We have a number of specialists and registrars (trainee specialists) who work at the Centre. Not all patients need to be seen by a specialist or trainee specialist, but they are available if required. In some situations a doctor will provide advice on management after reviewing results and discussing with the GP.

Most (although not all) patients who come to the Diabetes Centre will see one of our specialist nurses. Their main role is to teach you about diabetes and how to look after your diabetes (for example how to test your blood sugars at home). They may also help adjust medication and insulin doses if required. What Diabetes Nurses Do We teach people with diabetes and their families: steps necessary to reduce the risk of complications about effectively managing their glycaemic control with diet, exercise and lifestyle changes We provide education and resources so people with diabetes and their families can develop an understanding of how this chronic disease affects them by: teaching monitoring skills and how to interpret and take appropriate action to achieve treatment targets teaching what are healthy foods (with the dietitian) and necessary exercise why it is important to always take medication as the doctor orders teaching how to use insulin if this is necessary teaching people how to cope with changes in life that occur e.g. holidays, festive times, stress. We work with our team of doctors, dietitians, podiatrists and in shared care with General Practitioners. Where Care is Provided From: Auckland City Hospital Held at: • all wards who request the assistance of a Diabetes Nurse to help you while you are in hospital. • as a patient you can ask for our assistance. Greenlane Clinical Centre How We Provide Support to You One on one sessions with you and your family/caregiver where we: • assess your needs • discuss with you how these problems can be solved • give support to you when you start using insulin and other medication • help you with other associated problems. Group sessions for: • groups of people with similar problems • groups of people with an ethnic association needing interpreters. Telephone follow-up • we are happy to spend time with you on the telephone to discuss any issues you may have. See under "Other" for our Diabetes Nursing Staff List. Auckland Diabetes Centre Held at: 1st Floor, Building 4, Reception G Greenlane Clinical Centre 214 Greenlane West Satellite Clinics Carrington Satellite Clinic - Nurse, Dietitian and Podiatrist Rehab + 54 Carrington Road, Point Chevalier 1022 Operates on: Thursdays - Fortnightly, Friday - Weekly City Clinic (Young Adults) - Nurse and Dietitian University of Auckland - University Student Health and Counselling Service Level 3, Kate Edger Information Commons 2 Alfred Street Auckland 1010 Operates on: Wednesday afternoon - Monthly City Clinic (Young Adults) Park Rd - Diabetologist Auckland City Hospital Outpatient Clinic 2 Park Road Auckland 1010 Operates on: Tuesday - Monthly Mt Roskill Satellite Clinic - Nurse and Dietitian Wesley Community Centre 740 Sandringham Road extension Mt Roskill 1041 Operates on: Thursdays - Weekly Otahuhu Satellite Clinic - Nurse and Dietitian Library 28/30 Mason Ave Otahuhu, Auckland 1062 Operates on: Tuesdays - Fortnightly Glen Innes Satellite Clinic (Keruru Kidney Centre) Keruru Kidney Centre 45 Point England Rd Glen Innes 1072 Operates on: Mondays/Wednesdays Weekly & Thursday Monthly Waiheke Island (General Clinician) Waiheke Centre 61 Ostend Road Waiheke Island Operates on: Wednesdays - BiMonthly (every 2 months) Waiheke Island Satellite Clinic (Podiatry Only) Waiheke Health Trust 5 Belgium Street Ostend Waiheke Island Operates on: every 6 months Great Barrier Island - Nurse and Diabetologist Piritahi Hao Ora Trust Marae-based Primary Health Care clinic on Waiheke Island 54 Tahatai Road, Oneroa Auckland 1083 Operates on: 18 months These satellite clinics are available for those who are having difficulty getting into our Greenlane Centre due to mobility or transport problems. Places are limited in these clinics and we do not offer the full range of services in these areas (these clinics usually include nurses and dietitians only). We also offer occasional clinics on Waiheke Island and Great Barrier Island; once again spaces in these clinics are limited and places are given based on need. Specialist Teams Young Adult MultiDisciplinary Team (MDT) Clinic with the Young Adult Specialist Team (Diabetologist, Nurse, Dietitian, Psychologist) - Greenlane Auckland Diabetes Centre, Level 1, Building 4, Greenlane Clinical Centre Operates on: Monday afternoon - Fortnightly Pump MDT Clinic (Insulin Pump) Clinic with the Pump Specialist Team (Diabetologist, Nurse, Dietitian) - Greenlane Auckland Diabetes Centre, Level 1, Building 4, Greenlane Clinical Centre Operates on: Bimonthly (every 2 months) Diabetes Duty Nurse Available: Monday to Friday, 8am to 4pm. Phone: (09) 623 6440 for a health professional within ADHB. Email: Our dedicated team of Diabetes Nurse Specialists Lauren Paynter-Muller (Nurse Lead) Patricia Ball Gina Berghan Krizyl Ceas Ji Chen Marisa Guolo Mele Kaufusi Faieza Khan Sally Levie Sally Geary Cynthia Libalib Nana Tweneboah Mensah Jane Whitta Jane Wilkinson ( Nurse Prescriber) Registered Nurse Tracey Poi Surya Kupasseril

We have experienced Diabetes Dietitians, who offer specialist Medical Nutrition Therapy for people with Diabetes. Dietitians are trained under the Masters in Dietetics programme (5 year Dietetic Training) and are registered with the New Zealand Dietitians Board. The role of a dietitian is to evaluate scientific evidence about food and nutrition, and translate it into practical strategies. New Zealand dietitians work in partnership with individuals, whanau, communities and populations, in states of health and disease, to support optimal health and wellbeing. Dietitians use their dietetic knowledge, skill and judgement in a variety of contexts, which includes promoting and protecting public health, directing and delivering medical nutrition therapy services, and managing food and health systems. They may perform a variety of functions, including policy development, leadership, management, research, education, and communication roles. Scope of Practice for Dietitians, Gazetted by the Dietitians Board, April 2017 “A dietitian is a person with a qualification in nutrition and dietetics recognised by national authority [s]. The dietitian applies the science of nutrition to the feeding and education of groups of people and individuals in health and disease.” Medical nutrition therapy (MNT) is an integral component of all aspects of diabetes care from prevention to managing existing diabetes. MNT uses the latest available scientific evidence, takes into account treatment goals, includes clients in the decision making process and is individualised according to clients' needs. Auckland Diabetes Centre Diabetes Dietitians offer one-on-one consultation for patients with Type 1 and Type 2 diabetes at the Greenlane Clinical Centre or at specified community satellite clinics. For Type 1 diabetes patients, we also run a DAFNE (Dose Adjustment for Normal Eating) self management course (since 2009) - 5 courses per year. For Type 2 diabetes patients, we are running 4x1hr courses on:- 1. What is diabetes and introduction to carbohydrate counting - 25th August 2017 2. Fat and label reading - 1st September 2017 3. Sugar and label reading - 15th September 2017 4. Meal planning and how to eat healthily on a budget - 29th September 2017 Due to large demands on our service we are not able to offer long term follow-up or intensive programmes for weight loss. We are also involved in the training of other health professionals. At present we accept referrals for the following: • Type 1 diabetes • Type 2 diabetes, complex Those with newly diagnosed Type 2 diabetes (lifestyle and/or Metformin treatment only) are advised to attend a Diabetes Self Management (DSME) course run in the community. Greenlane Clinical Centre How We Provide Support to You One on one sessions with you and your family/caregiver where we: • Assess your needs • Discuss with you how these problems can be solved • Give support to you when you start using insulin and other medication • Help you with other associated problems. Group sessions for: • Type 1 Diabetes - DAFNE course AND Type 2 Diabetes Telephone follow-up Auckland Diabetes Centre Held at: 1st Floor, Building 4, Greenlane Clinical Centre 214 Greenlane Road Satellite Clinics Carrington Satellite Clinic - Nurse, Dietitian and Podiatrist Rehab + 54 Carrington Road, Point Chevalier 1022 Operates on: Thursdays - Fortnightly, Friday - Weekly City Clinic (Young Adults) - Nurse and Dietitian University of Auckland - University Student Health and Counselling Service Level 3, Kate Edger Information Commons 2 Alfred Street Auckland 1010 Operates on: Wednesday afternoon - Monthly City Clinic (Young Adults) Park Rd - Diabetologist Auckland City Hospital Outpatient Clinic 2 Park Road Auckland 1010 Operates on: Tuesday - Monthly Mt Roskill Satellite Clinic - Nurse and Dietitian Wesley Community Centre 740 Sandringham Road extension Mt Roskill 1041 Operates on: Thursdays - Weekly Otahuhu Satellite Clinic - Nurse and Dietitian Library 28/30 Mason Ave Otahuhu, Auckland 1062 Operates on: Tuesdays - Fortnightly Glen Innes Satellite Clinic (Keruru Kidney Centre) Keruru Kidney Centre 45 Point England Rd Glen Innes 1072 Operates on: Mondays/Wednesdays Weekly & Thursday Monthly Waiheke Island (General Clinician) Waiheke Centre 61 Ostend Road Waiheke Island Operates on: Wednesdays - BiMonthly (every 2 months) Waiheke Island Satellite Clinic (Podiatry Only) Waiheke Health Trust 5 Belgium Street Ostend Waiheke Island Operates on: every 6 months Great Barrier Island - Nurse and Diabetologist Piritahi Hao Ora Trust Marae-based Primary Health Care clinic on Waiheke Island 54 Tahatai Road, Oneroa Auckland 1083 Operates on: 18 months These satellite clinics are available for those who are having difficulty getting into our Greenlane Centre due to mobility or transport problems. Places are limited in these clinics and we do not offer the full range of services in these areas (these clinics usually include nurses and dietitians only). We also offer occasional clinics on Waiheke Island and Great Barrier Island; once again spaces in these clinics are limited and places are given based on need. Specialist Teams Young Adult MultiDisciplinary Team (MDT) Clinic with the Young Adult Specialist Team (Diabetologist, Nurse, Dietitian, Psychologist) - Greenlane Auckland Diabetes Centre, Level 1, Building 4, Greenlane Clinical Centre Operates on: Monday afternoon - Fortnightly Pump MDT Clinic (Insulin Pump) Clinic with the Pump Specialist Team (Diabetologist, Nurse, Dietitian) - Greenlane Auckland Diabetes Centre, Level 1, Building 4, Greenlane Clinical Centre Operates on: Bimonthly (every 2 months) Diabetes Dietitians Jennifer Robb - Dietitian Team Supervisor Kate Ellison - Senior Diabetes Dietitian NZRD (Prescriber), PGDipDiet, BSc (Human Nutrition), DAFNE accredited Diabetes Educator Hannah Hoeksema - Diabetes Dietitian NZRD (Prescriber), MHSc (Nutrition & Dietetics), BSc (Human Nutrition), DAFNE accredited Diabetes Educator Annabelle Malone - Diabetes Dietitian NZRD (Prescriber), MHSc (Nutrition & Dietetics), BSc (Human Nutrition) Foundations of Care and Comprehensive Medical Evaluation including MNT, Diabetes Care 2016.pdf.pdf.pdf.pdf.pdf.pdf.pdf.pdf.pdf.pdf (PDF, 713.3 KB)

The feet are supplied with blood to keep them healthy. They also have a multitude of nerves that act as an emergency warning system. For example, if there is a stone in the shoe, the nerves will send a message to the brain to investigate. However, if diabetes is poorly controlled for a long period of time this may lead to: • Nerve damage, or ‘peripheral neuropathy’, which impairs sensation to the feet, and/or • Reduced blood supply, also known as ‘poor circulation’. Nerve damage may mean that the patient no longer notices the stone in their shoe, due to loss of sensation in their feet. This could then lead to an injury they can’t feel and possibly infection. If there is poor circulation, any injuries or infections on the feet (i.e. cuts, burns or scratches) will take longer to heal. This is due to less blood flowing into the arteries in the foot. Blood provides energy to working muscles and aids in healing any tissue damage. Most foot problems for people who have diabetes occur when injuries - and often infections - go unnoticed and untreated, or when healing is delayed due to poor circulation. Ulcers Ulcers are an area of skin that is broken and is taking longer than normal to heal. Often the inside of an ulcer looks white. Ulcers occur most often over the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are sometimes due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by a healthcare provider right away. Not getting treatment for an ulcer can result in infection or gangrene, which in turn can lead to losing a limb (amputation). Corns Corns and calluses are a thickening of the skin. They are caused by repeated pressure or rubbing on the same area of the foot. Corns are often round, raised areas on the foot at points where the foot rubs against the shoe. Calluses are often larger areas of thickened yellowish skin around the heels or underneath the foot. If not treated, corns and calluses can act like stones in the shoe, putting pressure on the tissue underneath them. This pressure can lead to bruising, infection or an ulcer. This damage is often hard to see because it is underneath the corn or callus. If there is nerve damage the patient may not feel any pain. Show any corns or calluses to a podiatrist to get them treated. Never try to cut or cure corns yourself. Cracks Neuropathy, excessive weight and poor footwear can lead to cracking of the skin. Cracks allow bacteria to enter the foot and can cause infection which can be serious. It is important to keep the skin on the feet soft and supple. Regularly moisturising the skin will help prevent cracks or fissures. Nails Problem nails can be caused by injury, fungal infection, curved nails and badly fitting shoes. An in-grown nail may be painful, red and swollen, or have a fluid discharge. It can get infected very quickly. Get any problem nails seen by a podiatrist. Podiatrists Alexandra Noble-Beasley BHSc (Podiatry), PGDiploma Podiatric Surgery Jenny Luke BHSc (Podiatry) Sowyma Balla Katie Rutherfurd Chavarith Mounlath Michelle Garrett (Podiatry Professional Clinical Leader) Andrea Connel (Associate Podiatry Professional Clinical Leader)

Adult Diabetes Health Psychology Service We have an experienced health psychologist that specialises in diabetes psychology. Health psychologists are trained under a Post-Graduate Health Psychology programme (minimum 6 years training) and are registered with the New Zealand Psychologist’s Board. Diabetes Senior Health Psychologist Heidi Baxter MSc(Hons), PGDipHlthPsych Who Are Health Psychologists? Health psychologists fit somewhere between medicine and psychology. They have an understanding of physical health at the same time as behaviours, thoughts and feelings. In a nut shell they are interested in knowing about how diabetes affects people’s lives and how people’s lives affect how they live with diabetes. They are able to help people understand any struggles they are having with their diabetes self-management. Furthermore, they can support people to make changes that improve their physical and mental health outcomes. Health Psychologists are trained to use a range of proven psychological therapies that help people to make behavioural changes, lifestyle adjustments, reduce emotional distress, and improve their overall physical and mental well-being. Why See a Health Psychologist? Living with diabetes is challenging. In the early parts of the diabetes journey, there is a lot of new information and many changes you may need to make. This can feel really overwhelming and may take quite a bit of time to adjust to. It is common for people to experience a range of strong emotions and find it difficult to make changes. Many people discover that they feel sad, worried, or angry about how their physical health has changed their lives. This can be even more difficult when people have other problems and worries. Later on in the diabetes journey, many people find that they get worn out and exhausted. There are no breaks, lots of decisions to make, many medications to deal with, and constant monitoring. This can leave people feeling like they want to give up and go on a permanent holiday from diabetes. Thankfully, there are many things that can be done to get back on track no matter where people are on their diabetes journey. Taking some time to reflect and work through any struggles with diabetes can help people to improve their health and minimise the impact of it on the rest of their lives. Who Do We See? The diabetes health psychologist sees type 1 or type 2 patients under the Adult Diabetes Service for brief interventions. They work alongside diabetes doctors, nurses and other members of the health team to help overcome diabetes specific problems. Please note that this is not a general psychology service, nor a crisis service. Some of the common referral reasons are: · Adjustment to a new diagnosis · Difficulty taking medication · Difficulty monitoring blood glucose levels · Lifestyle changes · Diabetes distress/burnout · Fear of hypoglycaemia or hyperglycaemia · Fear of complications · Needle anxiety · Health anxiety · Mild to moderate mood impacting on diabetes e.g. anxiety, depression, stress · Disordered eating relating to diabetes (diabulimia) How to arrange a referral If you are under the Adult Diabetes Service, you can ask your GP or diabetes team for a referral to the health psychologist. The psychologist will then contact you directly to arrange an appointment as soon as possible. If there is a waitlist, you will be informed by letter first and given an approximate time to be seen. Reference Map for Mental Health Service Referrals and Health Psychology Referrals (DOCX, 446.2 KB)

Leaisa Bartley Care Coordinator Referral Pathway (DOCX, 549.5 KB)