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Seven is the lucky number for Type II diabetes patients.
By following the seven “self-care behaviors,” these patients can successfully manage their diabetes, according to Chris Steinhauser and Lauren Huckabee, who staff the Diabetes Education Program at the Platte Valley Medical Group, the subsidiary of the Kearney Regional Medical Center.
Huckabee is a registered dietitian. Steinhauser is a registered nurse and a certified diabetes educator. Working as a team, they help diabetics manage their conditions. They primarily work with patients who are newly diagnosed or who need assistance with some aspect of their ongoing care.
About 90 percent of diabetics are Type II, according to Huckabee. Formerly called adult onset diabetes, type II usually occurs after the age of 45 and is often hereditary. It most commonly affects Hispanics, Native Americans and African-Americans.
“Type II diabetes runs in families. Lifestyle and weight can affect it, too,” Huckabee said.
The seven self-care behaviors are:
1. Healthy eating
“‘Healthy eating’ is a broad definition,” Huckabee said. “We’re talking about healthy nutrition, with a focus on carbohydrates and how they impact the blood sugar. People with diabetes need to balance their carbohydrate intake to avoid high or low blood sugars.”
Huckabee encourages patients to plan meals in advance, and to keep a food journal noting how much, and when, they eat. Diabetics need to eat three consistent meals a day.
“Eating regular, consistent meals is important for blood glucose control,” she added. “Patients should avoid skipping meals because that can lead to overeating later in the day.” Also, certain medications can cause low blood sugars, so it is essential for patients who take these medications to eat regular meals, she added.
2. Staying active
Physical activity is critical for controlling blood sugar. Diabetics should exercise at least 30 minutes a day, five days a week, but they can also do this in increments, such as two 15-minute walks a day, Huckabee said.
“We often tell our patients to think of exercise as another medication. Exercise is very effective in lowering blood glucose numbers. It has many other benefits, such as heart health, increasing lean muscle, improved circulation and alleviating depression. Just like the meal plan, the exercise plan needs to address patients’ medical needs, lifestyle and tolerance,” she added.
While walking is the easiest and most accessible form of exercise, Huckabee said some people cannot walk comfortably because of joint pain or other issues. “In those cases, we look at other types of exercise, such as stationary biking or water walking,” she said. “Any increase in activity is going to be beneficial. Sometimes just a 10-minute walk is a big improvement.”
3. Monitoring blood sugars and other indicators
“Diabetes is incredibly self-managed, so patients really need to be in charge,” Huckabee said. “It’s hard to know by how they feel if it’s under control, so we use a blood glucose meter, a little device, to take a small drop of blood and put that on a test strip to give them blood glucose results.”
She said monitoring is critical because long-term complications from uncontrolled diabetes can be grim. Diabetics are at risk for other health problems, including heart disease, eye disease, stroke, kidney disease and nerve damage.
4. Taking medication
Huckabee and Steinhauser set a target for each patient and urge patients to follow up with their primary care provider every three months, although patients with well-controlled Type 2 diabetes can schedule such visits every six months. “Most see their providers every three months to monitor lab results and any complications,” Steinhauser said. If they need a change in medication or supplies, that can be handled then, she said.
5. Problem solving
“Diabetes isn’t much fun,” Huckabee said. “We want to make sure they have a good support system.” She said she and Steinhauser welcome family members who come in with patients, especially the patient’s “primary support” person, such as a spouse, an adult child or a good friend.
6. Reducing risks
Patients are urged to have yearly eye exams, Huckabee said. “And if they smoke, we want them to quit because smoking can increase the risk. They need to keep blood sugar under good control,” she said.
7. Healthy coping
“We want to be sure everyone is on the same page. Occasionally, if they’re really struggling, they may need a mental health professional. We try to help identify barriers and figure out what’s getting in the way of their management of this condition,” she said.
Another type of diabetes is gestational diabetes, which can result in women giving birth to babies who are over 9 pounds. All pregnant women become insulin resistant in response to hormones, but this condition occurs during the second half of pregnancy when a woman is not able to produce enough insulin to keep blood sugars in range. Insulin needs during pregnancy will double to triple over the duration of the pregnancy.
In all types of diabetes — Type I, Type II and gestational — meal planning is the primary tool for staying healthy, Huckabee said. This involves three meals and three snacks daily, with limited carbohydrates.
“For pregnant women, nutritional needs are balanced with blood glucose control. During pregnancy, the target blood glucose range is lower than with Type 1 or Type 2 (60-130 vs 80-180),” Steinhauser, a certified diabetes educator for 22 years, said. “Also, while gestational diabetes usually resolves after delivery, women are at higher risk for developing gestational diabetes with future pregnancies and Type 2 diabetes later in life.”
In 2016, their program received the American Diabetes Association Education Recognition Certificate for a quality diabetes self-management education program. The certificate assures that the program meets the national standards.
It is also covered by Medicare, including initial visits and follow-up visits in subsequent years.
When patients are referred to the program, their first visit is usually with Steinhauser, the diabetes educator. She assesses the patient’s learning needs and helps develop an individualized plan so he or she can manage their diabetes. She talks with the patient about the diabetes disease process and blood glucose targets. She helps set up a blood glucose meter, instructs them about their medications and advises the patient on when to call his or her health care team.
A week or so later, the patient meets with Huckabee for medical nutrition therapy. Huckabee, who has been a registered dietitian for four years, works with him or her to develop an eating plan to address goals, blood glucose range and lifestyle.
The roles of Huckabee and Steinhauser frequently overlap. For example, on that initial visit, the most frequent question Steinhauser hears is “What can I eat?” She addresses this concern, but Huckabee focuses on this topic when she meets with the patient.
Their work is critical because internists and their staffs often cannot adequately address many concerns of patients during routine visits. Huckabee and Steinhauser spend at least one hour with patients at the first two initial visits, and 30 minutes at follow-up visits.
“We are in frequent communication with the referring provider. We function as a very strong team in our program,” Steinhauser said.
By Mary Jane Skala
Kearney Hub Writer