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Huckabee, Steinhauser teach self-care for diabetes

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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


Kearney Regional Attains Blue Distinction Orthopedic Spine Surgery

Kearney Regional Medical Center has been named a Blue Distinction Center® in orthopedic spine surgery by the Blue Cross Blue Shield Association.  The award is given to medical facilities that demonstrate expertise in delivering quality health care. KRMC is one of only 3 hospitals in Nebraska and the only in Central Nebraska to have received this high honor.

Blue Cross Blue Shield of Nebraska recognizes select doctors, hospitals and other healthcare facilities as Blue Distinction® for the safe, effective care they provide to their patients. Each must meet a specific set of rigorous standards to receive the Blue Distinction designation.

“Given the news that we were selected to be a Blue Distinction facility is very humbling,” said Dr. David Benavides, Orthopedic Spine Surgeon.  “It is indicative of the commitment this facility has to provide the best of care, particularly to our spine patients.  It is a direct reflection of this hospital’s primary objective of putting patients first and making sure our community is well taken care of.”

“The Acknowledgement will allow KRMC to continue to remain at the forefront of spine surgery innovation focusing on patient outcomes,” added Dr. James Mahalek, Orthopedic Spine Surgeon.  “Patients will have assurance that spine treatments at KRMC will exceed standards of quality that few centers achieve.”

“The selection for Blue Distinction is an honor that reflects all the hard work coming to fruition for this facility,” added Dr. Benavides. “To be recognized by such a well-known and respected insurance company like Blue Cross Blue Shield of Nebraska allows KRMC to be able to tell patients that they trust us. We work hard to earn that trust from the patients and to provide the best possible care here in the best and newest facility around.”Blue Distinction Centers for spine surgery are awarded to medical facilities exhibiting a commitment to quality care, resulting in better overall outcomes for patients. These facilities offer experienced, comprehensive inpatient spine surgery services, including discectomy, fusion and decompression procedures. Research confirms that hospitals designated as Blue Distinction Centers for spine surgery have fewer patients with complications and fewer hospital readmissions than non-designated hospitals.

About Blue Cross Blue Shield of Nebraska
Blue Cross Blue Shield of Nebraska is a community-based, member-owned health insurance company serving Nebraskans for more than 75 years. BCBSNE is committed to providing stability and security to Nebraska families and is leading the way in supporting patient-focused care. We’re the state’s largest health insurance company, and the only one headquartered in Nebraska. Blue Cross Blue Shield of Nebraska is an independent licensee of the Blue Cross Blue Shield Association.

About Kearney Regional Medical Center

KRMC is a 93-bed acute care hospital.  Dedicated to improving the health of our patients, Kearney Regional Medical Center delivers expert medical care that is patient-focused and cost-effective. Kearney Regional Medical Center’s state of the art facility offers patients sophisticated diagnostic and therapeutic services covering the spectrum of care.  Kearney Regional is made up of Medical, Surgical, and Intensive Care Beds.  As well as a full suite of Operating Rooms, Interventional Cardiology and Radiology Labs, an Emergency Department, Maternity Care Center, and full Radiology Department for diagnostic services.

The staff at Kearney Regional consists of over 700 talented and compassionate physicians, nurses, clinical, and support staff.

Kearney Regional Honored with Distinction

Kearney Regional Medical Center has received the Mission: Lifeline® NSTEMI Bronze Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks.

The American Heart Association’s Mission: Lifeline program’s goal is to reduce system barriers to prompt treatment for heart attacks, beginning with the 9-1-1 call and continuing through hospital treatment.

“Kearney Regional Medical Center is dedicated to improving the quality of care for our patients who suffer a heart attack, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that goal through nationally respected clinical guidelines,” said John Lanning, Chief Operating Officer with Kearney Regional Medical Center. “We are pleased to be recognized for our dedication and achievements in cardiac care, and I am very proud of our team.”

“We commend Kearney Regional Medical Center for this achievement award, which reflects a significant institutional commitment to the highest quality of care for their heart attack patients,” said James G. Jollis, MD, past Chair of the Mission: Lifeline Advisory Working Group. “Achieving this award means the hospital has met specific reporting and achievement measures for the treatment of their patients who suffer heart attacks and we applaud them for their commitment to quality and timely care.”

Kearney Regional Medical Center earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of NSTEMI patients by providing emergency procedures to re-establish blood flow to blocked arteries when needed. Eligible hospitals must have adhered to these measures at a set level for at least one consecutive 90 day interval.

About Kearney Regional Medical Center

KRMC is an 89-bed acute care hospital.  Dedicated to improving the health of our patients, Kearney Regional Medical Center delivers expert medical care that is patient focused and cost effective. Kearney Regional Medical Center’s state of the art facility offers patients sophisticated diagnostic and therapeutic services covering the spectrum of care.  Kearney Regional is made up of Medical, Surgical, and Intensive Care Beds.  As well as a full suite of Operating Rooms, Interventional Cardiology and Radiology Labs, an Emergency Department, Maternity Care Center, and full Radiology Department for diagnostic services.

The staff at Kearney Regional consists of over 700 talented and compassionate physicians, nurses, clinical, and support staff.

 About Mission: Lifeline

The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI and NSTEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology Foundation clinical treatment guidelines.  For more information, visit