SULTRY, JAZZY MUSIC Ahhh! Ooh! Ahh! WOMAN LAUGHS, LIQUID SLOSHES We live in a toxic environment. So whatever the guidelines tell us, whether they're right or wrong, the reality is that our food environment is setting us up to fail. Why should we be setting up society to make it so hard for people to choose healthy food? At some point, governments are gonna realise that effectively the food manufacturers are bankrupting us. I mean, the only good thing from their point of view is you're gonna die younger, which means they won't have to pay your pension. ALARM CHIMES Christina Muaiava loves food. But having type II diabetes means she has to be very careful about what she eats. Hi, boys. Morning, Mum. I eat lots of fruit and vegetables, but then I eat lots of the other foods. I'm gonna have to seriously maintain what I should be doing, otherwise I've` I hate feeling unwell. I hate feeling sick. Tina injects insulin twice a day to help her body manage blood glucose. Last night she had a sugar blowout, so she's not expecting good news from her daily blood test. A reading over 6 is high. Uh, 12. Oh, zero-zero... Phew. (CHUCKLES) 8.1. But I didn't take my` my insulin and tablets last night, and I had koko samoa, so thankfully it's all right this morning. With anything over 20, she faints. She just drops. Then I have to pick her up. Left untreated, a diabetic coma is fatal. I had one koko samoa last night. But I usually have six or seven. And it has to have a lot of sugar. That's not good for you. (SOFTLY) Dammit. Cos I love koko samoa. < MAN CHUCKLES SOFTLY We can control blood sugar through diet. Many people don't realise a lot of carbohydrates will raise blood sugar levels. Bless this food we're about to eat. Amen. OTHERS: Amen. Chuck us the box. I had to refrain from telling too many people that I am diabetic. Cos they're quite judgemental. They say, 'Oh, should you be eating that?' 'Oh,' you know, 'I thought diabetes people don't eat that kind of food.' And I get annoyed. I get annoyed because I don't point the finger and look at what you're eating and what you put into your body. Cos it's my body. You'll get people that come up to you, '(GASPS) Don't eat that, Christina. Aren't you diabetic?' You know. I` Yes, I do know. You never tell a alcoholic, 'Don't have that drink.' Don't point the finger to other people. I don't tell other people what they should eat and what they shouldn't eat. We know what foods we're supposed to eat and what's nutritious for us, and we encourage each other to eat healthy. And, you know, Tony really cares about me and what I eat. CHUCKLES: Cos he's the one that has to look after me when I get sick. ELECTRONIC MUSIC For 16 hours a week, Brian Kairau's blood is filtered through a dialysis machine. It's a bit weird when you think that your life depends on this machine and how well it keeps you cleansed of all your toxins. This is, uh, me. This is my renal system right there. There you go. Some calcium. This bug kicks my immune system in the butt. If they can't bring any of this infection in control and it continues to start wasting my limbs, they have no option but to remove my legs from below the knee. Brian worries about his kids. His daughter, Sharmayne, once played softball for NZ. But that was before she became a mum. Got polonies, yogurt, cheese, mandarin, muesli bar. I'm not really healthy at the moment. (CHUCKLES) Being naughty. Eating bad food. I'm not doing sports any more. Just being a bit lazy at the moment. It is a bit hard for me to stay healthy as I can, you know, just paying your way and` It's quite hard. I just wanna live a better life. Being a mum, you're always, like, on your toes and you have to do all these things, and you don't really find the time to cook a healthy meal all the time. So it is quite easy just to go get takeaways or whatever. Pretty deep, eh? Hi, Dad. Oh, hello, honey. (CHUCKLES) Mwah! BOTH SIGH Missed you. (KISSES) Missed you too. Got you some oranges. Oh, cool. (GROANS) Sorry, I'm in a bit of pain at the moment. An infection in Brian's heel is eating the flesh. His body is struggling to fight it because he has poor circulation, typical of excess blood sugar clogging up the veins. Painful as all night. They had to keep giving me lots of medication. I got no feeling down there in my foot. Even digging it in there like that and twisting it around, I can't feel any of that. I could pretty much stand on a nail and it could go right through my foot, and I wouldn't feel it. I wouldn't know I've done it. There's not much they can do for him any more. I know he's struggling with it, going from a fit, healthy man just downhill straight away. I think maybe he's a bit ashamed about it. He told my brother that he doesn't think he'll make it. And I just broke down. I couldn't handle it. It was really sad to hear. I was actually ready to give up. I've been fighting for eight years. I'd had enough, to be quite honest. Yeah. And then I called all my sons in, and I told them. They argued a bit, 'Come on, Dad.' I said, 'Nah.' And I apologised to them that I was not as strong as they thought I was. They` They told me I was, but I said, 'Nah.' I said, 'I can't do this any more.' I said, 'It's just too hard. Very` Just too damn hard. I can't do it.' And then, um` Yeah, well, in the end, um, they all accepted my decision that I was just gonna` You know, here's me thinking I'm gonna lay back down and let it all` see the glory, you know? All that. Just let it go, come what may. All this sort of stuff. And then, um, my daughter heard what I was telling her brothers, and she come into our` That was it. I didn't have a chance after that, you know? I can't see my daughter weep or anything. It's just putty in my` I'm putty in her hands when she does that. But, uh, I tried to resist and I argued with her and I told her, tried to make her understand where I was at. And she didn't want nothing to do with that. She was like, 'Nah. I'm not ready to let you go, Dad.' And she just squeezed the heck outta me. She kept squeezing me. Just kept on doing it. Wouldn't let me go. I just told Dad, 'Please don't go. I don't want you to go.' And he said he can't` he can't do it. And I just kept asking him. And he said, when my brothers left, 'OK, daughter.' GENTLE ELECTRONIC MUSIC I'm the archive resources coordinator for the Archive of Maori and Pacific Music at the University of Auckland. Christina's family depends on her income. She's determined to keep working and avoid dialysis. She must be vigilant with her blood sugar. When I feel unwell, I probably haven't eaten, I'll get up and go and get something. To me, that's really telling everybody, 'Oh, it's coffee break.' (CHUCKLES) Mm. My father was a diabetic, and he was on dialysis for four years before he passed away. My aunties and uncles, cousins, three brothers and one sister ` we all have some kind of diabetes. I'm always checking labels. I look at the labels and see how high the sugar is, the sugar content. In everything you eat, I now know which ones have the highest sugar, so I try and get the ones that are low. People don't really know where sugar's coming from. I mean, it's really easy to look at a fizzy drink and a bag of lollies and say, 'Oh, I don't eat that. 'I don't eat a lot of sugar. My diet doesn't contain a lot of sugar. I eat healthily.' But what they don't realise is that all the packaged, processed foods that they might have in their diet contain sugar. And because reading labels is so incredibly difficult and we're constantly coming up with different ways of trying to guide people, the reality is that it's hard work. And people are getting a lot of sugar from a lot of places that they would have no idea. My health is better than it was 15, 20 years ago. I used to be really bad. I used to eat everything and anything, drink a lot of fizzies. I used to drink heaps of fizzies. It was about 2005 when I collapsed at home. And that was, yeah, my first wake-up call. And then, you know, I go really well. (CHUCKLES) And then after a while, when I think I'm really good, on top of the world, I'm eating healthy and I'm exercising. And then I get slack. I think, 'I'm all right. I'm all right.' I used to be ashamed to do my insulin. So because I was ashamed, I wouldn't do it. I don't want people to feel sorry for me either. One of the nurses said to me, 'You do know that, with your condition, 'diabetes, you've got kidney failure and... 'you know, you're dying. It's a slow, killing disease. 'You're dying, so we just give you meds to prolong your life.' And I said, 'Thank you very much.' Picked my bag up, went out the door, and I didn't go back. You know, just felt to me like, oh, I'm a waste of time. A waste of money. And I betcha there are a lot of other diabetes people who... you know, who the medical staff probably just roll their eyes and go, '(GROANS) Tsk.' There's an immense amount of stigma that's attached to type II diabetes. Uh, and the reason is because we get bombarded with messages about what the cause is. It's about being overweight and people overeating. Um, and so when someone is diagnosed with diabetes, it can be very shameful and embarrassing. Uh, which has a lot of consequence in terms of that person then being able to manage or deal with the type II diabetes. Hey, Brian. Hey! Brought you some biscuits. Oh, mean, bro. What we got? Plain biscuits! James Foafoa is Brian's diabetes buddy. They've been doing dialysis next to each other for years. I would much rather enjoy what time I have left` or I believe I have left, eating something I enjoy than bland food all the time. Yeah, yeah, yeah. When you know you've only got five years, you don't stuff around. There's lots of things I've gotta learn to live with now. And getting around with half a foot's nothing, compared to some of the other people I've seen on dialysis. Yeah. I sit there and go, 'Oh, lucky I don't have no legs like that guy.' You know? Lucky I've still got my hands. I was in a room once with a guy that went blind, and he was on dialysis for 17 years. Then I heard he died. And I was like, 'Far out.' And I'm going like, 'Man, they just seem to be dropping like flies at times.' The last time I saw that happen was a young guy. At a guess, I'd say he was lucky to be 20. And he'd just had both his legs amputated. And, yeah, happened right next door to me. He was on the bed next door to me, and the mother was hard-out screaming. We're sitting there trying to pretend we're used to it. So it makes you sit back and think about, 'Oh crap. How long is it before it happens to me?' Mm. I know, eh. It's like` I get like that as well. Eh? you know? And in saying that, I'm looking at these biscuits and I wanna eat one. I think if you can afford to eat healthy, eat healthy. Eh? That's pretty much how it goes. All the good kai, I would call it, is so cheap, that's what we can afford. So we feed that to our kids and ourselves and all that. You seldom see anybody that went to King's College or anything like that on dialysis, eh, bro? All the ones that are coming through, um, guys like you and I, really. MOURNFUL JAZZ PIANO At 47, James is already a dialysis veteran. The average life expectancy on dialysis is five years. I've been doing dialysis almost seven years now. Cos both my parents are both diabetic, but yet I'm the only one who's doing dialysis. I was working for Alert Taxis, but I was getting blackouts, so that's when I started dialysis. Um, I'm really careful with what I eat, kind of thing. I haven't had takeaways in ages. With the soft drinks, I just buy one can of Coke or Fanta. But mainly I just drink, um, water. I stopped drinking. I probably will have a drink when I turn 50, if I can make it that far. Yeah. The sugar's been there all my life. I know a lot of people that can live without sugar. And, um, they're saying people find it hard to stop smoking or stop drinking alcohol. But, um, I can stop those two things quite easily. It's not saying that one's more powerful than the other. I think it's just that, um, again, when you've been raised with something that's so freely available, really hard to kick it. Look at me, I'm perpetuating the cycle by, um, letting my grandchildren have treats because I've got that mindset that that's what grandparents are for. You spoil your grandchildren, so... I never had a grandparent that I can remember, so I'm just hoping I'm gonna do a good enough job to make my grandchildren happy. And sadly, I think that's also giving them treats. Christina, come through. Is this your husband? Yeah. Can he come through? Oh, absolutely. Come on through. Thank you. Come back through to the same room. Hi. Stephen Best. Hi. Tony. Tony, come on through. Thanks, Stephen. How's your diabetes going? Um, up and down. But it's all right... You know, like, this morning it was 8. If you have diabetes, there's a risk you may have diabetic retinopathy at the back of your eye. It needs to be looked out for, and we need to find this before you're aware of it. Just pop your forehead up against the head rest there again. So, I can see where your cataract surgery has been done. Mm-hm. And you have a little bit of cataract on your left eye. And this is the sort of cataract that we see more frequently in patients with diabetes. And I can see changes at the back of your eye typical of diabetes. They're little dot-and-blot haemorrhages and some exudates, where the vessels are leaking at the back of your eye. Certainly, the biggest issue we have in NZ at the moment is diabetes and the secondary effects it has with respect to the eye. When we look at the back of the eye, we can see changes before the patients are aware of any symptoms. And the most important thing about diabetic retinopathy is that it's related to blood glucose control. If you have routinely poor blood glucose control, then you're more likely to have a worsening of the diabetic retinopathy at the back of your eye. And lifelong treatment is required. In the worst-case scenario, people will actually have bleeding into the vitreous, which is the gel inside the eye. They'll then develop retinal detachments. And if they're not picked up early enough, they'll end up losing their sight. So, um, my biggest concern at the moment with you, Christina, is that the vision in your left eye is reduced because of cataract. But more importantly, > the cataract that you have stops us from seeing into the back of your eye, > just like it stops you from seeing out. > I'm going to suggest that we should look at removing the cataract from your left eye as well. > Brian's doctors have decided there's nothing more they can do. They're going to cut his foot off. I now understand why people want their legs amputated, because the pain's... yeah, it's not nice. Probably the best way to put it is I'm a pretty tough guy, and it keeps kicking my butt. So, um, I haven't been able to sleep for three days. It feels like the raw meat on my leg is being scraped against a rasping file. All night long, all day ` it just doesn't stop. UPBEAT SALSA MUSIC Right now I'm getting a health check done. Um, they check your blood sugar, your blood pressure, and you have to weigh in. And after this, we do Zumba. We try to keep healthy, and they watch for people who have, um, diabetes. When they have these health checks, I actually miss them, cos I know exactly what it's gonna be. (LAUGHS) It's gonna be` I can tell her now that it's high. I weighed myself, and I am 109. WHISPERS: Don't worry. It's very high. We do need to double check. That's a dangerous blood pressure. I real` I know. BEEP! Press that. MACHINE BEEPS (INHALES SHARPLY) Wow. But I was 29 this morning. Ai! Dangerous. My dear, did you know that you can have a heart attack with this kind of blood sugar and blood pressure? Are you aware of that? Mm. Tsk! Ahh! You can't exercise with that blood pressure. Oh yeah, I'll be fine. It's fine with you but not fine with me. Because if anything happens to you, they might take us to the court. Cos it's way too dangerous. It's high. So what we do, we need to refer her to the GP. (SCOFFS) But I am. Or after hours, no GP, we can take her straight to the hospital. She might have a heart attack or stroke any minute. So it's very dangerous. My dear, now it's above 200. It's dangerous. I'll be fine. I'll be fine. Don't worry. It's not fine. MUSIC PUMPS, MAN SHOUTS ENCOURAGEMENT Christina went straight to the emergency ward. REFLECTIVE MUSIC I'm guessing tonight's gonna be painful as. Brian's about to lose his foot, but he's worried it won't stop there. Can I, like, pretty brazenly ask what my, um, possibility is of me keeping my leg for the next 10 years or so? You know, we're up against it. Most of the work that's been done has been really to do with, you know, that, kind of, getting your dressings right, getting the podiatrist in, getting your diabetes under control, making sure your dialysis is good. And, as I say, my role has just been` It's not impossible, eh? No. My role's just been to come in here and tell you if we don't do something, you'll lose your leg, and then try and make sure you don't. And you done that quite well at the moment, yeah. So far, so good. For me personally, I feel like it's too late. Too little too late. That's where I'm at. But, um, I need to get on your wavelength, where there's` with a lot of good, hard work we can get there. I'm not there. I'm not sold on that yet. Come on, leg. OK. See you tomorrow. Thank you, Doctor. See ya. I'm at the bottom of the cliff here. He's already fallen off the cliff. Quite a large number of patients with type II diabetes and infection within their feet that they're coming here. And so there's a lot of patients get admitted and need operations on their foot and toes chopping off because of diabetes. It's pretty common. I've had over 20 operations done that are diabetic related. I'm just in awe of the fact that they want to try and do something where they can to stem that flow of, um, problematic issues that we're having. I reckon it's gonna be cool. Be given hope. Thumbs up. I'm resting at home today. I've been in hospital for two nights. Cos the doctor said that my kidneys are functioning at 50%, and it's deteriorated in the last three months at a fast rate. I just know I want to live longer... for my kids and my husband. And be happy. Food makes me happy. Everything in my life is around food. You know, our meals together, they're important. That's when we talk, you know, about our day. Yeah. I don't know if I eat more when I'm depressed, but I know I eat more when I'm happy. (CHUCKLES) So I'm happy all the time. (LAUGHS) We've been together, what, 30... 34 years. She's my soulmate so, yeah. She's the mother of my two boys, so. I've never smoked in my life, I've never drank alcohol in my life, never taken illicit drugs. Um, only that, yeah, I have this slow, killing disease called diabetes. Hi, Brian. Hello, Patricia. OK. So, you know why I'm here, eh? It's that time. Yes. Yeah? You're gonna take my dressing down. Yes, so the doctor can have a look. All right? Want me to hold it up? Yeah, please. Brian's about to see the remains of his foot for the first time. And it's uncomfortable viewing. One post-amputated foot. Just gotta hope that this all heals up nicely, and then I can keep my foot. Yeah. We've got Aquacel in there as well. Aqua`? Oh yeah, Aquacel dressing. There it is. Cool. Thank you. No worries. This is all a consequence of me not listening to the doctors 15 years ago, when I was first diagnosed with diabetes. And, um, yeah, unfortunately, this is one of the things that can happen. You can have` very slowly start getting amputations. And I've got all these things showing up on my hands, and if they can't find out what's causing that, and they start to swell and get infected, then I'll start losing fingers as well. I can't turn the clock back and say, 'I should've done this and should've done that.' I just have to accept that 15 years ago I made a choice not to listen to the doctors, and the consequence of that choice is what I'm facing today now. ALARM BEEPS Ah! Hello, my moko! You gonna climb up here? Hang on. Poppa gonna lower the bed. Poppa lower the bed first. Eh? Come on, then. You climb up, eh? Watch out for Poppa's leg. Climb up. Climb up. Careful. Huggy-huggy. Huggy-huggy. Mm! (KISSES) Hello. Ah, cool. Hello. Hi, Dad. Mwah! Yeah. Aww! Mwah! Poppa missed you. You wanna have a look at my leg? Gone. Yeah. You wanna see it? OK. You sure? You ready? Mm-hm. What it look like? Blood and meat. Blood and meat? In your toe. In my toe. My toe gone. Eh, moko? Yeah. 'I'm looking forward` finally gonna be discharged. 'I've spent the last eight years in and out of hospital, 'but, uh, I'm looking forward to being around my family.' In our next programme, we learn that the dangers of getting diabetes can start in the womb. And Brian is worried about how much more he can take. Captions by Tracey Dawson. www.able.co.nz Captions were made possible with funding from NZ On Air. Copyright Able 2016