’ivai ‘e ni’ihi) pea ‘oku lelei mo ha koniteina pelisitiki ‘oku‘ikai ke mafahi ngofua ‘oku tāpuni vilohi.‘Oku ‘IKAI totonu ke fa’o e ngaahi me’amāsilá ‘i he vevé pē ngaahi me’a tuku’anga veve recycle.‘Oku anga fēfē ‘eku li’aki ‘a e ngaahi me’a māsila fakakomiunitī?Fa’o ‘a e ngaahi me’a māsilá ‘i he koniteina totonu. Li’aki pē e ngaahi koniteiná ‘i he ngaahifeitu’u pau ki he ngaahi me’a māsila fakakomiunitī ‘i he:• Ngaahi falemahaki fakapule’angá• Ngaahi fale hu’ivai ‘oku nau fengāue’aki• Ngaahi lingi’anga veve ki he ngaahi me’a māsila fakakomiunitī• Ngaahi feitu’u ‘oku ‘i ai e polokalama ki he hui mo e me’ahuhu.Telefoni ki he ‘ofisi fakakolo ‘i ho feitu’ú pē ki he Kosilio Suka ‘a ‘Aositelēliá ‘i he 1300 342 238 kiha lisi ‘o e ngaahi feitu’u pau ke li’aki ai ‘a e ngaahi me’a māsilá.53

13Blood Glucose (Sugar) MonitoringMonitoring blood glucose levels is important to help you manageyour diabetes. Self blood glucose testing is a way of measuring howmuch glucose is in your blood.A drop of blood is obtained by pricking the finger with a needlecalled a lancet. The blood is applied to a test strip, and inserted intoa blood glucose machine (meter). The blood glucose(sugar) level isthen displayed.There are many types of meters available. Ask your doctor or diabetes educator which metersuits you. You will also need to be shown how to use your meter.Why you should monitor your blood glucose (sugar) levelBlood glucose levels respond to food, particularly carbohydrates. Other factors like physicalactivity, diabetes medication, changes in your daily routine, stress and illness will also causeblood glucose levels to go up or down.Visits to a doctor or heath professional may be weeks or months apart. It is important toknow and understand the readings/blood glucose levels and make some self-managementdecisions in between doctors visits.The benefits of using a meter include:• Seeing if your blood glucose level is too high or too low• Gives you a picture of your day to day diabetes management• Shows you whether your blood glucose levels are within yourrecommended target range• Shows you the effects of food, physical activity and medication onyour blood glucose (sugar) level• Gives you confidence to self-manage your diabetes.This gives you and your diabetes health care team the information needed to help youmanage your diabetes.When you should monitor your blood glucose (sugar) levelBlood glucose monitoring is usually done before meals or two hours after the start of a mainmeal. Ask your doctor or diabetes educator for advice on when and how often you need tocheck your blood glucose level.It is safe practice to check your blood glucose level before driving and on long journeys,especially for those people who are at risk of hypoglycaemia.Monitor your blood glucose level more often:• If you are sick• When adjusting tablets or insulin doses• When blood glucose levels are high -for example over 15 mmol/L• After exercise• After alcohol intake.54

13Ko hono Siofi mo Tokanga’i ‘a eKulūkousi (Suka) ‘i he Totό‘Oku mahu’inga ‘a hono tokanga’i ‘a e tu’unga ‘o e kulūkousí ‘i he totόke tokoni ki hono tokanga’i ho suká. Ko e taha ‘o e ngaahi foungake fua hono lahi ‘o e kulūkousi ‘i ho totό ko e sivi kulūkousi he totόfakaekoe pē. ‘E ma’u ha me’i toto ‘i ho’o huhu’i ho tuhú ‘aki ‘a e hui‘oku ui ko e lancet. ‘Oku ‘ai leva e toto ko iá ki ha la’i pepa fuolōloa, ‘ofakahū ki he misini toto kulūkousi (mita). ‘E ‘asi hake leva ‘a e tu’unga‘o e kulūkousi ‘i he totό.‘Oku lahi ‘a e ngaahi mita fa’ahinga kehekehe ‘oku ala ma’u atú. ‘Eke ki ho toketā pē ki he faiakosuká pē ko fē ‘a e mita ‘e fe’unga mo koé. ‘E toe fiema’u foki ke fakahinohino’i kiate koe ‘a honongāue’aki ho mitá.Ko e hā ‘oku mahu’inga ai hono siofi mo fakatokanga’i ‘a e tu’unga ‘o e kulūkousí(suka) ‘i ho totό‘Oku ngaue ‘a e tu’unga ‘o e kulūkousí he totό ‘o fakatatau ki he me’akaí, tautefito ki he ngaahicarbohydrates. Ko e ngaahi me’a kehe hangē ko e fakamālohisino, folo fo’i’akau suka, feliliuaki‘a e ngaahi ngāue faka’ahό, hoha’a mo e puke ‘e ala fakatupu ‘a e hiki hake pē holo hifo ‘a etu’unga kulūkousi he totό.‘Oku ala ke vāmama’o ‘a e ngaahi ‘a’ahi ki he toketā pe tokotahataukei mo’ui lelei ‘aki ha ngaahi uike pē māhina. ‘Oku mahu’inga keke‘ilo’i pea mahino hono lau ‘a e ngaahi fua e kulūkousi he totό/moe tu’unga ‘o e kulūkousí pea ke fai ha ngaahi tu’utu’uni fakaekoe kihono leva’i ho suká ‘i he vaha’a taimi ‘o e ‘a’ahi ki he toketā.‘Oku kau ‘i he ngaahi lelei ‘o hono ngāue’aki ‘a e mitá ‘a e:• Vakai pē ‘oku fu’u ma’olunga pē fu’u ma’ulalo ‘a e tu’unga kulūkousiho totό.• ‘Oatu ha ‘ata ‘o hono leva’i ho suká mei he ‘aho ki ‘aho.• Fakahā atu kiate koe pē ‘oku ‘i he tu’unga lelei ‘a e kulūkousí ‘i ho totό ‘a ia ‘oku fai ki ai ‘a etāketí.• ‘Oku ne fakahā atu kiate koe ‘a e ngaue ‘a e me’akaí, fakamālohisinό mo e faito’ό ki hetu’unga kulūkousi (suka) ‘i ho totό.• ‘Oatu ‘a e loto hangamālie ke ke leva’i pē ‘e koe ho suká.‘Oku ‘oatu heni kiate koe mo ho timi tauhi mo’ui leleí ‘a e suká ‘a e fakamatala ‘oku fiema’u ketokoni kiate koe ki hono leva’i lelei ho suká.Ko e taimi ‘oku tonu ke siofi mo tokanga’i ai ‘a e tu’unga kulūkousi (suka) ‘i ho totό‘Oku fa’a fai kimu’a he taimi kaí pē ha houa ‘e ua kimu’a he taimi kai lahí hono siofi mofakatokanga’i ‘a e kulūkousí he totό. Kumi fale’i mei ho toketā pē faiako fakahinohino suká kihe taimi mo e founga ke ke sivi ai ‘a e tu’unga kulūkousi ‘i ho totό.‘Oku malu’i koe ‘o ka ke sivi’i ‘a e tu’unga e kulūkousi ‘i ho totό kimu’a pea ke faka’uli peamo ha’o ‘alu ki ha ngaahi feitu’u mama’o, kae tautefito ki he kakai ko ia ‘oku ‘i he tu’ungafakatu’utāmaki ke nau ma’u ‘a e hypoglycemia.55

What my blood glucose levels should be?For most people with type 2 diabetes the recommended range for blood glucose levels is 6 to8 mmol/L fasting/before meals and 6 to 10 mmol/L two hours after the start of a main meal.Your doctor will advise you on what blood glucose level will be best for you.The Glycated Haemoglobin (HbA1c) Blood TestBlood glucose monitoring with a meter gives you a picture of your day to day diabetesmanagement. There is another important blood test called glycosylated haemoglobin –more commonly known as HbA1c. This blood test gives you a picture of your blood glucosecontrol over the last two to three months and is arranged by your doctor.The generally recommended HbA1c target level in people with type 2 diabetes is 7% or less.Your HbA1c should be checked at least every 6 months.If your HbA1c is greater than 7% it should be checked every three months.You will needto speak to your diabetes health care team about your diabetes management goals andpossible changes to your diabetes management and treatment.56

‘Ai ke lahi ange ho’o siofi mo fakatokanga’i ‘a e tu’unga ‘o e kulūkousí ‘i ho totό:• Kapau ‘oku ke puke• Taimi ‘oku liliu ai ‘a e mālohi ‘o e fo’i’akaú pē ‘inisuliní• Taimi ‘oku ma’olunga ai ‘a e tu’unga ‘o e kulūkousí ‘i he totό – hangē ka laka hake ‘i hemmol/L ‘e 15• Hili ‘a e fakamālohisino• Hili ha inu ‘olokaholo.Ko e tu’unga ‘oku tonu ke ‘i ai ‘ae kulūkousí ‘i hoku totόKo e tūkunga lelei taha ke ‘i ai ‘a e tu’unga kulūkousi he totό ‘i he kakai ‘oku nau ma’u ‘a e sukafa’ahinga 2 ko e vaha’a ‘o e mmol/L ‘e 6 ki he 8 ‘aukai/kimu’a he houa kaí pea mmol/L ‘e 6 ki he 10houa ‘e ua mei he kamata ‘o e houa kai lahí.‘E fale’i koe ‘e ho’o toketā ki he tu’unga kulūkousi ho totό ‘e lelei taha kiate koé.Ko e Sivi Toto Glycated Haemoglobin (HbA1c)‘Oku ‘oatu ‘i hono sivi mo fakatokanga’i ‘a e kulūkousi ‘i ho totό ‘aki ‘a e mitá ha fakatātā ‘oho’o leva’i faka’aho ‘a ho suká. ‘Oku ‘i ai mo e sivi toto mahu’inga ‘e taha ko e glycosylatedhaemoglobin - ‘oku lahi hono ‘ilo ‘aki ‘a e hingoa ko e HbA1c. ‘Oku ‘oatu ‘e he sivi toto ko ‘ení hafakatātā ‘o e anga hono pule’i ‘a e kulūkousi ‘i ho totό ‘i he māhina ‘e ua ki he tolu kuo ‘osí pea‘oku alea’i e sivi ni ‘e ho’o toketā.Ko e tu’unga lelei ‘oku tākei’i ke ‘i ai ‘a e HbA1c ‘i he kakai suka fa’ahinga 2 ko e 7% pē si’i ai.‘Oku tonu ke sivi fakamāhina 6 ‘a ho’o HbA1c.Kapau ‘e laka hake he 7% ‘a ho HbA1c ‘oku tonu ke sivi fakamāhina tolu. ‘Oku fiema’u ke ketalanoa ki ho timi tauhi mo’ui lelei ‘a e suká fekau’aki mo e ngaahi taumu’a ki hono leva’i leleiho suká mo e ngaahi me’a ‘e ala liliu ki hono leva’i lelei iá mo e faito’o ho suká.57

14Short Term Complications –HypoglycaemiaHypoglycaemia (low blood glucose levels)Hypoglycaemia is when the blood glucose (sugar) level drops below 4 mmol/L. It canhappen very quickly.Hypoglycaemia can occur in people who take certain oral diabetesmedication or use insulin.Ask your doctor or health care team if this applies to you.It is essential to know how to recognise the signs and symptoms ofhaving low blood glucose (sugar) and how to treat it.Blood glucose levels can be low because of:• Delayed or missed meals• Not enough carbohydrate in the meal• Extra activity or more strenuous activity• Too much diabetes medication• Alcohol.Signs and SymptomsThese can vary from person to person and may include:• Dizziness/light headedness• Sweating• Headache• Weakness, shaking• Tingling around the lips and fingers• Hunger• Mood changes, irritable/tearful• Confusion/lack of concentrationIf you feel any of these signs and symptoms, test your blood glucose level if possible.Treatment for low blood glucose levels (hypos) in a person who is conscious,cooperative and able to swallow.If you are unable to test, treat anyway.Treatment for low blood glucose levels (Hypos)Step 1Take quickly absorbed carbohydrate such as:• Half a glass of juice OR• 6 to 7 jellybeans OR• Half a can of regular (not diet) soft drink OR• 3 teaspoons of sugar OR honeyRetest the blood glucose level after 10 - 15 minutes.If still below 4 mmol/L repeat Step 158

14Ngaahi Faingata’a Fuonounou -HypoglycaemiaHypoglycaemia (ma’ulalo e tu’unga kulūkousi he totό)‘Oku hoko ‘a e hypoglycaemia ‘i he holo ‘a e kulūkousi he totό (suka) ‘o ma’ulalo hifo hemmol/L ‘e 4. ‘E lava ke hoko vave ia.‘E lava ke hoko ‘a e hypoglycaemia ki he kakai ‘oku nau folo ‘a fo’i’akausuká pē ngāue’aki ‘a e ‘inisuliní.‘Eke ki toketā pē timi tauhi mo’ui lelei ‘a e suká pē ‘oku ‘i ai hakaunga ‘a e me’a ni kiate koe.‘Oku mahu’inga ‘aupito ke ke ‘ilo’i ‘a e ngaahi faka’ilonga ‘o e ma’ulalo ‘ae kulūkousi he totό (suka) pea mo hono faito’o iá.‘E ala ma’ulalo ‘a e tu’unga kulūkousi he totό koe’uhi ko e:• Tuai e kaí pē ta’ekai• ‘Ikai ke lahi ‘a e carbohydrates ‘i he me’akaí• Fu’u lahi ‘a e fakamālohisinό pē fakamālohisino tōtu’a• Fu’u lahi ‘a e ‘insiuliní pē faito’o suká• ‘Olokaholo.Ngaahi faka’ilonga‘Oku hoko kehekehe mei he tokotaha ki he tokotaha ‘o kau ai ‘a e:• Ninimo/ongo’i ma’ama’a e ‘ulú• Tafe pupuha• Langa’ulu• Vaivaia, tetetete• Mofisifisi he loungutú mo e ngaahi tuhú• Fiekaia• Feliliuaki e ‘atamaí mo e lotό/hoha’a’ia/lo’imatatō• Puputu’u/ ‘ikai ke ma’u e tokangá.Kapau ‘oku ke ongo’i ha taha ‘o e ngaahi faka’ilonga ko ‘ení, sivi ‘a e tu’unga kulūkousi ho totόkapau ‘e lava.Kapau ‘oku ‘ikai te ke lava ‘o sivi, faito’o ‘e koe.Faito’o ‘o e tu’unga ma’ulalo ‘o e kulūkousi he totό (Hypos)Sitepu 1Inu pē kai ha carbohydrate ‘oku misi ngoufa ki he loto sinό hangē ko ha:• Vaeua’i ipu inu huhu’a fua’i’akau PĒ• Lole te’ekosi ‘e 6 pē 7 PĒ• Vaeua’i kapa inu kasa (‘ikai diet) PĒ• Sēpuni tī suka ‘e 3 PĒ hone.Toe sivi’i ‘a tu’unga ‘o e kulūkousi he totό hili ha miniti ‘e 10 – 15Kapau ‘oku kei ma’ulalo ‘i he mmol/L ‘e 4 toe ‘ai ‘a e Sitepu 159

Short Term Complications – Hypoglycaemia - continuedStep 2If your next meal is more than 20 minutes away, follow up with more slowly absorbedcarbohydrate such as:• 2 plain biscuits e.g. 2 Arrowroot or 2 milk coffee biscuits OR• 1 slice of bread OR• 1 glass of milk or soy milk OR• 1 piece of fruit• 1 tub of low fat yoghurt.If not treated the blood glucose levels can continue to drop, resulting in:• Loss of coordination• Confusion• Slurred speech• Loss of consciousness/fitting.THIS IS AN EMERGENCY ! !Instructions for the person present during this emergency:If the person having a hypo is unconscious theymust not be given anything by mouth.• Place the person in the ‘recovery position’ or ontheir side• Make sure the airway is clear• Ring 000 or if using a mobile ring 112 for anambulance stating “ diabetic emergency”• An unconscious person must NOT be left alone• If you are able and trained, give a Glucagon injectionImportant points for the person at risk of hypoglycaemia• Always carry ‘hypo’ food with you if you are on insulin or at risk ofhypoglycaemia. Ask your doctor if this applies to you.• Carry identification to say you have diabetes• Test before driving, before and after exercising and after alcohol intake60

Ngaahi faingata’a fuonounou – Haipōkalaisīmia hoko atuSitepu 2Kapau ‘oku miniti ‘e 20 ho’o houa kai hoko maí, hoko atu ‘aki ha me’a sitaasi ‘oku tuai ange ‘enehū ki he sinό hangē ko e:• pisikete ta’ekilimi ‘e 2 hangē ko e Arrowroot ‘e 2 pē pisikete hu’akau kofi ‘e 2 PĒ• Konga mā ‘e 1 PĒ Ipu hu’akau pē soy ‘e 1 PĒ• Konga fua’i’akau ‘e 1• ki’i puha yoghurt ‘e 1 ‘oku ‘ikai lahi e ngakό.Kapau ‘e ‘ikai faito’o ‘eni ‘e malava ke hoko atu ‘a e holo ‘a e tu’unga kulūkousi he totό, pea ‘eala hoko ‘a e:• Mole hono pule’i ‘a e ngaue e sinό• Puputu’u• STotoho ‘a e leá• L’Ikai ‘ilo pē ongo’i ha me’a faka’uto’uta.KO E FAKATU’UTĀMAKI ‘ENI!!Ngaahi fakahinohino ki he tokotaha ‘oku ‘i he feitu’u ‘oku hoko ai ‘a efakatu’utāmaki ni:‘Oua ‘aupito te ke ‘oange ha me’a ke kai pē inuki ha tokotaha hypo ‘o ‘ikai ke ne ongo’i ha me’a• Fokotu’u ‘a e tokotahá ki he tu’unga fakafiemālie pēki hono tafa’akí• MaFakapapau’i ‘oku ‘atā ‘a e halanga mānava he kiā• RTā ki he 000 pē ‘o ka ngāue’aki ha telefoni to’oto’o‘o tā ki he 112 ki ha ambulance ‘o ke talaange“fakatu’utāmaki suka”• A’OUA ‘e tuku tokotaha ha taha ‘oku ne ta’e’ilo pē ongo’i ha me’a• IKapau ‘oku ke lava pea kuo ke ‘osi ako’i koe, huhu’i ‘aki ‘a e Glucagon.Ngaahi poini mahu’inga ma’ae tokotaha ‘oku ‘i he tu’’unga fakatu’utāmakike ma’u ‘a e hypoglycaemia• To’oto’o ma’u pē ‘a e ngaahi me’akai ‘hypo’ kapau ‘oku ke ngāue’aki ‘a e ‘inisulinípē ‘i ha tu’unga fakatu’utāmaki ke ma’u ‘a ehypoglycaemia. ‘Eke ki ho toketā kapau ‘oku ‘iai ha kaunga ‘a e me’a ni kiate koe.• To’oto’o ha tohi fakamo’oni ‘oku tala ai ko etokotaha koe ‘oku suka• Sivi kimu’a pea ke faka’uli, kimu’a mo e‘osi ‘a e fakamālohisino pea mo e ‘osi ‘a e inu‘olokaholo.61

15Short term complications – high bloodglucose (sugar) level (hyperglycaemia,DKA, HONK/HHS, and sick days)Hyperglycaemia or high blood glucose levels is when the blood glucose (sugar) levels aremuch higher than recommended – above 15mmol/L.Blood glucose levels go high because of:• Eating too much carbohydrate• Not taking enough insulin or oral diabetes medications• Sickness or infection• Emotional, physical or mental stress• Certain tablets or medicines, (including cortisone or steroids)• A problem with your blood glucose meter, strips or testing technique• Lumps present at the injection site (if on insulin)• Fingers not clean when testing your blood• Testing too soon after eating. (Check your blood glucose two hours after the start of amain meal).Signs and SymptomsYou may feel:• Tired• Thirsty• Pass urine more frequently• Blurred vision• Generally unwell.If feeling unwell• Test your blood glucose levels more often: at least every 2 – 4 hours• Drink fluids and continue to eat normally if possible• Treat the cause of the illness• Tell someone and have them check on you.Test for ketones if advised to do so by your doctorWhen do I need to call my doctor?Contact your doctor for advice during illness if:• You can’t eat normally• You are not well enough to monitor your blood glucose levels• Your blood glucose level is higher than 15 mmol/L for more than 12 hours• Vomiting or diarrhoea continues for more than 12 hours• You continue to feel unwell or become drowsy.It is important to have a written sick day management plan prepared before you getsick or unwell. Talk to your diabetes health care team to arrange this.Ketone Testing and Diabetic Ketoacidosis (DKA)Ketones are chemicals in the blood which are produced from the breakdown of fat. If thebody has no insulin present, glucose (sugar) can’t be used for energy. Therefore the bodymakes ketones to provide a different source of energy. This may occur due to poor control ofdiabetes, not enough insulin or missed insulin doses, illness or infection.62

15Ngaahi faingata’a fuonounou –tu’unga ‘o e kulūkousí (suka) he totό(hyperglycaemia, DKA,HONK/HHS, mo e ngaahi ‘aho puke)‘Oku hoko ‘a e hyperglycaemia pē ma’olunga ‘e tu’unga ‘o e kulūkousí he totό ‘i ha hiki ‘o lahi ange he tu’unga‘oku totonu ke ‘i ai ‘a e kulūkousi he totό (suka) – laka hake he mmol/L ‘e 15.‘E hiki ‘a e tu’unga kulūkousi he totό koe’uhi ko e:• Fu’u lahi ‘a e kai carbohydrate• ‘Ikai ke fe’unga lelei ‘a e faito’o ‘inisuliní pē folo ‘a e fo’iakau suká• Puke pē ma’u ha siemu pipihi• Puputu’u fakaeloto, fakaesino pē fakae’atamai• Fa’ahinga fo’i’akau pē faito’o, (kau ai ‘a e cortisone pē steriods)• Palopalema mo ho’o mita fua kulūkousi he totό, lau’i pepa manifi sivi fua totό pē founga siví• ‘Asi ha fepulopulasi he me’a na’e fai ai ‘a e huhú (kapau ‘oku ke faito’o ‘inisulini)• ‘Ikai ke ma’a ho louhi’i nimá he taimi na’e fai ai ho sivi totό• Fu’u vave ‘a e siví he ‘osi pē ‘a e kaí. (Sivi e kulūkousi ho totό ‘i he ‘osi ha houa ‘e ua mei hekamata ho’o houa kai lahí).Ngaahi Faka’ilongaTe ke ala ongo’i:• Hela’ia• Lahi ange ho’o tu’uofí• Kovi fakalūkufua.• Fieinua• Nenefu ho’o siόKapau ‘oku ke ongo’i kovi• Toutou sivi ‘a e kulūkousi ho totό: feinga ke fakahoua 2 – 4• Inu ke lahi pea hoko atu ho kaí ‘o fakatatau ki he me’a ‘oku anga ki aí kapau ‘e lava• Faito’o ‘a e me’a ‘oku ne fakatupu ‘a e puké• Tala ki ha tokotaha kehe pea alea’i ke nau vakai’i ma’u pē koe.Sivi pē ‘oku ‘i ai ‘a e ketones kapau ‘oku fale’i koe ke ke fai pehē ‘e ho’o toketāKo fē ‘a e taimi ‘oku fiema’u ke u tā ki he’eku toketā?Fetu’utaki ki ho toketā ki ha fale’i lolotonga ‘a e puké kapau:• Kapau ‘oku ‘ikai ke ke lava ‘o kai ‘o hangē ko e me’a ‘oku ke anga ki aí• ‘Oku ‘ikai ke ke sai fe’unga ke ke sivi mo leva’i lelei ‘a e tu’unga ‘o e kulūkousi ho totό• ‘Oku ma’olunga ange ‘a e tu’unga e kulūkousi ho totό ‘o laka hake he mmol/L ‘e 15 ‘o laka hake he houa ‘e 12• Lua mo fakalele hokohoko ‘o laka hake he houa ‘e 12• ‘Oku kei ongo’i kovi pē kamata ninimo.’Oku mahu’inga ke teuteu mo hiki kimu’a ha’o palani ki hono leva’i ho ‘aho puké ‘i he taimi te keongo’i puke pē ongo’i kovi aí. Talanoa ki ho timi tauhi mo’ui lelei ‘a e suká ke alea’i e me’a ni.Sivi Ketone mo e Suka Ketoacidosis (DKA)‘Oku fakatupu ‘a e kemikale ‘i he totό ko e ketones mei hono veteki ‘o e ngakό. Kapau ‘oku ‘ikai ke ‘i he sinό ha‘inisulini, ‘e ‘ikai lava ke ngāue’aki ‘a e kulūkousí (suka) ke ma’u ai ha ivi. Ko ia ai ‘oku hange ‘e sinό ‘o ngaohi ‘a ekitouni ko ha founga ma’u’anga ivi kehe. ‘E lava ke hoko ‘eni koe’uhi ko e kovi hono pule’i ‘a e suká, ‘ikai ke lahife’unga ‘a e ‘inisuliní pē ‘ikai ke tauhi pau ‘a e faito’o ‘inisuliní, puke pē ma’u he ha mahaki pipihi.63

A build up of ketones can lead to a condition called ketoacidosis, requiring urgent medicalattention. Diabetic ketoacidosis (DKA) is a life threatening condition that usually only occursin people with type 1 diabetes. It causes dehydration and a buildup of acids in the blood.This results in vomiting and increased drowsiness.DKA IS AN EMERGENCY AND REQUIRES URGENT MEDICAL ATTENTIONIn very rare cases ketoacidosis can occur in people with type 2 diabetes and isusually caused by a serious infection.With type 2 diabetes it is not usually necessary to test for ketones. Discuss with your diabeteshealth care team if you need to check for ketones.There are two methods of testing for ketones – testing urine andtesting blood :Urine Ketone TestUrine test strips are available to check for ketones. Ask yourpharmacist about the types of urine ketone strips available andcarefully follow the directions for testing. Urine ketone tests must betimed exactly using a watch or clock with a secondhand.Blood Ketone Test meterThere are meters available to test blood for ketones. The same dropof blood to be tested for glucose can be used to test for ketones. Different test strips areused for testing glucose and ketones. Ketone test strips are not subsidised by the NationalDiabetes Services Scheme at present.Seek URGENT medical attention if:• The urine ketone test shows medium or high levels of urine ketones.• The blood ketone test result is higher than 0.6 mmol/L.Hyperosmolar Hyperglycaemic Syndrome (HHS) - previously known as HyperOsmolar Non Ketotic coma (HONK)HHS is a complication of type 2 diabetes that involves extremely high blood glucose (sugar)levels without the presence of ketones. This medical emergency occurs in anyone with type2 diabetes, regardless of treatment.When blood glucose levels are very high, the body tries to get rid of the excess glucose(sugar) in the urine. This significantly increases the amount of urine and often leads todehydration so severe that it can cause seizures, coma and even death.The main causes of HHS/ HONK are:• Undiagnosed type 2 diabetes• A current illness or infection e.g. pneumonia and urinary tract infection• Other major illnesses e.g. stroke, heart attack• Persistent physical or emotional stress• Certain medication. This is another reason you need to talk to your diabetes health careteam about the medications you are taking.Signs and Symptoms include:• Severe dehydration• Shock• Changes in consciousness• Coma.HHS/HONK requires URGENT medical attention.64

Ka lahi ‘a e kitouní ‘e alal fakatupu ai ‘a e me’a ‘oku ui ko e ketoacidosis, ‘a ia ‘e fiema’u ha tokoni fakafaito’o ‘i hevave tahá. ‘Oku fakatu’utāmaki ‘aupito ‘a e suka ketoacidosis (DKA) ki he mo’uí pea ‘oku fa’a hoko ia ki he kakai‘oku nau ma’u ‘a e suka kalasi 1. ‘Oku ne fakatupu ‘a e mole ‘a e vaí mei he sinό pea mo e fakatupu ‘o lahi ange ‘a engaahi acid ‘i he totό. ‘Oku ne fakatupu ‘a e lua mo lahilahi ange ‘a e ninimό.‘OKU FAKATU’UTĀMAKI ‘A E DKA PEA ‘OKU FIEMA’U HA TOKONI FAKAFAITO’O ‘I HE VAVE TAHÁ‘Oku ‘ikai ke fa’a hoko ‘a e ketoacidosis ka ‘oku ala hoko ‘i he kakai ‘oku nau ma’u ‘a e suka fa’ahinga 2pea ‘oku fa’a fakatupu ia ‘e ha mahaki pipihi ‘oku fakatu’utāmaki.‘I he suka fa’ahinga 2 ‘oku ‘ikai fa’a fiema’u ke fai ha sivi ki he ketones. Talanoa mo ho’o timi tauhi mo’ui leleí kapau‘oku fiema’u ke fai ha sivi ki he ketones.‘Oku ‘i ai ‘a e founga sivi ‘e ua ki he ketones – sivi tu’uofi mo e sivi toto:Sivi Kitouni Tu’uofi‘Oku ma’u atu ‘a e ngaahi lau’ipepa manifi sivi tu’uofi ke fai’aki ‘a e sivi ki he ketones.‘Eke ki ho tokotaha hu’ivaí pē ko e hā ‘a e fa’ahinga lau’ipepa manifi sivi tu’uofi ki heketones‘oku ma’ú pea ke tokanga ‘o muimui ki he ngaahi tu’utu’uni ‘o e siví.Mita Sivi Ketones ‘i he Totό‘Oku ‘i ai e ngaahi mita ‘oku ma’u atu ki hono sivi ‘a e ketones ‘i he totό. ‘E lava kengāue’aki ‘a e konga toto tatau ‘o e sivi kulūkousí ki he sivi ketones. ‘Oku ngāue’aki ‘ae ngaahi lau’ipepa manifi sivi kehekehe ki he sivi kulūkousí mo e sivi ketones. ‘Oku‘ikai ke tokoni’i fakapa’anga ‘e he National Diabetes Services Scheme ‘a hono fakatau ‘a e ngaahi lau’ipepa manifisivi ki he ketones he lolotonga ni.Fetu’utaki ‘I HE VAVE TAHÁ ki ha tokoni fakafaito’o kapau:• ‘Oku ‘asi he sivi tu’uofi ki he ketones ‘oku tālotoloto pē ma’olunga ‘aupito ‘a e tu’unga ‘o e lahi e ketones ‘i hetu’uofí.• ‘Oku ma’olunga ange ‘i he mmol/L ‘e 0.6.Hyperosmolar Hyperglycaemic Syndrome (HHS) – ‘uluaki ‘ilo’i ko e Hyper Osmolar Non Ketotic coma(HONKKo e HHS ko ha ola kovi tolonga fuoloa ‘i he suka fa’ahinga 2 ‘oku hoko ia ‘i he ma’olunga fau ‘a e tu’ungakulūkousi (suka) he totό kae ‘ikai ‘i ai ha kitouni. Ko e fakatu’utāmaki fakamahaki ko ‘ení ‘e ala hoko ki ha taha ‘okune ma’u ‘a e suka fa’ahinga 2, tatau aipē pē ko e hā ‘a e fa’ahinga faito’o ‘oku fai ki aí.Ko e taimi ko ia ‘oku ma’olunga ai ‘a e tu’unga kulūkousi he totό, ‘oku feinga ‘a e sinό ke ne tukuange ‘a e kulūkousi(suka) ‘oku fu’u lahi ‘i he tu’uofí. ‘E fakatupu lahi ‘a e tu’uofí ‘o ne fakatupu ‘e ia ‘a e holo lahi e vaí he sinό ‘o hoko ‘a emahaki tete, mole ‘a e ongo kotoa he sinό ‘o a’u ‘o mate.Ko e ngaahi ‘uhinga lahi ‘o hoko ‘a e HHS/HONK ko e:• Suka fa’ahinga 2 na’e ‘ikai ke ‘ilo’i fakatoketā• Ha pule lolotonga pē puke ha mahaki pipihi hangē ko e niumōnia pē mahaki’ia e halanga tu’uofí• Ngaahi mahaki lalahi kehe hangē ko e pā kalava, pē mahaki mafu• Puputu’u fakaesino pē fakaeloto• Ngaahi faito’o ‘e ni’ihi. Ko e ‘uhinga ‘eni ‘e taha ‘oku tonu ke ke talanoa ki ho timi mo’ui lelei ki he suká fekau’akimo e ngaahi faito’o ‘oku ke folό.‘Oku kau ‘i he ngaahi faka’ilongá ‘a e:• Mole lahi ‘aupito ‘a e vai mei he sinό• Mo’utāfu’ua• Feliliuaki e ongό• Coma.‘Oku fiema’u ‘e he HHS/HONK ‘a e tokanga fakafaito’o ‘I HE VAVE TAHÁ.65

16Chronic complicationsBlood glucose (sugar) levels that remain high for long periods of time can cause diabetesrelated complications such as eye disease, kidney disease, nerve damage as well as heartdisease and circulation problems. High blood glucose levels also increase the risk of infectionand slow down recovery from infection. For these reasons it is very important that you tryand keep your blood glucose levels within the ranges recommended by your doctor ordiabetes health care team.Diabetes and eye disease:Damage can occur to the back of the eye (retina) where there are very fine blood vesselsimportant for vision. This is called diabetic retinopathy. The development of retinopathy isstrongly related to how long you have had diabetes and how well the blood glucose levelshave been controlled.High blood pressure, high cholesterol levels and kidney failure can also affect the severity ofdiabetic retinopathy.Vision loss or blindness is preventable through early detection and treatment.The treatment for diabetic retinopathy can be laser therapy or surgery.Glaucoma and cataracts can occur at an earlier age and more often in people with diabetes.Cataracts affect the eye’s lens causing it to become cloudy with a loss of vision. The treatmentfor cataracts is surgery.Glaucoma occurs when the pressure inside the eye becomes very high, causing damage tothe optic nerve. The treatment for glaucoma can be eye drops, laser therapy or surgery.Diabetes and kidney disease:Your kidneys help to clean your blood. They remove waste from the blood and pass it out ofthe body as urine.Over time diabetes can cause damage to the kidneys. If the kidneys fail to work properly,waste products stay in the body, fluids build up and the chemical balance is upset. This iscalled diabetic nephropathy.You will not notice damage to your kidneys until it’s quite advanced, however early signs ofkidney problems can be detected through a urine test.Finding out about early kidney damage is simple and painless and should be checked everyyear from the time of diagnosis of diabetes. Treatment at this time can prevent further damage.In severe kidney disease dialysis treatment or a kidney transplant may be needed.People with diabetes are also at increased risk of infection of the bladder, kidneys and urinary tract.The good news is that the risk of developing kidney problems can be reduced by: stoppingsmoking if you smoke, managing your blood glucose levels, having regular kidney and bloodpressure checks and leading a healthy lifestyle.66

16Ngaahi mahaki tauhi mo hono ngaahifaingata’a‘O ka fuofuoloa ‘a e taimi ‘oku ma’olunga e tu’unga kulūkousi (suka) he totό ‘e lava ke fakatupu ha ngaahifaingata’a fakamahaki ‘oku fekau’aki mo e suká hangē ko e mahaki’ia e matá, mahaki’ia e kofuuá, maumaue neavé pea mo e mahaki mafu mo e ngaahi palopalema ki hono tufaki e totό he sinό. ‘Oku fakatupu ‘e hema’olunga ‘o e tu’unga e kulūkousi he totό ha faingata’a ki hono ta’ofi ‘a e ulufia e mahakí mo tuai ‘ene mo’uimei he ulufiá. Koe’uhi ko e ngaahi me’a ni ‘oku mahu’inga fau ke ke feinga ke tauhi ‘a e tu’unga e kulūkousiho totό ‘i he leveolo ko ia ‘oku taukapo’i ‘e ho’o toketā pē timi tauhi mo’ui lelei ‘a e suká.Ko e suká mo e mahaki matá‘E lava ke maumau ‘a e konga ‘i mui ho matá (retina) ‘oku ‘i ai ‘a e ngaahi halanga toto manifi fau ‘okumahu’inga ki he ngāue sio ‘a e matá.’Oku ui ‘eni ko e diabetic retinopathy. ‘Oku kau lahi ‘a e fuoloa hono ma’ukoe ‘e he suká mo hono leva’i ‘o e tu’unga e kulūkousi he totό ki hono fakatupu ‘a e diabetic retinopathy.‘Oku kau kovi ‘aupito ki he diabetic retionopathy ‘a e toto ma’olungá, ma’olunga ‘e tu’unga chloresterolmo e ‘ikai ngāue lelei ‘a e kofuuá.‘E ala ta’ofi ‘a e mole e siό pē kuí ‘o ka ma’u vave ‘a e mahakí pea faito’o leva. Ko e faito’o ‘o e diabeticretinopathy ko e ngāue’aki ‘a e ivi huelo (laser) pē tafa.‘Oku ala hoko ‘a e glaucoma mo e ngaahi tu’utolo ‘i he kei si’í kā ‘oku lahi ange ‘ene hokό ‘i he kakaisuká. ‘Oku fakakuihi ‘e he ngaahi tu’utolo ‘a e matá ‘aki ‘ene uesia ‘a e lens ‘o e matá ‘o tupu ‘a e tu’utoloai. Ko e faito’o ‘o e cataracts ko e tafa.‘Oku hoko ‘a e glaucoma ‘i he lahi hono lomi ‘a e loto matá, ‘o fakatupu maumau ki he neave optic. Koe faito’o ‘o e glaucoma ko e tulu’i e matá, ngāue’aki ‘a e ivi huelό pē tafa.Ko e suká mo e mahaki e kofuuá:‘Oku tokoni ‘a e ongo kofuuá ki hono fakama’a ho totό. ‘Oku na to’o ‘a e ngaahi me’a ta’e’aonga mei hetotό ‘o tukuange ia ki tu’a mei he sinό ko e tu’uofi.‘I ha taimi ‘e ala maumau’i ‘e he suká ‘a e kofuuá. Kapau ‘e ‘ikai ke ngāue lelei ‘a e kofuuá, ‘e nofo ‘a engaahi me’a ta’e’aonga he sinό, fakatupu ‘o lahi ange ‘a e huhu’a vaí pea tokehekehe leva ‘a e palanisi engaahi kemikalé. ‘Oku ui ‘eni ko e diabetic nephropathy.He ‘ikai te ke fakatonga’i ‘e koe ha maumau ki ho kofuuá kae’oua kuo fuoloa ‘ene hokό, ka neongo ia ‘elava ke ‘ilo vave ‘a e ngaahi faka’ilonga ‘o e ngaahi palopalema ‘o e kofuuá ‘i hano fai ha sivi tu’uofi.‘Oku faingofua mo ‘ikai ke ‘i ai ha mamahi ‘i hono ‘ilo kei taimi ‘a maumau e kofuuá pea tonu ke sivifakata’u ma’u pē mei he taimi pē ne ma’u fakatoketā ai ‘oku ke suká. Ka faito’o he taimi ko ‘ení ‘e lava keta’ofi ha toe maumau.‘I ha mahaki’ia lahi ‘a e kofuuá ‘e faito’o ia ‘aki ‘a e dialysis pē ha tafa fakafetongi kofuua ‘o ka fiema’u.‘Oku lahi ange ‘a e tu’unga fakatu’utāmaki ki he kakai suká ke nau ma’u ‘a e mahaki pipihi ‘i he tangamimí,kofuuá mo e halanga tu’uofí.Ka ko hono leleí ‘e lava ke fakasi’isi’i ‘a e tu’unga fakatu’utāmaki ‘o e hoko ha ngaahi palopalema ‘i hekofuuá ‘i hano: ta’ofi ‘a e ifí kapau ‘oku ke ifi, leva’i lelei ‘a e tu’unga e kulūkousi ho totό, toutou sivi ekofuuá mo e toto ma’olungá mo fili ki ha filingamo’ui ‘oku fakamo’ui lelei.67

Chronic complications - continuedDiabetes and nerve disease:Diabetes over time can cause damage to nerves throughout the body. This damage isreferred to as diabetic neuropathy.Neuropathy leads to numbness, changes in sensation and sometimes pain and weakness inthe , feet, legs, hands and arms. Problems may also occur in the digestive tract, heart and sexorgans.Diabetic neuropathy also appears to be more common in people who have:• Problems controlling their blood glucose levels• High levels of blood fat• High blood pressure• Excess weight• An age greater than 40• Had diabetes for a long time.Signs and symptoms of nerve damage may include:• Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers• Muscle wasting of the feet or hands• Indigestion, nausea, or vomiting• Diarrhoea or constipation• Feeling dizzy or faint due to a drop in blood pressure when standing• Visual problems• Problems with urination• Erectile dysfunction (impotence) or vaginal dryness• Sweating and palpitations• Weakness• Dry skin• Dry mouth, eyes, nose.Neuropathy can also cause muscle weakness and loss of reflexes, especially at the ankle,leading to changes in the way the person walks. Foot deformities may occur. Blisters andsores may appear on numb areas of the foot because pressure or injury goes unnoticed,leading to the development of an ulcer. If foot injuries or ulcers are not treated quickly, theinfection may spread to the bone, and in extreme circumstances, may result in amputation.Due to neuropathy and its effect on daily living the person may lose weight and is more likelyto suffer with depression.The best way to minimise your risk for developing neuropathy is to keep your blood glucoselevels as close to the recommended range as possible. Daily foot care is of great importanceto reduce complications.Treatment of neuropathy includes pain relief and other medications as needed, dependingon the type of nerve damage. Discuss the options with your health care team.Diabetes and heart disease/stroke:People with diabetes are at increased risk of heart disease and stroke. Higher thanrecommended blood glucose and cholesterol levels and high blood pressure over longperiods of time damage the large blood vessels. This can lead to heart disease (coronaryartery disease), damage to the brain (cerebral artery disease) and other blood vessel disease(peripheral artery disease).Blood vessel disease is progressive and causes hardening and narrowing of the arteries dueto a gradual build up of plaque (fatty deposits).68

Ngaahi mahaki tauhi mo hono ngaahi faingata’a – hoko atuKo e suká mo e mahaki ‘o e neavé:Diabetes over time can cause damage to nerves throughout the body. This damage isreferred to as diabetic neuropathy.Neuropathy leads to numbness, changes in sensation and sometimes pain and weakness inthe , feet, legs, hands and arms. Problems may also occur in the digestive tract, heart and sexorgans.‘Oku lahi ange ‘a e ‘asi ‘a e diabetic neuropathy ‘i he kakai ‘oku nau:• Palopalema’ia hono leva’i ‘a e tu’unga e kulūkousí he totό• Ma’olunga e ngako he totό• Toto ma’olunga• Fu’u lahi e fua mamafá• Lahi e ta’u motu’á ‘i he 40• Suka fuoloa.‘Oku kau e ngaahi faka’ilonga ‘o e mamau e neavé ‘a e:• Ongo’i mamate, mofisifisi, pē mamahi e louhi’i va’é, va’é, nimá, umá mo e louhi’i nimá• Vaivai ‘a e ngaahi uoua ‘o e va’é pē nimá• Futengia, tokakovi pē lua• Fakalele pē faingata e tu’umama’ό• Ongo’i ninimo pē pongia ho’o tu’ú koe’uhi ko ha tōlalo e fua e totό• Ngaahi palopalema sio• Ngaahi palopalema tu’uofi• ‘Ikai ngāue lelei ‘a e me’a fakatangatá (impotence) pē mōmoa e me’a fakafefiné• Pupuha’ia mo tā vavevave e mafú• Ongo’i vaivai• Pakupaku e kilí• Pakupaku e ngutú, matá, ihú.‘E ala fakatupu ‘e he neuropathy ‘a e vaivai ‘o e uouá mo mole ‘a e reflexes, tautefito ki heva’é, ‘o tupu ai ‘a e liliu ‘i he lue ‘a e tokotahá ni. ‘E lava ke fōlinga kehe ‘a e va’é. ‘E ala ‘asi hangaahi mata’i pala ‘i he feitu’u ko ē ‘i he va’é ’oku mamaté koe’uhi ka lomi’i pē lavea ia ‘e ‘ikaifakatokanga’i, pea ‘e lava ke fakatupu pala. Kapau ‘e ‘ikai ke faito’o vave ‘a e laveá pē palá, ‘e lavake pipihi ki he huí ‘ae ngaahi siemu, pea ka kovi ‘aupito, ‘e ala tu’usi.Koe’uhi ko e uesia ‘a e mo’ui faka’aho ‘a ha tokotaha ‘e he neuropathy mo hono ngaahi ola koví‘e lava ke holo e sinό pea ‘e ala ke ne ongo’i ongosia faka’atamai.Ko e founga lelei taha ke fakasi’isi’i ho’o ma’u ‘a e neuropathy ko hono tauhi ‘a e kulūkousí ‘i hototό ‘i he tu’unga ‘oku fakafiemālie tahá. ‘Oku mahu’inga lahi foki ke tokanga’i faka’aho e va’é kefakasi’isi’i e ngaahi faingata’a ‘e hokό.‘Oku kau hono faito’a e neuropathy ‘a e folo fo’i’akau pe faito’o ‘oku ne fakafiemālie ‘a emamahí mo e ngaahi faito’o kehe ‘o ka fiema’u, ‘o fakatatau ki he fa’ahinga maumau ‘oku hono‘i he neavé. Talanoa mo ho timi tauhi mo’ui leleí ki he ngaahi me’a ‘oku ala faí.Ko e suká mo e mahaki mafu/pā kalava:‘Oku ‘i ai ‘a e tu’unga fakatu’utāmaki ‘o malava ke hoko ‘a e mahaki mafu mo e pā kalava ki hekakai suká. ‘Oku hoko ‘a e maumau ki he ngaahi kālava toto lalahí kapau ‘e ma’olunga ange ‘a ekulūkousí he totό mo e cholesterol mo e toto ma’olungá ‘i he tu’unga ‘oku totonu ke ‘oi aí ‘i hataimi lōloa. ‘E lava ke hoko ai ‘a e mahaki mafu (ngaahi mahaki felāve’i mo e kālava ki he mafú),mamau ‘a e ‘utό (ngaahi mahaki felāve’i mo e kālava ki he ‘utό) mo e ngaahi mahaki kehe ‘i hengaahi kālavá (ngaahi mahaki kehe ‘i he kālavá).69

Chronic complications - continuedCoronary artery disease is the most common form of heart disease. Blood carries oxygen andother important nutrients to your heart. Blood vessels to your heart can become partially ortotally blocked by fatty deposits. Chest pain (angina) or a heart attack occurs when the bloodflow supplying oxygen to your heart is reduced or cut off.Over time, coronary artery disease can weaken the heart muscle and lead to heart failurepreventing the heart from pumping blood properly to the rest of the body. This can also leadto abnormal beating rhythms of the heart.A stroke occurs when blood supply to part of your brain is interrupted and brain tissue isdamaged. The most common cause is a blocked blood vessel. Stroke can cause physicalproblems such as paralysis, problems with thinking or speaking, and emotional problems.Peripheral artery disease occurs when blood vessels in your legs are narrowed or blockedby fatty deposits causing reduced blood flow to your legs and feet.Many people with diabetes and peripheral artery disease do not have any symptoms.Other people may have the following symptoms:• leg pain, particularly when walking or exercising, which disappears after a few minutes of rest• numbness, tingling, or coldness in the lower legs or feet• sores or infections on feet or legs that heal slowly.Certain exercises, such as walking, can be used both to treat peripheral arterial disease andto prevent it. Medications may help relieve symptoms. In advanced cases treatment mayinvolve surgical procedures.You can lower your risk of blood vessel damage by keeping your blood glucose, bloodpressure and cholesterol in the recommended range with healthy eating, physical activity,and medication. Quitting smoking is essential to lower your risk.Diabetes and infection:High blood glucose levels can lower your resistance to infection and can slow the healingprocess.Oral health problems and diabetesWhen diabetes is not controlled properly, high glucose levels in saliva may increase theamount of bacteria in the mouth and may also cause dryness of the mouth. Blood glucose(sugar) levels that stay high for long periods of time reduces the body’s resistance toinfection, and the gums are likely to be affected.Periodontal diseases are infections of the gums and bones that hold your teeth in place. Evenif you wear dentures, you should see your dentist at least once a year.Signs and symptoms of oral health problems include:• Gums that are red and swollen, or that bleed easily• Persistent bad breath or bad taste in the mouth• Any change in the fit of dentures.Fungal infections /ThrushThrush is the term used for a common infection caused by a yeast-like fungus.Yeast infections are often associated with diabetes, especially when the blood glucose level isvery high. Persistent cases of thrush may sometimes be an early sign of diabetes.Thrush can occur in the mouth, throat, digestive tract, vagina or on the skin. It thrives in themoist areas of the body.70

Ngaahi mahaki tauhi mo hono ngaahi faingata’a – hoko atu‘Oku tupulaki ‘a e ngaahi mahaki kālava totú ‘o ne fakatupu ‘a e fakafefeka mo e fakafāsi’i ‘a engaahi kālavá koe’uhi ko e tānaki ‘a e plaque (tānaki’anga ‘a e ngako).Ko e fa’ahinga mahaki mafu ‘oku lahi tahá ‘a e mahaki kālava ki he mafú. ‘Oku hanga ‘e he totό‘o ‘ave ‘a e ‘oxygen mo e ngaahi me’afakaivi keheke ki ho mafú. ‘E lava ke hanga ‘e he ngakό ‘otāpuni fakakonga pē tāpuni’i ‘aupito ‘a e ngaahi kālava ki ho mafú. ‘Oku mamahi ‘a e fatafatá(angina) pē hoko ha mahaki mafu ‘i he taimi ‘oku si’isi’i pē ta’ofi ai ‘a e tafe ‘a e toto ‘oku ne tufa‘a e oxygen ki ho mafú.Hili ha ngaahi taimi, ‘e lava ‘e he mahaki kālava ki he mafú ‘o fakavaivai’i ‘a e uoua ‘o e mafú ‘o‘ikai ngāue ‘a e mafú pea ne ta’ofi ‘a e pamu fakalelei ‘e he mafú ‘a e toto ki he toenga ‘o e sinό.‘E ala hoko heni ha tā fetō’aki ‘a e ‘a e mafú.‘Oku hoko ‘a e pā kalava ‘i he taimi ‘oku fakafaingata’a ai ‘a e ‘ave ‘a e totό ki he konga ho ‘utόpea mamau foki mo e kofukofu ‘i he ‘utό. Ko e ‘uhinga lahi ‘oku fa’a hoko aí ko ha poloka ‘a hakālava toto. ‘Oku lava ke fakatupu ‘e he pā kalavá ‘a e ngaahi palopalema fakasino hangē ko emamatea, ngaahi palopalema ‘i he fakakaukaú pē leá, mo e ngaahi palopalema fakaeloto.‘Oku hoko ‘a e ngaahi mahaki kehe ‘i he kālavá ‘i he taimi ko ia ‘oku fāsi’i ai pē poloka ‘e hengako kuo tānakí ‘i ho va’e ‘o ne fakasi’isi’i ‘a e tafe ‘a e totό ki ho alangá mo e va’é.‘Oku tokolahi ‘a e kakai suka ‘oku nau ma’u ‘a e ngaahi mahaki kehe ‘i he kālavá ‘oku ‘ikai ‘asi hangaahi faka’ilonga. Ka ko e kakai kehe ia te nau ala ma’u ‘a e ngaahi faka’ilonga ko ‘ení:• mamahi e va’é, tautefito ‘i he luelué pē fakamālohisinό, ka ‘e pulia hili ha mālōlō taimi nounou• mamate, mofisifisi, pē momoko ‘a e konga ki lalo e va’é• ngaahi pala pē pipihi e siemú ‘i he va’e ‘oku tuai ‘ene mo’uí.‘E lava ke fakatou faito’o ‘a e ngaahi mahaki kehe ‘i he kālavá mo ta’ota’ofi ia ‘aki hano faie ngaahi fakamālohisino hangē ko e luelué. ‘E ala tokoni ‘e he ngaahi faito’o ‘a e ngaahifaka’ilongá. ‘I he ngaahi mahaki ‘oku lahi angé ko e faito’o ‘e ala faí ko e tafa.‘E lava ke fakasi’isi’i ‘a e tu’unga fakatu’utāmaki ‘o e mamau ki he kālava totό ‘aki ha’o tauhi ‘ae kulūkousí ‘i ho totό, toto ma’olungá mo e cholesterol ‘i he tu’unga ‘oku fakafiemālie tahá ‘iha’o kai fakamo’uilelei, fakamālohisino, mo e tauhi e ngaahi faito’o. ‘Oku fiema’u ke tuku e ifí keholoki ‘a e tu’unga fakatu’utāmaki ‘oku ke ‘i aí.Ko e suká mo e siemu pipihi:‘Oku lava ke holoki ‘e he tu’unga ma’olunga ‘e kulūkousí he totό ‘a ho’o malava ke matatali ‘a esiemu pipihí pea ‘e tuai ‘ene mo’uí.Ngaahi palopalema mo’uilelei e loto ngutú mo e sukáKo e taimi ko ia ‘oku ‘ikai leva’i lelei ai ‘a e suká, ‘e lahi ange ‘a e tu’unga kulūkousi he fāvaí ‘o fakatupuai ha ngaahi siemu (bacteria) lahi ‘i he ngutú pea ‘e lava ke ne toe fakatupu mo ha mōmoa e ngutú.Ko e fuoloa ange ‘a e nofo ma’olunga ‘a e tu’unga kulūjkousi he totό ko e si’i ange hono malava ‘ehe sinό ke ne ta’ofi ‘a e ngaahi siemu pipihí, pea ‘e lava ke ne uesia ‘a e te’enifό.Ko e ngaahi mahaki peridontal ‘a ē ‘oku uesia ‘e he siemu pipihí ‘a e te’enifό mo e ngaahi hui‘oku ne pukepuke ma’u ho nifό. Tatau aipē pe ‘oku ke tui ha nifo loi, ‘oku totonu ke ke sio kiho’o toketā nifό he ta’u kotoa.Ko e ngaahi faka’ilonga ‘o e ngaahi palopalema ki he mo’uilelei ‘a e loto ngutú ‘oku kau ai ‘a e:• Ngaahi te’enifo ‘oku kula mo pupula, pē totototo vave• Fa’a namukū ‘a ho mānavā pē ngutú• Liliu ke hao ho nifoloí.71

Chronic complications - continuedOral thrush, a fungal infection in the mouth, appears to occur more frequently among peoplewith diabetes including those who wear dentures. Thrush produces white (or sometimes red)patches in the mouth. It may cause a painful, burning sensation on your tongue. It can affectyour ability to taste foods and may make it difficult for you to swallow.In women, vaginal thrush is a very common infection. A common symptom is itching andsoreness around the vagina.Urinary tract infections are more common in people with diabetes. They are caused bymicro-organisms or germs, usually bacteria.Signs and symptoms include:• Wanting to urinate more often, if only a few drops• Strong smelling and cloudy urine• Burning pain or a ‘scalding’ sensation on urination• A feeling that the bladder is still full after urination• Blood in the urine.It is important to see your doctor immediately if any infection is suspected.72

Ngaahi mahaki tauhi mo hono ngaahi faingata’a – hoko atuNgaahi siemu pipihi fungal/ThrushKo e fo’ilea ko e thrush ‘oku ‘uhinga ia ki ha mahaki pipihi ‘oku lahi ‘ene hokό pea fakatupu‘e ha fungus hangē ha īsitē. Ko e ngaahi mahaki pipihi pehē ni ‘oku fa’a fekau’aki mo e suká,tautefito ki he taimi ‘oku ma’olunga lahi ai ‘a e tu’unga kulūkousi ‘i he totό. ‘E lava ke ‘asi vave ‘ae faka’ilonga ‘o e suká kapau ‘oku toutou lahi ‘a e ‘asi ‘a e thrush.‘Oku ala hoko ‘a e thrush ‘i he ngutú, mongá, feitu’u ‘i he sinό ‘oku momosi ai ‘a e me’akaí, ‘i heme’a fakafefiné pē ‘i he kilí. ‘Oku mo’ui lelei ‘i he ngaahi konga ‘o e sinό ‘oku hauhau.‘Oku lahi ‘a e ‘asi ‘i he kakai suká ‘o kau ai e ni’ihi ‘oku nau nifo loí’a e thrush he ngutú, pea mo esiemu pipihi fungal ‘o e ngutú. ‘Oku fakatupu ‘e he thrush ha me’a lanu hinehine (fa’a kulokulahe taimi ‘e ni’ihi) ‘i he ngutú. ‘Oku ne fa’a fakatupu ha ongo ‘oku mamahi, mo vevela ‘i ho ‘elelό.‘E lava ke ne uesia ‘a e fakaifo kaí pea ‘e lava ke faingata’a ho’o folo e me’akaí.‘Oku fa’a hoko ‘i he kakai fefiné ‘a e thrush honau me’afakafefiné. Ko ha faka’ilonga ‘oku fa’ahokό ko e veli pea mamahi e tafatafa’aki me’afakafefiné.‘Oku lahi ‘a e hoko’a e siemu pipihi he halanga tu’uofí ‘i he kakai suká. ‘Oku fakatupu ‘eni ‘e hefanga ki’i manu iiki ‘aupito pē siemu, ‘o lahi ko e bacteria.Ko e ngaahi faka’ilongá ‘oku kau ai ‘a e:• Fie toutou tu’uofi, tatau aipē pē ‘oku si’isi’i• Nanamu mālohi e tu’uoí mo lanu melo• Ongo’i vela pē ha ongo ‘velahia’ ‘i he tu’uofí• Ongo ‘oku kei fonu ‘a e tangamimí neongo kuo ‘osi tu’uofi• Toto ‘i he tu’uofí.‘Oku mahu’inga ke ke sio ki ho toketā ‘i he vave tahá kapau ‘oku ngali ‘i ai ha siemu pipihi.73

17Diabetes and your FeetDiabetes may affect the feet in two ways.Firstly, nerves which allow you to feel pain, temperature and give an early warning of possibleinjury, can be damaged.Secondly, the blood supply to the feet can be reduced due to blockage of the blood vessels.Damage to the nerves and blood vessels is more likely if you have had diabetes for a longtime, or if your blood glucose (sugar) levels have been too high for too long.It is recommended that people with diabetes should be assessed by a podiatrist or doctor atleast every six months. They will advise a common sense, daily care routine to reduce the riskof injuries and complications.It is also essential to check your feet every day for any problems.Caring for your feet• Maintain blood glucose levels within the range advised by your doctor• Help the circulation to your feet with some physical activity like walking• Know your feet well– Look at your feet daily. Use a mirror if you need to. Check between your toes– Wash your feet daily in warm (not hot) water, using a mild soap. Dry gently and thoroughly– Never soak your feet– Use a moisturiser to avoid dry skin– Only cut your toenails if you can do so safely. Cut straight across – not into the corners –and gently file away any sharp edges.• Choose footwear which is appropriate for your activity. Smooth out wrinkles in socks• Check your shoes regularly for excess wear on the outside and for any rough spots on theinner lining• Avoid foot injuries by wearing shoes or slippers around the house and footwear at thebeach or pool• Avoid contact with very hot or cold items, such as hot water bottles, heaters, electricblankets, hot sand/pathways and hot bath water• Wear insulated boots to keep feet warm on cold days• Corn cures and medicated pads can burn the skin. Do NOT treat corns yourself - see yourpodiatrist• Get medical advice early if you notice any change or problems with your feet.74

17Suká mo ho Va’é‘Oku lava ‘e he suká ‘o uesia ho va’é ‘i ha founga ‘e ua.‘Uluakí, ‘oku ngali maumau ‘a e ngaahi neave ‘oku ne fakahoko kiate koe ‘a e ongo mamahí, fuamāfaná pea ne ‘oatu ha fakatokanga vave ka ngali hoko ha lavea.Uá, ‘e ala holo ‘a e ma’u’anga toto ki he va’é koe’uhi ko e poloka ‘a e ngaahi halanga totό.Ko e maumau ki he ngaahi neavé mo e halanga totό ‘oku ala tupu ia mei he fuoloa hono ma’ukoe ‘e he suká, pē na’e tu’u he tu’unga ma’olunga ‘o fuoloa ‘a e kulūkousí (suka) ‘i ho totό.’Okufokotu’u atu ki he kakai suká ke nau feinga sio ki ha toketā va’e pē ha toketā fakamāhina ono.Te nau ‘oatu ha fale’i fakapotopoto, polokalama faka’aho ke holoki ‘a e tu’unga fakatu’utāmakiki ha hoko ha ngaahi lavea pē ngaahi ola kovi kehe ‘e ala hoko.‘Oku mahu’inga fau ke ke sivi faka’aho ho va’é ki ha ngaahi palopalema.Ko hono tokanga’i ho va’é• Tauhi ‘a e tu’unga kulūkousi he totό ‘i he tu’unga kuo fale’i ‘e ho’o toketā• Tokoni’i ‘a e tufaki e totό ki ho va’é ‘aki ha’o fakamālohisino hangē ko e lué• ‘Ilo ki he tūkunga ho va’é– Sio faka’aho ki ho va’é. Ngāue’aki ha sio’ata ka fiema’u. Vakai’i ‘a e vaha’a louhi’i va’é.– Fufulu faka’aho ho va’e ‘i ha vai mafana (‘ikai vela), ‘o ngāue’aki ha koa ‘oku ‘ikai ke fu’umālohi. Fakaalaala mo holo ke mātu’ú lelei– ‘Oua ‘aupito te ke fakavai ho va’é– Ngāue’aki ha kilimi fakahauhau kili ke ne ta’ofi ‘a e mōmoa e kilí– Tutu’u ho nge’esi va’é kapau te ke lava lelei. Tutu’u hangatonu pē ‘oua te ke tutu’u e tulikinge’esi va’é – pea ke faile ma’ama’a pē ‘a e ngaahi feitu’u ‘oku māsilá• Fili ‘a e sū ‘oku fe’unga mo ho’o ngaahi me’a ‘oku faí. Fakatokalelei ‘a e ngaahi manuminumi ‘ihe sitōkená• Vakai’i ma’u pē ho ngaahi sū na’a ‘oku mahaehae ‘a tu’a pea na’a ‘oku ‘i ai ha ngaahi konga ‘ihe ‘aofi sū ‘oku fefeka mo tokakovi• Faka’ehi’ehi mei hono fakalavea ‘o e va’é ‘aki ha’o tui sū pē silipa ‘i fale pea mo tui sū ‘i hematātahí pē vaikaukaú• Faka’ehi’ehi mei he ala ki ha me’a vela ‘aupito pē ngaahi me’a momoko, hangē ko e hinavaifakamāfana, ngaahi me’a fakamāfana, kafu fakamāfana ‘uhila, ‘one’one vela/hala vela mo evai kaukau vela• Tui ha puti māfana ke ne fakamāfana’i ho va’é he ngaahi ‘aho momokό• ‘Oku lava ke vela ‘a e kilí kapau ‘e ngāue’aki ‘a e ngaahi faito’o ki he tunga e va’é mo e ngaahivavae faito’ό. ‘OUA te ke faito’o ‘e koe ‘a e va’e tungá – sio ki ho toketā va’é• Kumi fale’i fakafaito’o ‘i he vave tahá kapau ‘oku ke fakatokanga’i ha liliu pē palopalema moho va’é.75

18Diabetes and PregnancyThe key to a healthy pregnancy for a woman with diabetes isplanning, Before you become pregnant discuss your target bloodglucose levels or other pregnancy issues with your doctor ordiabetes educator.Note: the target blood glucose levels are tighter during pregnancy.You will need a diabetes management plan that balances meals,physical activity and diabetes medication (usually insulin).This plan will change as your body changes during your pregnancy.If your pregnancy is unplanned it is important to work with yourmedical team as soon as you know you are pregnant.Why you need to keep your blood glucose levels within therecommended range for pregnancyHaving good blood glucose management reduces the risk of the baby having anyabnormalities when all of its organs are being formed in the first 12 weeks of pregnancy. Asyour pregnancy progresses, it is very important that you maintain good blood glucose levelsotherwise extra sugar in your blood will pass to the baby who can then become big. Deliveryof big babies can cause problems.Who will help you before, during and after your pregnancy?Apart from your diabetes health care team, other health professionals that will support youare:• an obstetrician (a specialist doctor that looks after pregnant women)• a neonatal paediatrician (a specialist doctor that looks after babies)• a midwife (a nurse, who assists women in childbirth).Exercise, especially for people with type 2 diabetes, is a key part of diabetes managementbefore, during and after pregnancy.Discuss your exercise plans with your diabetes health care team.In general, it’s not a good idea to start a new strenuous exercise program during pregnancy.Good exercise choices for pregnant women include walking, low-impact aerobics orswimming.76

18Suká mo e FeitamáKo e kī ki he mo’ui leleí ‘a ha fefine suka ‘oku feitama ko e palani.Kimu’a pea ke feitamá talanoa mo ho toketā pē faiako suká ki hetāketi ‘oku tonu ke ‘i ai e tu’unga ‘o e kulūkousi ho totό pē ha ngaahime’a kehe fekau’aki mo e feitamá.Tokanga: ‘oku toe fu’u mahu’inga ange ke tāketi’i ke tonu ‘aupito ‘a etu’unga ‘o e kulūkousi ‘i he totό lolotonga ‘a e feitamá.‘E fiema’u ke ‘i ai ha’o palani leva’i ‘o e suká ke ne palanisi ‘a e kaí,fakamālohisinό mo e faito’o ki he suká (fa’a ‘ai ki he ‘inisuliní).‘E liliu ‘a e palani ko ‘ení ‘o fakatatau ki he feliliuaki ‘oku hoko ki ho sinόlolotonga ho’o feitamá.Kapau na’e ‘ikai palani ho’o feitamá ‘oku mahu’inga ke ke ngāue moho’o timi fakafaito’ό ‘i ho’o ‘ilo pē kuo ke feitamá.Ko e ‘uhinga ‘oku mahu’inga ai ke tauhi lelei ‘a e tu’unga kulūkousi he totό ‘i he feitamá‘I hono leva’i lelei ‘a e kulūkousi he totό ‘e holoki ‘a e tu’unga fakatu’utāmaki ‘e ala hoko kihe ngaahi ‘okani ‘o e sino e pēpē lolotonga ‘ene tupu ‘i he ‘uluaki uike ‘e 12 ‘o e feitamá. ‘I hehokohoko atu e feitamá, ‘oku mahu’inga ‘aupito ke ke tauhi ke lelei ‘a e tu’unga kulūkousi hetotό ka ‘ikai ‘e paasi ki he pēpē ‘a e suka lahi makehe ‘oku ‘i ho totό pea ‘e ala tupu lahi ia. ‘E alahoko ha ngaahi palopalema ‘i ho fā’ele’i e ngaahi pēpē lalahí.Ko hai ‘e tokoni kiate koe kimu’a, lolotonga mo e ‘osi e feitamá?Tukukehe ‘a e timi taukei mo’ui lelei ki he suká ‘oku ‘i ai mo e kau taukei ‘i he mo’ui leleí kehe tenau tokoni kiate koe ko e:• toketā faifā’ele (ko ha toketā taukei ‘i hono tokanga’i e kakai fefine feitamá)• toketā pēpē (ko ha toketā taukei ‘i hono tokanga’i e fanga ki’i pēpē)• ko e neesi faifā’ele (ko e neesi, ‘oku tokoni ki he kakai fefine lolotonga ;enau fā’elé).Ko e fakamālohisinό, ‘a e kī ki hono leva’i ‘a e suká kimu’a, lolotonga mo e ‘osi ‘a e feitamá, ‘ofakatautefito ki he kakai ‘oku nau ma’u ‘a e suka fa’ahinga 2.Talanoa ki ho timi mo’ui lelei suká fekau’aki mo ho’o palani fakamālohisinό.‘I he lau fakalūkufuá, ‘oku ‘ikai ko ha fakakaukau lelei ke kamata ha polokalama fakamālohisinofefeka fo’ou lolotonga e feitamá. Ko e ngaahifakamālohisino lelei ma’ae kakai fefine feitamá ‘oku kauai ‘a e lue, low-impact aerobics pē kakau.77

19Diabetes and your emotionsChronic diseases such as diabetes can have a major impact onyour emotions because they affect every aspect of your life.The physical, mental or emotional reactions to the diagnosis ofdiabetes and the ability to cope may impact on your diabetes,your family, your friends and your work colleagues.When a person is diagnosed and living with diabetes there canbe many emotions that may be experienced. These include:• Guilt• Frustration• Anger• Fear• Anxiety• DepressionMany people do not like the idea that they may have mental oremotional problems. Unfortunately, they find it embarrassing orview it as a weakness. Having diabetes increases your riskof developing depression. Tell your doctor how you feel.If you feel you are more comfortable talking with othermembers of your diabetes health care team such as adiabetes educator or podiatrist, talk to them.You need to tell someone. Then you will be referred tothe right person who can help you move in the rightdirection.Recommended websites:www.australiandiabetescouncil.comwww.beyondblue.org.auwww.diabetescounselling.com.auwww.blackdoginstitute.org.auwww.diabeteskidsandteens.com.au78

19Suká mo ho ngaahi Ongo Fakaelotό• Ongo’i tautea• Ta’emanonga• ‘Ita• Ilifia• Hoha’a• Ha’iha’isia fakaeloto pē faka’atamai.Chronic diseases such as diabetes can have a major impact onyour emotions because they affect every aspect of your life.The physical, mental or emotional reactions to the diagnosis ofdiabetes and the ability to cope may impact on your diabetes,your family, your friends and your work colleagues.‘E ala uesia ho ngaahi ongo fakaelotό ‘e he ngaahi mahaki tauhihangē ko e suká koe’uhi ‘oku ‘i ai ‘ene kaunga ki he me’a kotoa ‘iho’o mo’uí.Ko e ngaahi ongo fakasino, ‘atamai pē fakaeloto hili hono ma’ufakatoketā ‘a e suka ‘iate koé pea mo e founga ho’o matatali ‘ae ngāue ‘a e suka ‘iate koé, ho fāmilí, kaungāme’á pea mo hokaungā ngāué.‘O ka sivi fakatoketā ‘o ma’u ha taha ‘oku suka ‘e ala hoko e ngaahiongo fakaeloto ko ‘eni. Hangē ko e:‘Oku tokolahi ‘a e kakai ‘oku ‘ikai ke nau sai’ia ‘i he pehē‘oku nau ma’u ‘a e palopalema faka’atamai pē fakaeloto.Me’apango, ‘enau pehē ko e me’a fakamā ia pē nau sio koe me’a pē ‘a e kau ngāvaivai. ‘Oku hiki ‘e he mahaki suká ‘ae tu’unga fakatu’utāmaki ki ha’o ongo’i ha’iha’isia fakaelotopē faka’atamai. Tala ki ho toketā ‘e me’a ‘oku ke ongo’í.Kapau ‘e sai ange kiate koe ke ke talanoa ki ha mēmipakehe ‘i ho timi tauhi mo’ui lelei ki he suká hangē ko efaiako suká pē toketā taukei ki he va’é.‘Oku fiema’u ke ke tala ki ha taha. Pea ‘e fakahoko koe ki hetokotaha totonu ke ne tokoni kiate koe ke ke ‘alu ki he feitu’u totonu.Ngaahi uepisaiti ‘oku fokotu’u atu:www.australiandiabetescouncil.comwww.beyondblue.org.auwww.diabetescounselling.com.auwww.blackdoginstitute.org.auwww.diabeteskidsandteens.com.au79

20Diabetes and drivingHigh or low blood glucose (sugar) levels in people with diabetes can affect their abilityto drive safely. People with diabetes may have developed complications such as visionproblems, heart disease or nerve damage, which also can affect driving ability. It is vital thatpeople with diabetes know what to do in order to keep themselves and others safe while onthe road.Austroads, the road transport and traffic safetyauthority for Australia and New Zealand, hasdeveloped guidelines for doctors to help assess theirpatient’s fitness to drive. Diabetes and cardiovasculardisease are just two of the many conditions for whichthere are specific medical standards and guidelineswhich must be met for licensing and insurance.The main concern when driving is a low blood glucose(sugar) level. It can affect a driver’s ability to reactand concentrate. Low blood glucose can also causechanges in consciousness which could lead to losingcontrol of the vehicle. People who are taking certaindiabetes medication and/or insulin are at risk ofhypoglycaemia.Ask your doctor or diabetes educator if you are at risk.Hyperglycaemia or high blood glucose levels can also affect driving ability as it can causeblurred vision, fatigue and decreased concentration.Medical Standards for LicensingPrivate and Commercial – People with diabetes who are managed without medication donot need to notify the Drivers Licensing Authority and may drive without license restriction.However, they should be reviewed regularly by their doctor for progression of the disease.Private Licence – People with diabetes who are managed with medication, but not insulin,and do not have any diabetes complications do not need to notify the Drivers LicensingAuthority. They need to be reviewed every five years (meeting all other Austroads criteria). Ifyou do have any acute or chronic complications a conditional licence may be granted afterreview by your treating doctor.Commercial Licence – People with diabetes who are managed with medication, but notinsulin, need to notify the Drivers Licensing Authority in person. A conditional driver’slicence may be granted subject to the opinion of the specialist, the nature of the driving taskand at least an annual review (meeting all other Austroads criteria)Private Licence – People with diabetes who are managed with insulin need to notify theDrivers Licensing Authority in person. A conditional licence may be granted subject to theopinion of the specialist/treating doctor, the nature of the driving task and at least a twoyearly review (meeting all other Austroads criteria)80

20Suká mo e faka’ulí‘Oku ala uesia ‘a e malava pē ta’emalava ke faka’uli malu ‘a e kakai suká ‘o ka ma’olunga pēma’ulalo e tu’unga kulūkousi he totό (suka). ‘Oku ala ke fakatupu ‘i he kakai suká ‘a e ngaahipalopalema ‘i he siό, mahaki mafu pē maumau ‘a e neavé, ‘a ia te ne uesia foki mo e malavapē ta’emalava ke faka’ulí. ‘Oku mātu’aki mahu’inga ke ‘ilo’i ‘e ke kakai suká ‘a e me’a te nau fai ketauhi ke malu kinautolu mo e kakai kehe lolotonga ‘enau faka’uli ‘i he halá.Kuo hanga ‘e Austroads, ko e ma’umafai pule ki hefefononga’aki malu he halá ma’a ‘Aositelēlia mo Nu’uSilá, ‘o fokotu’u ‘a e ngaahi fakahinohino ma’ae kautoketā ke nau tokoni ki hono sivi ‘a e tu’unga ‘o ‘enaukau mahakí ke ma’u e fakafuofua pē ‘oku taau kenau faka’uli. Ko e suká mo e mahaki mafú ko e ongomahaki ‘e ua ‘i he ngaahi mahaki kehekehe oku ‘i ai ‘ae ngaahi fiema’u tefito mo e fakahinohino pau ke faikimu’a pea laiseni mo ‘inisua.Ko e me’a ke fai ki ai ‘a e tokanga lahi tahá ko e faka’ulilolotonga ‘oku ma’ulalo e tu’unga kulūkousi (suka) hetotό. ‘E lava ke ne uesia ‘a e malava pē ta’emalava kematatali ha me’a mo e fai fakatokanga. ‘E ala fakatupu‘e he ma’ulalo ‘a e kulūkousi he totό ‘a e ngaahi liliu kihe faka’ilo’ilό mo ‘a’ā pea ‘e ala hoko ai ha faingata’a ke pule’i ’a e me’alelé. ‘Oku ‘i he tu’ungafakatu’utāmaki ke hoko ‘a e hypoglycaemia ‘i he kakai ‘oku nau folo pē ngāue’aki e faito’o suka‘e ni’ihi pea/pē mo e ‘inisuliní.‘Eke ki ho toketā pē ho’o faiako suká pē‘oku ke ‘i ha tu’unga fakatu’utāmaki.‘Oku ala uesia ‘e he hyperglycaemia pē ma’olunga e tu’unga kulūkousi he totό ‘a e malava pēta’emalava ke faka’ulí koe’uhi ‘oku ne fakatupu nenefu ‘a e siό , ongosia pea mo holo ma’u ‘a efakakaukaú.Ngaahi Fiema’u Tefito Fakafaito’o ki he LaiseníTaautaha mo Komēsiale – Ko kinautolu ‘oku ‘ikai ke nau ngāue’aki ha faito’o ka ‘oku leva’i leleihonau suká ‘oku ‘ikai fiema’u ke nau tala ki he Ma’u Mafai Pule ki he Laiseni Faka’ulí pea ‘oku saipē ke nau faka’uli ta’e ‘i ai ha fakangatangata laiseni. Ka neongo ia, ‘oku tonu ke toutou vakai’ima’u pē kinautolu ‘e he’enau toketā ki ha tupulaki ‘a e mahakí.Laiseni Fakafo’ituitui – Ko kinautolu ‘oku leva’i honau suká ‘aki ha faito’o, ‘o ‘ikai ko e ‘inisulini,pea ‘ikai ha ngaahi faingata’a ki honau suká ‘oku ‘ikai fiema’u ke nau tala ki he Ma’u Mafai Puleki he Laiseni Faka’ulí. ‘Oku fiema’u ke toe sivi fakata’u nima (mo fakafiemālie ‘a e ngaahi fiema’ufakahokohoko ‘a e Austroads). Kapau ‘oku ‘i ai hao mahaki fakataimi pē mahaki tauhi ‘e ala ‘oatuha laiseni fakangatangata ‘i ha ‘osi hono toe sivi koe ‘e ho’o toketā tauhí.Laiseni Komēsiale – Ko kinautolu ‘oku leva’i honau suká ‘aki ha faito’o, ‘o ‘ikai ko e ‘inisulini, ‘okufiema’u ke nau ‘alu tonu ‘o tala ki he Ma’u Mafai Pule ki he Laiseni Faka’ulí. ‘E ala ‘oatu ha laisenifakangatangata kae makatu’unga ‘i he lau ‘a e toketā taukeí, natula ‘o e ngāue faka’ulí pea moha toe sivi fakata’u (mo fakafiemālie ‘a e ngaahi fiema’u fakahokohoko ‘a e Austroads).81

Diabetes and driving - continuedCommercial Licence – People with diabetes who are managed with insulin need to notifythe Drivers Licensing Authority in person. A conditional licence may be granted subjectto the opinion of the diabetes specialist, the nature of the driving task and annual review(meeting all other Austroads criteria).Other factors can affect your driver’s licence. Ask your doctor. Otherwise contact the DriversLicensing Authority in your State:• Australian Capital Territory - Department of Urban ServicesPhone: (02) 6207 7000• New South Wales - Roads and Traffic Authority NSWPhone: (02) 9218 6888• Northern Territory - Department of Planning and InfrastructurePhone: (08) 8924 7905• Queensland - Queensland TransportPhone: 13 23 80• South Australia - Department of Transport, Energy and InfrastructurePhone: (08) 8343 2222• Tasmania - Department of Infrastructure Energy and ResourcesPhone: 13 11 05• Victoria - VicRoadsPhone: (03) 9854 2666• Western Australia - Department for Planning and InfrastructurePhone: 13 11 56(08) 9427 8191If you require further information access the Austroads websitehttp://www.austroads.com.au/aftd/index.html82

Suká mo e faka’ulí – hoko atuLaiseni Taautaha – Ko kinautolu ‘oku nau leva’i honau suká ‘aki ‘a e ‘inisulini ‘oku fiema’u kenau ‘alu tonu ‘o tala ki he Ma’u Mafai Pule ki he Laiseni Faka’ulí.‘E ala ‘oatu ha laiseni fakangatangata kae makatu’unga ‘i he lau ‘a e toketā taukeí/tauhí,natula ‘o e ngāue faka’ulí pea mo ha toe sivi fakata’u ua (mo fakafiemālie ‘a e ngaahi fiema’ufakahokohoko ‘a e Austroads).Laiseni Komēsiale – Ko kinautolu ‘oku nau leva’i honau suká ‘aki ‘a e ‘inisulini ‘oku fiema’u kenau ‘alu tonu ‘o tala ki he Ma’u Mafai Pule ki he Laiseni Faka’ulí.‘E ala ‘oatu ha laiseni fakangatangata kae makatu’unga ‘i he lau ‘a e toketā taukeí suká, natula ‘oe ngāue faka’ulí pea mo ha toe sivi fakata’u (mo fakafiemālie ‘a e ngaahi fiema’u fakahokohoko‘a e Austroads).‘Oku ‘i ai ha ngaahi me’a kehe te nau ala uesia ho’o laiseni faka’ulí. ‘Eke ki ho’o toketā. Ka ‘ikaifetu’utaki ki he Ma’u Mafai Pule ki he Laiseni Faka’ulí ‘i ho Vāhengá:• Vāhenga Kolomu’a ‘o ‘Aositelēlia (ACT) - Department of Urban ServicesTelefoni: (02) 6207 7000• Niu Sauele - Roads and Traffic Authority NSWTelefoni: (02) 9218 6888• Vāhenga Tokelau - Department of Planning and InfrastructureTelefoni: (08) 8924 7905• Kuinisilani- Queensland TransportTelefoni: 13 23 80• ‘Aositelēlia Tonga - Department of Transport, Energy and InfrastructureTelefoni: (08) 8343 2222• Tasimēnia - Department of Infrastructure Energy and ResourcesTelefoni: 13 11 05• Vikatōlia - VicRoadsTelefoni: (03) 9854 2666• ‘Aositelēlia Hihifo - Department for Planning and InfrastructureTelefoni: 13 11 56(08) 9427 8191Ka ‘oku ke toe fiema’u ha fakamatala hū ki he uepisaitihttp://www.austroads.com.au/aftd/index.html83

21Diabetes and travelHaving diabetes does not mean your travelling days are over. To ensure you have a safe andenjoyable trip, be sure to plan ahead. Good preparation may seem time consuming but it willhelp to ensure you get the most out of your holiday.• Discuss your travel plans with your doctor or diabetes educator. Also discuss medicationadjustments for situations you may encounter such as crossing time zones, or whenexperiencing diarrhoea and/or nausea• Carry several copies of a typed, signed letter from your doctor outlining your diabetesmanagement plan, medications, devices you use to give medication (if applicable) andequipment needed to test your blood glucose level. You will also needto carry scripts for all medications (clearly detailing your name), doctorscontact details, and both the name and type of medication, emergencycontacts and your National Diabetes Services Scheme card• Always wear some form of identification that says youhave diabetes• Pack more test strips, insulin, syringes, pens and otherdiabetes equipment than you will need for the trip. Ifpossible, pack a spare meter in case of loss or damage• Depending on your journey and destination, you mayneed to consider taking an insulated travel pack foryour insulin• Take a small approved sharps container for used lancets and syringes. Some airlines, hotelsand airports offer a sharps disposal service• Keep insulin, syringes/pens and testing equipment in your hand luggage. Do not placeinsulin in your regular luggage that will be placed in the cargo hold because it is nottemperature controlled. The insulin may be damaged or lost• When flying, check with the airline in advance for specific securityguidelines as these are subject to change• Customs regulations vary from country to country so it is advisable tocontact the embassy of the country you’re visiting before travelling• When visiting some countries certain vaccinations arerecommended. Information in regard to vaccinations can beobtained from your doctor• The anticipation/stress of a trip or changes in routine may affect yourblood glucose (sugar) levels, so you may need to check your bloodglucose level more often• Contact your airline about meal times and food available duringyour flight. It is also recommended that you carry your own supplyof portable carbohydrates in case of unexpected meal delays or if84

21Suká mo e Fefolau’akí‘Oku ‘ikai ‘uhinga ho’o suká ke tuku ai ‘a e fefolau’akí. ‘Oku totonu ke palani kimu’a, kefakapapau’i ‘e malu mo fakafiefia ‘a ho’o ‘evá. ‘E ngali fakamole taimi ha’o teuteu lelei ka ‘etokoni ia ke ha’o ma’u ha taimi ‘eva lelei ‘aupito.• Talanoa ki ho toketā pē faiako suká fekau’aki mo ho palani folaú pē ‘evá. Talanoafoki ki he fetongi ‘a e faito’ό ‘i he taimi ko ē te ke folau atu ai ki he feitu’u ‘e liliu ai e taimí, pē‘e hoko ha fakalele pea/pē tokakovi• To’oto’o ha ngaahi tatau kuo ‘osi taipe’i, ‘o ha tohi kuo fakamo’oni ‘e ho’o toketā fekau’akimo e palani leva’i ho suká, ngaahi faito’ό, ngaahi nāunau ‘oku ngāue’aki fakafaito’o (kapau‘oku fiema’u) pea mo e ngaahi nāunau ‘oku fiema’u ke sivi ‘aki ‘a e tu’unga‘o e kulūkousí ‘i ho totό. ‘Oku toe fiema’u foki ke ke to’oto’o ha ngaahi tohitalavai fakatoketā ki he ngaahi faito’o kotoa (hiki mahino ai ho hingoá),fakaikiiki ‘o e kau toketā, hingoa mo e fa’ahinga faito’o, ngaahi fakaikiiki ‘o ekakai ke fetu’utaki ki ai ‘i ha fakatu’utāmaki mo ho kaati National DiabetesServices Scheme• To’o pē tui ma’u pē ha fa’ahinga me’a ke nefakapapau’i kohai koe mo ‘asi ai ‘oku ke suka• Fa’o ha ngaahi lau’ipepa tesi manifi ke lahi, ‘inisulini, ‘ume’ahuhu, ‘u peni mo e ngaahi nāunau suka ‘e fiema’uki ho’o folaú. ‘O ka lava, fa’o ha mita makehe telia na’ahoko ha mole pē maumau• Mahalo na’a fiema’u ke ke ‘ai ha ki’i kato ‘ikai hū ha ‘eaki ai ki ho’o ‘inisuliní, ka ‘e fua’aki pē ‘a ho’o fonongá mo e feitu’u ‘oku ke ‘alu ki aí• To’oto’o ha ki’i koniteina fe’unga ke fa’o ki ai ‘a e ngaahi hui mo e me’ahuhu kuongāue’akí.’Oku ‘i ai ‘a e ngaahi vakapuna, hōtele mo e mala’evakapuna ‘oku ‘i ai ‘enau sēvesike tānaki e ngaahi me’a māsila ni ‘o ave ‘o li’aki• Tauhi ‘a e ‘inisuliní, ‘u me’ahuhú/pení mo e nāunau siví ‘i ho katoto’oto’ό. ‘Oua ‘e tuku ‘a e ‘inisuliní ‘i ho katoleta ko ia ‘e ‘ave ki he me’atuku’anga utá koe’uhi ‘oku ‘ikai ke pule’i ‘a e fuamāfana ‘o e ‘eá aí• Vakai’i ki he kautaha vakapuná ki ha ngaahi fakahinohino pau ki hepuná, he ‘oku ala feliliuaki• ‘Oku tokehekehe ‘a e ngaahi tu’utu’uni fakakasitomú mei he fonuaki he fonua ko ia ai ‘oku taau ke ke tetu’utaki ki he ‘ofisi fakafofonga ‘oe fonua ‘oku ‘amanaki ke ke folau ki aí kimu’a pea ke folau• ‘Oku ‘i ai ‘a e ngaahi fonua ‘e ni’ihi ‘oku taau ke ke tomu’a huhu malu’ipea ke toko ‘alu ki ai. ‘Oku ma’u atu ‘a e ngaahi fakamatala ki he huhumalu’í mei ho toketā85

Diabetes and travel - continuedyou dislike the meal offered. If you take insulin with meals, do not give your insulin until yourmeal arrives.• To help prevent blood clots move about the cabin at regular intervals and do chair basedexercises. Drink plenty of water. Your doctor may advise you to wear support stockings• If you are driving long distances make sure you stop regularly and take your blood glucoselevels before and during your trip• Carry a small first aid kit with you in case of minor illness or injury.Useful websites are www.dfat.gov.au and www.health.gov.auTravel insurance is highly recommended. Make sure it covers situations which may arise inrelation to diabetes. The Australian Government has arrangements with some countries providingbenefits similar to Medicare, if needed. Remember to take your Medicare card with you.For more information, call Medicare Australia on 132 011 orvisit: www.medicareaustralia.gov.auAt your destination• Differences in activity, routines, food and stress may affect your blood glucose levels, checkyour blood glucose levels more often• Food options may differ from home. It is important to maintain carbohydrate intake. Ifyou are going to a different country do some research before you leave to help you makeappropriate food choices• Take care with food and drink choices, particularly in developing countries where foodhygiene may not be adequate. Bottled water is preferable even for brushing teeth• Protect your skin from sun burn• Do not go barefoot. Be careful of hot sand and pavements. Check feet daily.86

Suká mo e fefolau’akí – hoko atu• ‘Oku lava ke uesia ‘a e tu’unga kulūkousi (suka) ho totό ‘i he teuteu ho’o folaú/hoha’a ‘o e teufolaú pē liliu ‘a e me’a ‘oku ke anga ki aí, ko ia ai ‘oku totonu ke toutou sivi ma’u pē ‘a etu’unga ‘o e kulūkousi ho totό• Fetu’utaki ki ho kautaha vakapuná fekau’aki mo e taimi kaí mo e me’akai ‘oku ma’ulolotonga ho’o puná. ‘Oku tonu ke ke to’oto’o ha’o me’akai sitaasi telia na’a tuai hono tufaatu ‘a e me’akaí pē ke fehi’a he me’akai ‘oku ‘oatú. Kapau ‘oku ke ‘ai ‘a e ‘insuliní he taimi kaí,‘oua te ke ‘ai e ‘inisuliní kae’oua kuo tufa mai e me’akaí• Lue holo he loto vakapuná mo ke ‘ai e ngaahi fakamālohisino ta’utu he seá ke tokoniki hono ta’ofi ‘a e clot ‘a e totό. Inu ke lahi ‘a e vaí. ‘E ala fale’i koe ‘e ho’o toketā ke ke tui ‘a esitōkeni ke ne pukepuke lelei ho va’é• Kapau ‘oku ke faka’uli lōloa ki ha ngaahi feitu’u manatu’i ke ke toutou tu’u ‘o sivi ‘a e tu’ungae kulūkousi ho totό kimu’a mo lolotonga ho’o fonongá• To’oto’o ha ki’i kato faito’o koe’uhi na’a ke puke pē lavea.Ko e ongo uepisaiti ‘aonga ‘a e www.dfat.gov.au mo e www.health.gov.au‘E lelei ‘aupito ke ‘ai ha ‘inisua fefolau’aki. Tokanga ke fakakau ai ha ngaahi me’a ‘e ala hoko ‘okufekau’aki mo e suká. ‘Oku ‘i ai ‘a e ngaahi alea ‘a e Pule’anga ‘Aositelēliá mo e ngaahi fonua ‘e ni’ihi kema’u tatau ‘a e ngaahi monū hangē ko ia ‘oku ma’u atu ‘e he Medicare, kapau ‘e fiema’u. Manatu’i keke ‘alu mo ho’o kaati Medicare.Fetu’tuaki ki he Medicare Australia ‘i he 132011 ‘o ka ke fiema’u ha toe fakamatalapē ‘a’ahi ki he: www.medicareaustralia.gov.au‘I he feitu’u ‘oku ke folau ki aí• ‘E lava ke uesia ‘a e tu’unga e kulūkousi ho totό, koe’uhi ko e kehe ‘a e ngaahi me’a ‘e faí,kehe mo e me’a kuo ke anga ki aí, me’akaí mo e hoha’a, ko ia ai hanga ‘o toutou sivi ‘a etu’unga e kulūkousi ‘i ho totό• ‘Oku fa’a faikehekehe ‘a e me’akai ‘oku ala ma’ú mo ia ‘i ‘apí. ‘Oku mahu’inga ke tauhi ke ‘i hetu’unga lelei ‘a e carbohydrates. Kapau ‘oku ke folau ki ha fonua kehe ‘uluaki fekumi ke ke ‘ilo‘a e fa’ahinga me’akai fe’unga ‘oku ke ala fili ke kai aí• Tokanga ki he me’akai mo e me’ainu te ke inú, tautautefito ki he ngaahi fonua langalangahake ‘oku kei ta’efe’unga ‘a e haisini ‘o e me’akaí. ‘Oku sai ange hono ngāue’aki ‘a e hina vaí ‘oa’u ki he fufulu nifό• Malu’i ho kilí mei he fohia he la’á• ‘Oua te ke lue ta’esū holo. Tokanga ki he ‘one’one mo e ngaahi halanga lue’anga ‘oku velá.Vakai’i faka’aho ho va’é.87

22A free telephone interpreter service isNeed an Interpreter?available for people who may have difficultyin understanding or speaking English. Thisservice is available through the Translating andInterpreting Service (TIS) of the Department ofImmigration and Multicultural and IndigenousAffairs (DIMIA).TIS have access to professional interpreters in almost 2000 languages and dialects and canrespond immediately to most requests.Accessing an interpreter:Simply ring the Translating and Interpreting Service on 131 450Explain the purpose for the call e.g. wanting to talk to an educator/dietitian at AustralianDiabetes Council.The operator will connect you to an interpreter in the required language and to an AustralianDiabetes Council health professional for a three-way conversation.This free service has been set up by the Australian Diabetes Council and will be promotedwith assistance from the Australian Government Department of Health and Ageing.88

22‘Oku ‘i ai ‘a e ngāue ta’etotongi ki he fakatonuleaFiema’u ha Tokotaha Fakatonulea?fakatelefoní ki he kakai ‘oku nau ala faingatā’a’iake mahino pē lea fakapapālangí. ‘Oku ma’u atu engāue ni mei he Ngāue Liliulea mo Fakatonulea(TIS) ‘a e Department of Immigration andMulticultural and Indigenous Affairs (DIMIA).‘Oku ma’u ‘e he TIS ‘a e kau fakatonulea ‘i hengaahi lea mo e ngaahi dialects ‘e meimei 2000.Ko hono ma’u ha tokotaha fakatonulea:Faingofua ho’o tā ki he Ngāue Liliulea mo Fakatonulea ‘i he 131 450Fakamatala ‘a e ‘uhinga ho’o tā angé hangē ko ha’o fie talanoa ki ha faiako/tokotaha taukeifakafuofua kai ‘i he Kosiliō Suka ‘a ‘Aositelēliá.‘E fakahoko koe ki ha tokotaha fakatonulea ‘i he lea ‘oku fiema’ú ki ha taukei ki he mo’uí ‘i heKosiliō Suka ‘a ‘Aositelēliá ke mou talanoa tokotolu.This free service has been set up by the Australian Diabetes Council and will be proNa’e fokotu’u ‘a e ngāue ta’etotongi ni ‘e he Kosiliō Suka ‘a ‘Aositelēliá pea tu’utaki ‘i he poupou’imo e tokoni ‘a e Australian Government Department of Health and Ageing.89

23National Diabetes Services Scheme (NDSS)The NDSS is a federal government funded program, administered on behalf of thegovernment by Australian Diabetes Council.The NDSS provides free syringes and needles for those requiring insulin, as well as blood andurine testing strips at subsidised prices to those who are registered.Registration is free and you are only required to register once unless your treatment changesto require insulin.You do not need a doctor’s prescription to purchase NDSS products for diabetesmanagement.Registering for the NDSSOnce you have been diagnosed with diabetes, your doctor or credentialled diabeteseducator can register you with the NDSS. If you are not sure whether you are registered withthe NDSS, or want more information, call Australian Diabetes Council on 1300 342 238.Where to buy NDSS productsYou can buy products at Australian Diabetes Council offices or through pharmacy sub agents.You can also order your products from Australian Diabetes Council by phoning 1300 342 238or visiting www.australiandiabetescouncil.com.Your products will be mailed to you free of charge.Who should register for the NDSS?Australian residents that have been diagnosed with diabetes by a doctor and who hold acurrent Australian Medicare card or Department of Veteran Affairs file number should register.If you are a visitor to Australia and from a country with a Reciprocal Health Care Agreement,you may be entitled to temporary registration to the NDSS.Please call Australian Diabetes Council on 1300 342 238 for further information.90

23Ko e Polokalama Fakafonua ‘o e ngaahiNgāue ki he Suká (NDSS)Ko e polokalama NDSS ‘oku totongi ‘e he pule’anga fakafonuá, ‘o fakalele ‘e he Kosiliō Suka ‘a‘Aositelēlia ma’ae pule’angá.‘Oku ‘oatu ‘e he NDSS ha ngaahi me’ahuhu mo e hui kiate kinautolu ‘oku nau fiema’u ‘inisuliní,‘o kau ai mo e ngaahi la’i pepa sivi manifi ki he totό mo e tu’uofí ‘i ha totongi ma’ama’a angekiate kinautolu ‘oku lesisitá.‘Oku ta’etotongi ‘a e lesisitá pea ‘oku fiema’u ke ke lesisita tu’otaha pē tukukehe ka liliu hofaito’ό ‘o ke fiema’u ‘a e ‘inisuliní.‘Oku ‘ikai fiema’u ha tohi talavai mei he toketā ke fakatau ‘aki ‘a e ngaahi nāunau NDSS ki honoleva’i e suká.Ko e lesisita ki he NDSSKo hono sivi fakatoketā koe ‘o ma’u koe ‘e he suká, ‘e lava ke ke kelesisita ‘i he NDSS ‘e ho’otoketā pē ha faiako suka mahino. Kapau ‘oku ‘ikai mahino kiate koe pē ‘oku ke lesisita mo eNDSS, pē ‘oku ke fiema’u ha toe fakamatala, tā ki he Kosiliō Suka ‘a ‘Aositelēliá ‘i he1300 342 238.Feitu’u ‘oku fakatau ai ‘a e ngaahi nāunau NDSS‘Oku lava ke ke fakatau ‘a e ngaahi nāunaú ‘i he ngaahi ‘ofisi ‘a e Kosiliō Suka ‘a ‘Aositelēliápē ‘i he ngaahi fakafofonga fale talavai. ‘E toe lava foki ke ke order ‘a e ngaahi nāunau nimei he Kosiliō Suka ‘a ‘Aositelēliá ‘i ho’o telefoni ki he 1300 342 238 pē ‘a’ahi ki he www.australiandiabetescouncil.com. ‘E lī atu kiate koe ta’etotongi ‘a e ngaahi nāunaú.Ko hai ‘oku totonu ke lesisita ki he NDSS?‘Oku totonu ke lesisita ‘a e kau nofo ‘Aositelēlia kuo sivi fakatoketā ‘oku ma’u ‘e he suká pea ‘oku‘i ai ha’ane kaati Medicare ‘Aositelēlia pē fika ‘i he faile ‘a e Department of Veteran Affairs.Kapau ko ha ‘a’ahi koe ki ‘Aositelēlia pea mei ha fonua ‘oku ‘i ai ‘a e Aleapau FakafetongiTauhi kihe Mo’ui Leleí, ‘e ala ke ke ma’u ha lesisita fakataimi ‘i he NDSS.Kātaki ‘o tā ki he Kosiliō Suka ‘a ‘Aositelēliá ‘i he 1300 342 238 ki ha toe fakamatala.91

24Australian Diabetes CouncilAustralian Diabetes Council is a non-profit, non-government charity dedicated to helping allpeople with diabetes. It provides:• education programs• conducts public awareness campaigns• funds research into diabetes management and the search for a cure• advocacy, (protecting the rights of people with diabetes).Australian Diabetes Council has a network of branches and support groups to providesupport and encouragement for people affected by diabetes.Our Customer Care Line has diabetes educators, dietitians and exercise physiologists availableto provide personalised and practical assistance to benefit people with diabetes and theircarers.To find out about all the benefits of becoming a member of the Australian Diabetes Councilcontact 1300 342 238.92

24 Kosiliō Suka ‘a ‘AositelēliáKo e Kosiliō Suka ‘a ‘Aositelēliá ko ha kautaha anga’ofa ‘oku ‘ikai ke nau ngāue ke ma’u ha tupupea ‘ikai ko ha kautaha fakapule’anga. ‘Oku ne fakalele ‘a e:• ngaahi polokalama ako• fakalele ‘a e ngaahi kemipeini ki he ‘ilo ‘e he kakaí• tokoni fakataukapo, (malu’i ‘a e ngaahi totonu ‘a e kakai ‘oku nau ma’u ‘a e suká).‘Oku ‘i ai ha ngaahi va’a kehekehe mo e ngaahi kulupu poupou kehekehe ‘a e Kosiliō Suka ‘a‘Aositelēliá ke nau tokoni’i mo fakalotolahi’i ‘a e kakai ‘oku uesia kinautolu ‘e he suká.‘Oku ‘i ai ‘a e kau faiako suka, kau taukei fakafuofua kai mo e kau fakamālohisino fisiolosia ‘okuma’u atu ‘i he’emau Laine Tokoni Ma’ae Kau Kasitomā ke nau ‘oatu ha tokoni fakafo’ituitui mopractical ‘oku ‘aonga ki he kau suká mo honau ngaahi tauhí.Fetu’utaki ki he Kosiliō Suka ‘a ‘Aositelēliá ‘i he 1300 342 238 ki ha fakamatala ki he ngaahi lelei‘e ma’u ha’o hoko ko ha memipa.93

For more information call us onStreet address Postal address Customer Care Line Phone +61 2 9552 990026 Arundel Street GPO Box 9824 1300 diabetes Fax +61 2 9660 3633Glebe NSW 2037 Sydney NSW 2001 1300 342 238ABN 84 001 363 766 CFN 12458© 2012 Australian Diabetes Council. May not be reproduced in whole or in part without prior permission.