Every part of our health is intertwined. Our blood pressure, blood glucose, and cholesterol are interconnected, and an issue with one of those may lead to an issue with another.
For example, someone with diabetes is more likely to have hypertension (high blood pressure). They are also more likely to have high cholesterol leading to coronary artery disease (CAD) and other comorbidities (having two chronic diseases at once). This is why people with diabetes should know their ABCs.
What are the ABCs?
A – A1C
A1C is your estimated average blood glucose level over a three month time span. Unlike the normal blood glucose test, the A1C provides an in-depth look at your blood sugar levels.
An A1C below 5.7% is normal
An A1C between 5.7% to 6.4% is within the prediabetes range
An A1C above 6.5% or higher is within the diabetes range
Lifestyle changes can improve blood glucose levels. Read a personal story here.
B – Blood Pressure
Two out of three people with diabetes have high blood pressure.1 When your heart beats, blood moves through your body providing blood and oxygen throughout. When someone has high blood pressure, blood vessels can become constricted, limiting the flow of blood and oxygen.
The general goal is for your blood pressure to be less than 120/80. However, if you have high blood pressure, your blood pressure goal may be different. For example, if your blood pressure is normally above 140/90, your goal may be to bring your numbers down to 130/80.
It is possible for someone with hypertension to bring their numbers down to less than 120/80.
C – Cholesterol
Cholesterol is a waxy substance naturally produced in the liver. It is also found in animal based products, and is needed to make hormones and is used for food digestion.
There are two types of cholesterol. LDL (low-density lipoproteins) is the bad cholesterol and HDL (high-density lipoproteins) is the good cholesterol. LDL increases the risk of heart disease and plaque buildup. HDL carries cholesterol to the liver so it can be removed from the body.
Triglycerides are a type of fat that can cause a blockage in an artery if LDL levels are high and HDL levels are low. A diet that increases HDL and lowers LDL can protect your heart health.
Make sure you know your numbers and make healthy choices to prevent and manage diabetes.
Hyperglycemia (high blood sugar) is caused when there is a build up of glucose (sugar) in the blood. People with diabetes can experience hyperglycemia if they are unable to manage their diabetes; causing frequent urination, increased thirst, and high levels of sugar in their urine.
Hypoglycemia (low blood sugar) is another term that people, diabetics in particular, should know. Blood sugar falling below the target range (see National Diabetes Month) can lead to insulin shock or even death.
Signs and Symptoms of Hypoglycemia
Weak and lethargic
Lightheaded or dizziness
Tingling or numbness
The 15-15 Rule is a method used to treat hypoglycemia without spiking blood sugar. It consists of consuming 15 grams of carbohydrates then waiting 15 minutes before checking to see if your blood sugar is above 70 mg/dL.
I remember watching my maternal grandpa slowly fill up a syringe and inject medicine (insulin) into his stomach. Sometimes, I would hold the side of his stomach so that he could administer his medicine. Grandpa would do the same with each of his grandchildren, walking them through the steps of injecting insulin and taking his blood glucose readings.
Although he had diabetes, which runs in his family, Grandpa learned as much as he could and took steps to manage it. He enjoyed exercising, would go to his appointments regularly, checked his blood sugar throughout the day, and ate a balanced diet, which would include an occasional small scoop of butter pecan ice cream when he wanted to indulge.
On the other end of diabetes self-care spectrum, I remember the latter years of my paternal grandmother’s life. I remember walking into Memaw’s room at a nursing home in complete shock because both of her legs had been amputated, and there were dark boils on her body. She laid there in agony. Her complexion, which was once light, was now darker and ashen.
The same grandmother whose smile could brighten up a room was losing her battle to diabetes. Life happens to everyone, but I believe the hardships of her life overshadowed her being able to manage her diabetes. She couldn’t properly care for herself and succumbed to the disease.
Growing up, I only thought of diabetes as “the sugar disease.” I thought that if I limited how much sugar I ate; I would be okay. I had no idea that my health was at risk because diabetes runs on both sides of my family. I had no idea what insulin was, that there are different types of diabetes, or ways other than diet that could prevent me from getting it.
Thankfully, I don’t have diabetes nor am I prediabetic. Having diabetes run on both sides of my family has made pay attention to any changes in my body. It has also motivated me to keep track of all of my lab reports for over the past ten years. It’s hard, even as a health educator, but I try my best to focus on what I have control over (i.e., nutrition, exercise, stress management, sleep hygiene, etc.) to keep my blood glucose number down. I also enjoy being able to share my personal experiences, knowing and working with people who have diabetes, to educate others. This post is simply that, a means to provide basic diabetes education.
What is diabetes?
If someone were to ask you what diabetes is, what would you say? I can recall the responses from people in my Diabetes Mapping classes. While they had diabetes, some of them didn’t understand what it is. Let me break it down as much as possible.
Diabetes is a group of diseases that is caused by a build up of sugar in the blood stream causing hyperglycemia (high blood sugar).
Let’s say that you eat a slice of pizza. That slice of pizza is broken down into sugar when it enters your body and then the sugar enters your blood stream. If the sugar from the food you eat builds up in your bloodstream, your nerves, blood vessels, organs, and other parts of your body can be damaged.
What causes the build up?
Insulin is a hormone produced in the pancreas; it is known as the key in diabetes terminology because it unlocks cellsso that blood sugar (glucose) can enter. Some people may not make insulin or enough insulin, while some make insulin that does not work properly. If insulin does not unlock cells for blood sugar to enter, the sugar begins to build up in the blood stream.
Glucose is needed because it provides the body with energy and supports cells, muscles, and organs like the brain. But be careful, too much glucose can harm the body.
The three types of diabetes
There are three types of diabetes: type 1, type 2, and gestational. Prediabetes is not diabetes, but it is a diagnosis if someone has a high risk of developing diabetes because of their A1C (2-3-month blood sugar reading).
Type 1 Diabetes
Type 1 diabetes, also referred to as juvenile diabetes, occurs when a person’s immune system attacks cells in the pancreas that make insulin. Because the pancreas is attacked, it either does not make insulin OR it does not make enough.
This type of diabetes normally occurs in childhood but anyone of any age can have it.
Type 2 Diabetes
Type 2 diabetes is the most common type of diabetes where the body does not use insulin properly leading to insulin resistance.
Gestational diabetes occurs when a pregnant woman has a build up of glucose in her bloodstream. Pregnant women are normally tested for diabetes between their 24th – 28th week of pregnancy.
Having gestational diabetes can put a woman at risk for developing type 2 diabetes.
Prediabetes is not diabetes. Being diagnosed with prediabetes means that you are on the verge of developing diabetes. However, weight loss, exercise, and a change in other lifestyle factors can prevent you from becoming diabetic.
Personal Story: Someone who joined one of my 8-week health classes started off prediabetic. He joined the class because the doctor told him to lose a few pounds because of his diagnosis. After losing 20 pounds and making major changes to his diet and exercise routine, he received news that he was no longer prediabetic!
Knowing your numbers
A person’s blood sugar reading depends on their health, if they have diabetes, their activity level, what they eat and when they eat. Have you noticed that you’re asked not to eat or drink anything besides water before a physical? That’s because of blood work that is done to check your blood sugar/A1C. Below are the blood glucose and A1C ranges. It’s important to keep your blood glucose reading within a healthy range and keep track of changes in your blood sugar results as you age.
Prevention and Management
A family history, race/ethnicity, and age are factors that we have no control over. But diabetes can be prevented and managed through:
Weight loss – Losing 10% of your body weight can help prevent and manage diabetes.
Nutrition – Following a diet low in sodium, saturated and trans fats, simple carbohydrates (i.e., white grains, pasta, honey, milk) and high in vegetables, lean protein, fruit (too much fruit can be bad for a diabetic) and complex carbohydrates (i.e., whole grains) may prevent and manage diabetes. Diabetics should “test” how their body responds do certain foods by checking their blood glucose 2 hours after eating.
Exercise – Exercising moves glucose into muscles, moving it from the blood stream. Diabetics should have an exercise routine that will help them manage their diabetes without causing hypoglycemia (low blood sugar – not enough blood sugar).
Sleep hygiene – Getting restorative sleep (all stages, specifically 3 &4) regulates blood sugar and heals the body.
Stress management – Practicing stress management techniques can lower blood pressure and improve blood glucose.
Medication management – Taking medications as prescribed is one of the most important ways to manage diabetes.
Glucose numbers – Knowing your blood sugar range/A1C is the first step to prevention and management of diabetes.
As soon as the boarders were open, I decided to go on an overdue trip to provide health education and outreach in Ghana. While there, I met a young lady, Mary, who was excited to share with me what she recently learned at her church’s Breast Cancer Awareness Month event.
Mary and I discussed risk factors, signs and symptoms, how to do a self-breast exam, and what she learned about breast cancer in the United States. Because I wanted to learn specifically about breast cancer in Ghana, I decided to ask Mary a few questions.
Tonja: What did you learn about breast cancer here in Ghana?
Mary: Breast cancer in Ghana has increased every year. The last two years, it has increased. But, if a woman has a lump and it is detected early, the cancer can be removed, so that she can be free from cancer.
Tonja: Do women here go to the doctor to get a breast exam every year?
Mary: You know…in Ghana, most people feel shy to go to the doctor, or maybe they don’t go because of low income. They may be afraid that if they go to the doctors, they’ll be charged and not have the money for it. They may think, “Why would I force myself to go to the doctors without having money,” so they don’t go. Those who have money in big cities like Accra, Kumasi, Cape Coast, they may pay and have health exams. Those who have family that work at health facilities may also get checked.
Tonja: Do you think there is anything that can be done to make people feel less afraid or shy of getting a breast exam?
Mary: If someone has a family member that works at the doctor, and they are diagnosed, they may be afraid that the news will spread. If possible, avoid going to a doctor where you have a family member or know someone.
Tonja: Do you think the stigma of breast cancer is just as bad as having HIV?
Mary: Yes. For example, if you have breast cancer and have to have your breast removed, people may stare and talk because it is different.We don’t really see that. People will talk.
Tonja: What do you think can be done for more women to get checked and decrease stigma?
Mary: I think more breast cancer awareness. It gives women education and information about breast cancer and helps them to know they can get help. Women can also get to know that they need to have their breast checked each year.
One thing that I’ve learned about being in Ghana is how many people view food as medicine. Mary also learned about the benefits of eating a variety of local fruits and vegetables to lower a person’s risk of developing breast cancer.
Fast Facts about Breast Cancer in Ghana
Breast cancer is the most common type of cancer in Sub-Saharan Africa
Breast cancer is diagnosed at early ages across Africa than on other continents
The highest incidence rates of breast cancer in Ghana is for women ages 40 to 46
Forty-seven to 57% of breast cancer cases in Ghana are women diagnosed under 50 years of age
Source: Iddrisu, M., Aziato, L. & Dedey, F. Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study. BMC Psychiatry20, 353 (2020). https://doi.org/10.1186/s12888-020-02760-4
Because of health observances like Breast Cancer Awareness Month, people all over the world are seeking knowledge, gaining knowledge, and making small changes; and in my opinion, combating stigma little by little.
During graduate school, I learned about breast cancer stigma and the role it played in breast cancer prevention, diagnosis, and treatment. When we think of stigma in health, HIV or AIDS may come to mind; however, women and men (read Breast Cancer in Men) around the world have experienced stigma due to breast cancer.
Here are the facts:
Breast cancer is the most common type of cancer among women
In 2012, 1.7 million women around the world were diagnosed with breast cancer
Approximately 500,000 women die from cancer each year
The incidence rates vary from 27 per 100,000 in Middle Africa and Eastern Asia to 92 per 100,000 in North America1
Nearly 50% of breast cancer cases and 58% of deaths occur in less developed countries2
A lack of education, access to adequate healthcare, and medical bias are a few factors that may impact data; outside of family history, genetics, age, lifestyle factors, and even cultural beliefs. However, stigma may also play a role in the number of people seeking care at later stages and dying.
Why the stigma?
“I think about fear, death, and loneliness.” – Uknown3
The association between cancer and death is a major cause of stigma.4 Personally, I remember being a teenager when I found a lump on my right breast. My first thought was cancer. Afraid to tell my mother, I waited a few days until I finally said something. Thankfully, the lump was only an abscess that I was able to treat with antibiotics. Others may not have the same experience.
In a recent article published by BioMed Central, Breast cancer stigma among Indonesian women case study of breast cancer patients, participants in a breast cancer study had, “negative perceptions towards breast cancer screening because of their experience of fear and shame,” and the “fear of suffering from the disease” was even greater.4 One participant did not seek care for 3 months when experiencing pain, and other participants were diagnosed with an advance stage of cancer when they sought care.4
“If you get treatment early enough, they say you should be ok…it could be the end.” – Unknown3
A cancer study conducted in South Africa found similar findings regarding stigma.5 Participants stated that a physician’s diagnosis was important, but that cancer would lead to negative perceptions from community members.5 A key finding from this study revealed that stigma resulted from the belief that HIV/AIDS and cancer were the same. According to the study, “cancer stigma due to conflation of stereotypes of deadliness associated with HIV may contribute to negative consequences, including social isolation.”
While there continues to be stigma regarding breast cancer, the rates of survival have improved because more people are being diagnosed at an earlier stage.1
What are some ways that stigma is being combated?
Education – Education is a means to combat cancer stigma by clearing misconceptions and increasing knowledge. Healthcare professionals, especially community health workers, can provide this education.
Awareness – Events like Relay for Life bring awareness to breast cancer and empowers many.
Community outreach programs – Community outreach programs can provide education in a formal or informal way. They may also serve as a support system for survivors and those battling cancer.
Increasing social support – One of the reasons some are afraid of getting screened for breast cancer is because they perceive they’ll receive a negative reaction from those close to them. Educating families and increasing social support between patients and their families may help with early detection and treatment.
Times are steadily changing, and we’re living in a world where education and information is within close reach for many. Nevertheless, we have more to do to combat stigma when it comes to cancer; especially when it comes to stigma related to breast cancer in men, and other types of cancer that are often overlooked and not widely spoken of.
Oystacher, T., Blasco, D., He, E., Huang, D., Schear, R., McGoldrick, D., Link, B., & Yang, L. H. (2018). Understanding stigma as a barrier to accessing cancer treatment in South Africa: implications for public health campaigns. The Pan African medical journal, 29, 73. https://doi.org/10.11604/pamj.2018.29.73.14399
October is recognized as Breast Cancer Awareness Month. You may see ads of survivors and supporters lavished in pink, bringing awareness to the impact that breast cancer has made on the lives of many. However, one group may be overlooked…men.
While the percentage is low, men also get breast cancer. Male breast cancer makes up less than 1% of all breast cancer cases in the United States.1 According to the American Cancer Society, 2,620 men will be diagnosed with, and 520 men will die from, breast cancer by the end of 2020.2
A male’s breast tissue can develop cancerous cells in various parts of the breast. Although normally not functional in men, cancer can begin in the ducts that carry milk to the nipple (ductal cancers) and glands that make milk (lobular cancers). Ductal carcinoma in situ, invasive lobular carcinoma, and invasive ductal carcinoma are the most common types of breast cancer in men. 3
The risk factors for breast cancer among women and men are similar in many ways. However, there are two differences. Liver disease and conditions that affect the testicles increases the risk that a man will develop breast cancer.
Source: Centers for Disease Control and Prevention, 2020
Signs and Symptoms
Common signs and symptoms of male breast cancer are:
Pain in the nipple area
Pulling in of the nipple
A lump or swelling in the breast
Redness or flaky skin around the breast
Irritation or dimpling of the breast
Source: Centers for Disease Control and Prevention, 2020
Clinical breast exam – Similar to a woman’s breast exam, a doctor uses their fingers to exam the breast.
Imaging tests – Men can receive an X-ray or ultrasound.
Biopsy – The most conclusive way to determine if cancer is present. Tissue is extracted from the area and examined.
Source: Mayo Clinic, 2020
Surgery – Removal of tumor and breast tissue
Radiation therapy – May be used after surgery to remove cancerous cells
Hormone therapy – Tamoxifen may be used for treatment as other hormone therapy treatments used for women may not work
Chemotherapy – Chemotherapy may be administered intravenously, through a pill, or both
Source: Mayo Clinic, 2020
Though there are risk factors that put men at a greater risk of developing breast cancer, making healthy lifestyle changes, weight management, exercising, eating a healthy diet, limiting alcohol consumption, and quitting smoking may lower the risk that a man will develop most types of cancer.
As we acknowledge women impacted by breast cancer, let us remember that there are men who have survived and lost their lives to the same disease.
Breast cancer is caused by a growth of abnormal cells in the breast which may cause a tumor (lump in breast). There are actually different types of breast cancer with ductal carcinoma in situ (DCIS) and invasive carcinoma being the most common types, while phyllodes tumors and angiosarcoma are the less common types.1
Breast Cancer Facts
Breast cancer is the most common type of among women around the world
1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime
There are over 3.5 million breast cancer survivors in the United States.
On average, every 2 minutes a woman is diagnosed with breast cancer in the United States.
There are over 3.5 million breast cancer survivors in the United States.
On average, every 2 minutes a woman is diagnosed with breast cancer in the United States.
Source: National Breast Cancer Foundation, Inc., 2020
Signs and Symptoms
swelling of all or part of the breast
skin irritation or dimpling
nipple pain or the nipple turning inward
redness, scaliness, or thickening of the nipple or breast skin
a nipple discharge other than breast milk
a lump in the underarm area
Source: Breastcancer.org, 2020
Methods of Detection
While research has “not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by women themselves (breast self-exams),” women should continue to do a self-breast exam to detect any changes in the breast.4
A mammogram is an x-ray of the breast and can detect cancer years before symptoms occur.
Three-dimensional [3D] Mammography (Digital Breast Tomosynthesis) is a newer type of mammogram that finds more types of breast cancer and is beneficial for women with denser breast.
What are the mammogram recommendations?
Every Two Years
Women ages 40-44
Women ages 45-54
Women 55 and older
Annually OR Every Two Years
Like other chronic diseases, there are factors that increases a person’s susceptibility of developing breast cancer. Those factors include:
Reproductive history (starting menstrual cycle before 12 and beginning menopause after 55)
History of breast cancer
Previous use of radiation
Over consumption of alcohol
Source: Centers for Disease Control and Prevention, 2018
There are risk factors that you do have control over that may lower your risk of developing cancer.
Being overweight increases your chances of developing cancer. Regularly exercising and being physically active may reduce your risk of developing cancer.
Eating a balanced diet rich in fruits and vegetables may lower your risk of cancer. However, more research is needed to determine which foods provide the most benefits.
There is a link between alcohol consumption and breast cancer. For women who do drink, they should not have more than 1 alcoholic drink per day.6
In honor of all those who have died from breast cancer, and all the survivors, let’s do our part by educating ourselves and those around us about cancer prevention and early detection.
What is medication management and why is it important? Medication management is simply a method used to safely take medication as prescribed. One of the benefits of medication management is that it can prevent medication errors which can lead to hospitalization, disability, and even death.
You can practice medication management by:
Speaking with a doctor and/or pharmacist about your medications
September 21-25 is Fall Prevention Awareness Week. The purpose of this health observance week is to provide education to people on ways they can prevent falls.
When diving into the data on falls, you can see why this matter is a public health issue.
Thirty million older adults (age 65+) fall each year
Each year, 3 million older adults are treated for a fall injury
1 in 5 falls results in a broken bone or head injury
300,000 older adults are hospitalized because of a fall
95% of hip fractures are caused by a fall
Every 20 minutes an older adult dies from a fall in the U.S.
Source: Centers for Disease Control and Prevention, 2019
Although you are more likely to fall as you get older, there are ways to prevent from doing so.
There are medications linked to falls. Some medications may cause sleep deprivation, disorientation, and even a drop in blood pressure. It is important that you practice medication management by taking your medication(s) as prescribed and speaking with your doctor about medication interactions and side effects.
Hearing and Vision
A change in your hearing and vision may cause a fall. The function of the ear is not only for the sense of hearing, but it is also connected to balance. Hearing is also important so that you can know what is going on in your surroundings. A small change in hearing decibels increases your likelihood of falling.
Trouble seeing may cause you to miss a step, walk on a slippery surface, or even walk into something. Cataracts, diabetic retinopathy, and glaucoma are a few diseases that impact vision and increases your chances of falling. It’s been shown that removing cataracts from one eye greatly reduces falling.
You should have your hearing and vision checked annually.
Aging changes our sleep pattern. As we age, we spend more time in lighter sleep causing sleep deprivation and a slower reaction time. Try practicing sleep hygiene to get more sleep.
Regularly exercising and being physically active can prevent falls. Strength training builds muscles, flexibility exercises prevent injuries and helps with recovery, balance exercises can make you more agile. You should create an exercise plan that incorporates all four types of exercise.
Nutrition is important for weight loss and fall prevention. Calcium, vitamin D, potassium, and vitamin K are imperative for bone health. Foods like low-fat dairy, salmon, collard greens, broccoli, protein, spinach, kale, and fortified breakfast cereals provide nutrients for healthy bones. While some people are encouraged to take over-the-counter vitamins, it is best to get nutrients from foods instead of vitamin capsules.2
Limit sodium, caffeine, and alcohol as they decrease calcium absorption and lead to bone loss.
Keep a phone on the floor if you are doing floor exercises
Get a hearing aid
Use a cane or walker
Purchase a medical alert system, some detect falls
Limit alcohol consumption
Eat a balanced diet
Keep a list of emergency numbers in a visible place
Use railings in the shower
Watch out for pets
Use a step ladder or reaching tool when trying to reach high objects
Ask for help
Know what to do if you fall
Speak with your doctor about your fear or risk of falling
First Picture by Andrea Piacquadio from Pexels
National Council on Aging
The NCOA has free resources on fall prevention tips for older adults, videos on how to prevent falls, a list of fall prevention programs, and will host a Fall Prevention Facebook Live event in English on September 23rd and En espanol on September 24th.
Centers for Disease Control and Prevention – STEADI
The CDC’s STEADI initiative includes information on ways to prevent falls and more.
As we age, our body goes through various changes. You may gain and retain weight more easily. Your bones may become brittle because of hormonal changes causing diseases like osteoporosis. You may develop osteoarthritis or even find that your joints are stiffer because of a lack of movement.
Exercise and physical activity are the keys to staying fit, mobile, and independent as you age. The recommended amount of exercise/physical activity per week is 150 minutes of moderate-intensity aerobic exercise.1 With moderate activity, you are able to speak when in movement; however, with vigorous activity, which is an option for 75 minutes per week, you need to “catch your breath” before you speak. One hundred- and fifty-minutes sounds like a lot, but you can easily break it down to exercising 30 minutes a day, 5 days a week. Thirty minutes can also be broken down to three 10-minute intervals throughout the day.
Physical Activity vs. Exercise
The difference is simple. Physical activity is anything the involves body movement. This can include going for a walk, gardening, light cleaning, walking to the mailbox, or even walking down the stairs to get something. Exercise on the other hand involves strategic movement with a purpose. There’s a goal that one is trying to accomplish for a specific number of minutes, miles, repetitions, sets, etc.
All exercise is a form of physical activity, but not all physical activity is exercise.
Ways to Incorporate Physical Activity
Four Types of Exercise
Exercise can be broken into four different groups, Endurance, Strength Training, Balance, and Flexibility. Each type of exercise serves a specific purpose, and it is important to corporate a variety of each throughout the week.
Endurance exercise gets your heart rate up and your blood circulating, improving the health of your heart and lungs.2
Strength training builds and tones muscle, strengthens bones, aids in fall prevention and mobility. Exercises from this group may also prevent diabetes and help those with diabetes manage their condition.
Balance exercise aid in fall prevention and strengthens your core.
Flexibility exercises can prevent injuries, help you recover quicker if you are injured, and aids in agility.
Incorporating different types of exercise can help you stay active and independent as you age, and help to prevent and manage chronic diseases. Remember, speak with your healthcare team before starting an exercise regime, stretch before and after exercising, and go at your own pace.
First Picture by FFWPU from Pexels
Go4Life is an exercise and physical activity program developed by the National Institute on Aging at the National Institutes of Health. Although their previous grant is over, you can still find information about ways to increase and maintain physical activity regardless of age and health conditions. For more information visit https://www.nia.nih.gov/health/exercise-physical-activity.
MOVE is a weight management program developed by the U.S. Department of Veterans Affairs. Countless individuals have participated in the program to manage and lose weight, increase physical activity, and as a means for support. The website includes information on nutrition, exercise, mindful eating, and more. Please visit https://www.move.va.gov/.