Diabetes in West O`ahu - The Queen`s Medical Center

November 24, 2014
Volume 23 – Number 48
Lifting the Burden of Diabetes in West O‘ahu
Susan Murray, Sr. VP, unties a maile lei in a blessing ceremony for
the QMC–WO Diabetes Management and Education Center.
Living well is the key. If you have
diabetes, the newly opened QMC – West
O‘ahu Diabetes Management and Education Center is not out to make your life
miserable by imposing rules that are impossible to follow. Rather, their mission
is to arm you with expert diabetes education and help you manage your self-care
with a plan that’s doable. All of that is
set within an overall vision to reduce the
burden of diabetes in West O‘ahu.
According to Family Nurse Practitioner Anne Leake, PhD, APRN, BC-ADM,
of the Diabetes Management and Education Center, reducing the burden of
diabetes means less distress for the person with diabetes, fewer complications,
and less disability. “We’re like your
coach,” she says of their role in diabetes
management. The “we” on her team also
includes dietitian Kelly McDaniel and
Naomi Fukuda, RN, who is a certified
diabetes educator. Regular classes are
also offered. A big proponent of classes,
Above: Anne Leake, PhD, APRN, uses a Hoberman sphere to
illustrate how insulin (triangle) attaches to a cell to “open” it so
sugar can enter. Left: Lou Brock addresses diabetes self-care.
Anne notes that people who learn in a
group tend to have better glucose balance and are better able to change behavior because they meet others in the
same situation as themselves.
With few endocrinologists practicing
in West O‘ahu and an estimated 16,000
people with diabetes, the opening of the
Diabetes Management and Education
Center is a welcome development. The
Queen’s Board of Trustees also strongly
supported the center and charged QMC
– West O‘ahu with developing it.
The QMC-WO Diabetes Management
and Education Center opened on November 14, which was World Diabetes Day. A
private untying of a maile lei and blessing was held at suite 180 of the Clinical
Services Center, which adjoins the hospital building. Afterwards, baseball hall
of famer Lou Brock, formerly of the St.
Louis Cardinals, was the guest speaker
at a public event held outdoors. Speaking about how he manages his diabetes,
(Continued on page 2.)
Diabetes in West O‘ahu
(Continued from page 1.)
he used a baseball analogy of “keeping the ball within the bounds of fair
play” to encourage those with diabetes
to keep within the boundaries of diabetes. “When you hit the ball within the
bounds of play,” said Brock, you’ve got a
shot to score. Similarly, if you keep your
blood sugar and A1C level within bounds,
you acquire “invisible energy” to stay in
the game and move on to the next level.
The next level, said Brock, is the next day.
He also said that having someone you
trust to help you keep diabetes within its
bounds also gives you invisible energy to
“make another hit against diabetes.”
That’s where the Diabetes Management and Education Center comes in.
With the ability to book longer visits,
they can work with a patient’s primary
care provider to unravel the mysteries of why their diabetes is poorly controlled—diagnostic puzzles, as Anne
calls them. They’re well equipped. Today, medical professionals have the
ability to “hit our bat,” with the ball,
Diabetes in a Nutshell
Diabetes is a group of diseases in which
a person develops high blood glucose
(sugar) because insulin production is too
low or the body’s cells don’t respond
properly to insulin, or both. Untreated diabetes can lead to many longterm complications, such as heart disease,
stroke, kidney failure, foot ulcers, and eye
damage. A1C is a common blood test
used to diagnose diabetes and to gauge
how well the disease is being managed.
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Above: Susan Murray, Sr. VP, QMC – West O‘ahu, Jacqueline and Lou Brock, Anne Leake,
PhD, APRN, Naomi Fukuda, RN, CDE, and Kelly McDaniel, Registered Dietitican.
as Brock put it. Not only are there new
medications and technology, but also
fresh techniques and perspectives on
overcoming the distress of diabetes.
For example, a new, once-a-week noninsulin treatment lowers blood sugar for
certain adults with type 2 diabetes. The
treatment comes in a “pen,” which the
patient uses to inject GLP-1, a hormone
that the body may not be making enough
of. GLP-1 helps the pancreas release the
right amount of insulin to move sugar
from the blood into cells when it’s needed. Another benefit of GLP-1 is that it can
help the patient lose weight.
Another is a new class of diabetes
medications for type 2 diabetes called
SGLT2 inhibitors. Taken in pill form,
the medication reduces blood sugar
by telling the renal tubules to excrete
glucose in the urine. SGLT2 inhibitors
also help with weight loss.
In addition, there is now a concentrated form of insulin available. Taken
in smaller doses than conventional insulin, the concentrated insulin is better absorbed and used more efficiently
by the body to control glucose. The
new insulin is for those who currently
take over 200 units of insulin daily.
A fourth tool in the fight against diabetes is continuous glucose monitoring
technology, which is not only an effective diagnostic tool, but can tell a patient how much insulin to take. Worn
by the patient for a week, the device
checks blood sugar every five minutes.
Attached by a soft catheter inserted in
the skin on the stomach, the electronic
device creates a graph of high and low
blood sugar numbers so clinicians can
finely tune a patient’s treatment.
This arsenal against diabetes is now
available to patients, and the Diabetes Management and Education Center
staff knows how to use them. The staff
is also ready with fresh perspectives and
techniques to relieve the distress surrounding diabetes. They offer “distress
stress management.” One of four major
sources of distress, says Anne, is with
a diabetes regimen that is too hard, too
inconvenient (e.g., checking blood sugar levels), costs too much, or all of the
above. The Diabetes Management and
Education Center can work with a patient’s primary care provider to simplify
the regimen as much as possible.
The second area is physician-related
stress. “Sometimes, patients get huhu
with their doctor,” she says. “We can
work with patients to have a better relationship.” The Diabetes Management
and Education Center staff can suggest
ways to make visits more productive for
patients, such as writing questions for
the doctor in their log book, and to ask
direct questions: “I’m not happy with
my numbers—what should I do?” “Can
you refer me to a diabetes specialist?”
There is also emotional distress. Feeling like you don’t want to do the diabetes regimen anymore or give up because
it’s hopeless is different from depression, notes Anne. Perhaps the patient is
frustrated because they don’t want to be
dependent on anyone. The fourth area
is interpersonal distress. A patient isn’t
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EBP Makes Practical Impact on Care
“The advancement of nursing interventions and knowledge of effective
nursing protocols to achieve optimal
outcomes has exploded in the last decade,” wrote Stephen D. Krau, PhD, RN,
CNE, in the foreword of the recently
published journal Integrating Evidence into Practice for Impact. The journal, which
was published as a hardcover book, contains 14 evidence-based practice (EBP)
projects, half of which came from nurses
at The Queen’s Medical Center. A lunch
was held recently to celebrate publication, present the authors with awards,
and foster encouragement for the continued success of more projects.
The publication is part of a yearly
workshop and internship sponsored by
the American Association of Colleges of
Nursing (AACN), now in its sixth year.
Diabetes in West O‘ahu
(Continued from page 2.)
getting along with their spouse, child, or
caregiver. “But maybe that’s not the underlying problem,” says Anne. “Maybe it
doesn’t have anything to do with diabetes.” Yet, she says, interpersonal distress
can lead to poor glucose balance. To
learn more about controlling diabetes,
visit www.learningaboutdiabetes.org.
Anne cites leading endocrinologist
Steve Edelman, MD, who said that it’s an
excellent year if you are diagnosed with
diabetes because of all the new treatments, technologies, and strategies that
are now available. If you have diabetes,
don’t hesitate to keep your life within the
bounds of the disease and to ask for help
in doing it. The services of the Diabetes
Management and Education Center are
It encompasses 65 teams of 176 nurses
working at 17 different sites across the
nation. The AACN is the national voice
for baccalaureate and graduate nursing
education, and works to establish quality
standards for nursing education; assists
schools in implementing those standards; influences the nursing profession
to improve health care; and promotes
public support for professional nursing
education, research, and practice.
The Queen’s nurses held monthly sessions with writing deadlines from June
to December of last year. One member
from each EBP project team attended every session for feedback on their write-up
and presentation. Sessions were summed
up as: Write, write, write, edit, rewrite,
edit, rewrite. “It was definitely a process,”
confirmed Renee Latimer, MPH, MSN,
RN, Director of the Queen Emma Nursing Institute and a publication editor.
“It’s about the work you do every day—
this is just the documentation of your
hard work,” added Debra D. Mark, PhD,
RN, nurse researcher, Hawai‘i State Center for Nursing, Assistant Professor at
the University of Hawai‘i School of Nursing & Dental Hygiene, and also one of the
book’s editors. “It is wonderful to get support [from the State and QMC], because
it has been a long journey. Evidenceavailable by referral. You can ask your
primary care provider to make a referral,
or you can just call the Diabetes Management and Education Center, which will
call your doctor or nurse practitioner for
you. They can be reached at 691-3370.
For those who live closer to town, QMC
– Punchbowl also has an Outpatient Diabetes Education Center (691-4823).
A few of the authors: Deborah Bransford,
Maryline Dolor, Michele Hadano, Flo
Agos, Raina Haarz, Casey Shoda, Becky
Cole, and Maile Salter.
based practices improve patient care, affect cost, and are nurse-sensitive.”
The ultimate goal behind evidencebased practice projects is to improve
patient care, help nurses change practices, and apply and generate knowledge. “Billions are spent on research
not directly applied to the bedside,
but EBP can change that,” Debra concluded. The Hawai‘i State Center for
Nursing initiated the EBP program to
achieve EBP competencies. They remain more relevant than ever for RNs,
new grads, and for licensure.
QMC’s published authors include: Florence Agos, RN; Juliet Beniga, RN, CNRN,
CCRN; Deborah Bransford, RN; Rebecca
Cole, RN; Maryline Dolor, RN; Maimona
Ghows, MD; Michele Hadano, RN; Lois
Han, RN, CCRN; Raina Haarz, RN, Rose
Hata, RN, APRN, CCRN, CCNS; Leilani
Hill, RN; Kara Izumi, PharmD, BCPS,
BSNSP; Katherine Johnson, RN, APRN,
CCRN, CNRN, CNS-BC; Renee Latimer,
MPH, RN; Asa Miyahira, RN, CCRN;
Christy Passion, RN, CCRN; Maile Salter; Casey Shoda, RN; Jill Slade, RN,
CCRN; and Mihae Yu, MD, FACS.
A quote from Anna Gawlinski, RN, Director of Evidence-based Practice at the
UCLA School of Nursing, was posted on
every table, succinctly summing up the
message behind the celebration: “Nurses
who engage in evidence-based practice
create a healing environment for patients
and a healthy workplace for colleagues.”
For more detailed information about
the EBPs, visit nursing.theclinics.com.
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Technical Milestones
Ann Loengard, MD, has been named
Chief Medical Officer of the Queen’s
Clinically Integrated Physician Network (QCIPN). The Network is comprised of 300 primary care physicians
and 750 specialists across the state.
Dr. Loengard trained in internal medicine at Beth Israel Deaconess Medical
Center at Harvard University and completed a geriatrics fellowship at the
University of Arizona. She focused her
practice on palliative care and homebased primary care for the frail elderly at the Department of Geriatrics, Mount Sinai Medical Center, New
York. She is now on the faculty of the
University of Hawai‘i John A. Burns
School of Medicine and was the 2013
Healthcare Association of Hawai‘i
(HAH) Physician of the Year.
. . . . . . . . . . . . . . . . . . . .
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Queen’s Medical Center – West O‘ahu
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Ring in the holiday season! Give the
gift of "Fabulash" 3D fiber lash mascara
in a special wrapping she will love. Email:
itd@hawaii.rr.com.
Placing an ad: Queen’s employees only. Include
name, phone and Employee ID number. Mail
to Creative Services—Print Connection, fax to
691-4002 or e-mail to jkimura@queens.org by
Wednesday. The Print Connection reserves the
right to edit or refuse any ad. The Print Connection
does not make any warranty about the fitness of
any product or service listed in Q-Mart.
4
They may work with patients, but
no patient will ever remember them.
Yet, they are an important part of a
team that saves lives by detecting and
removing precancerous polyps during
colonoscopies, as well as examining or
treating other diseases like GERD (Gastroesophageal reflux disease), colitis,
and Barrett’s esophagus. These are the
is available for viewing on YouTube at
http://youtu.be/gXR_FzquVoc.
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Early registration is now open for
the 2015 Great Aloha Run, which will
be held on Monday, February 16. Join
the Queen’s team Presidents’ 100 Club
today for special bonuses. Register
online at greataloharun.com and enter Club Code 53. Early registration
closes at noon on Friday, December 5.
Friends and family are encouraged to
participate. Contact lsekiya@queens.org
with any questions about joining the
Queen’s team.
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“Haiyan…After the Storm,” a TV
special by Emme Tomimbang, will be
broadcast on KGMB Thanksgiving
night, Thursday, November 27 at 9:00
pm. Tune in for a look at the devastation in the Phillippines, the intensive
recovery efforts, and insight into the
resiliency and spirit of the country
and the Filipino community worldwide. Queen’s is one of the sponsors of
the special, which will be rebroadcast
on Sunday, November 30 at 9:00 pm,
also on KGMB.
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The Café Aloha will now close at
1:00 am daily.
GI techs Matthew Patao-Torres, (Associate), Minerva Tomacder (Advanced), Mharie Marcos (Advanced), Janet Santos (Advanced), and Alyssa Perales (Associate).
GI techs of Kamehameha 4 and POB III
Endoscopy. Recently, five Kamehameha
4 GI techs earned Associate and Advanced Associate certificates from SIGNA (Society of Gastroenterology Nurses
& Techs). An advanced certificate qualifies a GI tech to assist in key specialty
procedures. The rigorous, online SIGNA course for the advanced certificate
takes three to six months to complete.
Queen’s techs were the first in Hawai‘i
to earn advanced certificates. Queen’s
has 11 GI techs in all—seven in Kamehameha IV and four in POB III.
The Queen’s Print Connection is published
by Creative Services. If you have news or
wish to opine, call us at 691-7532 or e-mail
jkimura@queens.org. The news deadline is the Monday prior to publication.
QHS/QMC President. . . . . Art Ushijima
Publisher. . . . . . . . . . . . . . . . . Keala Peters
Editor/Writer. . . . . . . . . . . . Jason Kimura
Assist. Ed./Writer. . . . . . Glee Stormont
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