Healthcare is changing dramatically for those who seek care and those who deliver it.  The Patient Protection and Affordable Care Act has brought healthcare coverage to millions of consumers who previously could not afford or did not want health insurance.  Now the health benefit experience will present them and others with a variety of choices and complexities to consider. Those choices will be difficult if they don’t have an understanding of what’s being said or written and they’re making those choices for the first time.
Presently, consumers are overwhelmed by the flood of information and decisions that need to be made. Health Literacy can play a huge role in providing understandable communications between the consumer and their healthcare provider.
The growing pressure on health systems is to reduce, ration and delay health services to contain health costs.  But people are living longer creating more time for minor dysfunctions to develop into disabling chronic diseases. Health literacy or people’s ability to obtain, process, communicate and understand basic health information and services is essential to those actions. Yet, few American are proficient in understanding available health information.
The Health Literate Care Model article cited: Health Education Behavior, December 2013, 40:6635-639.  “The Public Health Journey: The Meaning and the Moment” by Howard Koh, Cindy Brach, Linda Harris, Michael Pearlman, calls for health professionals to approach all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them.  Health Literacy would then become a value that is used in all aspects of planning and clinical information systems.
Howard Koh, MD, MPH, wrote when he was Assistant Secretary for Health , “As a result, I’ve observed the difficulties many people face as they attempt to use our health care systems. When people receive accurate, easy to use information about a health issue, they are better able to take action to protect and promote their health and wellness.  
Improving health literacy, that is, the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions is critical to achieving the objectives set forth in Healthy People 2020, 2021, and 2022.   
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The National Action Plan to Improve Health Literacy envisions a restructuring of the ways we create and disseminate all types of health information in this country.  The Plan also calls us to ensure that all children graduate with health literacy skills that will help them live healthier throughout their lifespan. It seeks to engage organizations, professionals, policymakers, communities, individuals and families in a linked effort to improve health literacy. Its plan is to provide everyone with access to accurate and actionable health information and supports lifelong learning and skills to promote good health.
It has been my experience as a RN Community Health Educator that  Prediabetics and Diabetics who were diagnosed in the past still have basic questions that should have been dealt with for the successful at home self-management of their disease.  It was my good luck and search to find the Florida Literacy Coalition to join those who have wisdom, insight, research, technicians and practices within the world of family and adult health literacy. 
The Florida Literacy Coalition has knowledge of the problem as the health delivery system continues to drastically change, the education of health professionals continues to change, as new medications are discovered and the cost of care continues to soar.  Tomorrow’s health care systems are destined to change. 
Mary Gynn, RN

By Mary Gynn - Diabetes Educator ​
Let me start with the reminder that Diabetes affects 25.8 million people. Those diagnosed are 18.8 million people and undiagnosed total 7.0 mil-lion people. Unfortunately, both Type 1 and Type 2 diabetes are affecting the younger generation, as well, the numbers being a staggering 215,000. (Center for Disease Control and Prevention in Atlantic, GA. www,cdc.com). Prediabetes and diabetes are now officially listed as an epidemic in the US. And, the numbers are growing.
An epidemic? This is 2018. Ironically, diabetes was first described in an Egyptian manuscript from 1500 BC and the first cases were described by Indian physicians in 400-500 AD identified as Type 1 and Type 2. Then in 1776, a Dr. Matthew Dobson con-firmed an excess of a kind of sugar in the urine. (Dobson,M. 1776, Medical Observations and Inquiries 5:298-3Is it the 10). And in 1889, it was found that dogs whose pancreas was removed developed all the signs and symptoms of diabetes.
So, considering these very early discoveries, why are we dealing today with Diabetes now an epidemic? Shouldn't the disease have been either controlled or eliminated all these years later?
Does "It", the epidemic, have some-thing to do with the following questions? I ask:
• Is it lack of community health and diabetes education?
• Is it the abundance available and consumption of processed foods?
• Is it lack of Americans knowing the existence of a gene somewhere in their ancestry that they may have inherited predisposing them to diabetes? Do most Americans have any idea of what a genetic inheritance (aka genome sequence) is? And all the variety of genes we all have predisposing us to health issues?
• Is it because the majority of Americans are addicted to sugar and sugar is present in practically all our food? And, why is sugar in all of our food?
• Is it the growing numbers of people who don't want to adapt a healthy life-style either early on or when diagnosed with a blood test they have prediabetes?
• Is it because people aren't aware of their predisposition to the disease and have no knowledge of the metabolic syndrome?
• Is it because Americans who if they do have some pre-diabetes symptoms just want a quick-fix pill to avoid facing reality and say nothing to or deny any symptoms to their physician?
• Is it due to the insidious development of overweight and/or the obesity epidemic?
• Is it in anyway connected to the in-activity or a "sitting" population in to-day's America?
• Is it connected to stress in our lives in today's stressful world that we do nothing about?
• Is it the multitude of pills or insulin pre-diabetics and diabetics ingest and inject and think they are the "cure"?
• Is it the lack of diabetics not knowing how to self-manage their own dis-ease resulting in permanent sugar control?
• Is it pre-diabetics and diabetics have no desire to self-manage or fearful of taking control of their disease?
In my years of being a registered nurse and diabetes educator, I could go on and on identifying the multitude of questions. They help me arrange my diabetes self-management education programs and discuss your answers to the above questions. Your answers assist my effort to understanding why we now have a diabetes epidemic.
Mary Gynn, RN, MSN/MS, MPH, CDE


​http://seniorvoiceamerica.org/
​http://www.svatampabay.com/
​http://seniorvoiceamerica.com/
http://www.getsva.com/
​813-693-5511

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​Teaching For Health Series,
​PREDIABETES
By Mary Gynn, RN, BSN, MSN/MS, MPH, Diabetes Educator
​WHAT IS PREDIABETES?
Prediabetes is a condition that can lead to Type 2 diabetes and heart disease. When you have prediabe-tes, your blood glucose (sugar) levels are higher than normal, but not high enough to be diagnosed as diabetes. Diabetes can lead to many health problems and chronic complications, so it’s very important to prevent diabetes in the first place.
“Prediabetes is a red flag letting you know that you are at high risk for problems,” said Dr. Samuel Klein, of the Washington School of Medicine in St. Louis, Mo. “Approximately 86 million Americans, one in three, are estimated to have a blood glucose level that is higher than normal but not high enough for the diagnosis of diabetes.”
Without lifestyle changes to improve health, 15-30 percent of people with pre-diabetes will develop Type 2 diabetes within five years, per the CDC.
PRE-DIABETES RISK FACTORS:
- HbA1c between 5.7-6.4 percent, per Dr. Ralph
DeFronzo of the University of Texas Health Science Center in San Antonio
• Age 45 or older
• African American, Hispanic / Latino, American Indian, Asian American, or Pacific Islander
• Have a parent, brother, or sister with diabetes
• Overweight
• Physically inactive
• High blood pre sure (140/90 Hg or higher) or taking medication for high blood pressure
• Low HDL cholesterol (35mg/dL or lower) and/or high triglycerides (higher than 250mg/dL
• A woman who had diabetes during pregnancy
• Diagnosed with Polycystic Ovary Syndrome (PCOS
REVERSING PRE-DIABETES:
• Cut back on calories and saturated fat (read labels)
• Lose weight
• Increase your daily physical activity
• Get in touch with a Diabetes Educator who has
studied diabetes and can support your life-style changes and work with you on a personal level. They give the time that the doctor does not have. The knowledgeable people in the endocrine “community” can play an important role in keeping you from getting diabetes.
If you are overweight, losing 5-10 percent of your total weight is very helpful. So, if you weigh 200 lbs., the goal would be to lose 10-20 pounds. It can be done gradually, and you can avoid getting diagnosed with “full-blown” diabetes. The less there is of your body and body fat, the easier it is for your pancreas’s beta cells to produce insulin.
You don’t have to make big changes. Small steps can lead to big results, especially eating less and moving more. Walking at least 30 minutes a day, five days a week and eating less fat and calories can lead to big results. Start counting your calorie intake today.
Start each dinner with a salad of leafy greens. Salad provides nutrients and fills you up. Start with switching from regular soda to no-calorie water and eating fewer high-calories foods (read the labels). Start to make the gradual changes to keep diabetes away.
Please remember: “Prediabetes is a red flag. Education is key to diabetes prevention.”
Mary Gynn, RN, is a certified diabetes educator and facilitates diabetes


​http://seniorvoiceamerica.org/
​http://www.svatampabay.com/
http://www.getsva.com/
​813-693-5511