Blog – Lena House Clinic

Type 2 diabetes is a chronic condition that occurs when you have persistently high blood sugar or glucose levels (hyperglycaemia). This is primarily due to two reasons: the pancreas does not produce enough insulin, a hormone that regulates the movement of sugar into the cells or the cells become resistant to insulin and cannot efficiently use the insulin the body produces, so absorb less glucose. Without treatment, high blood sugar levels in the bloodstream can lead to complications such as heart disease, stroke, kidney disease and disorders of the nervous and immune systems.

Type 2 diabetes is the most common type of diabetes. Type 2 diabetes was formerly known as adult-onset diabetes because it was primarily diagnosed in adults. However, the increase in childhood obesity, physical inactivity and family history have resulted in type 2 diabetes in younger people.

Risk factors for type 2 diabetes can be classified into non-modifiable and modifiable risk factors.

Non-modifiable risk factors

Non-modifiable risk factors are risk factors that are out of your control and cannot be changed. These are:

Race and ethnicity – Black African, African American, African-Caribbean, Native Americans, Hispanics and people of South Asian descent are more likely to develop diabetes than white people.

Family history – You are two to six times more likely to get type 2 diabetes if you have a parent, sibling or child with diabetes.

Age – The risk of type 2 diabetes increases with age. Although type 2 diabetes is diagnosed in children, adolescents and young adults, it is more common in people aged 45 and older.

Gestational diabetes – If you have a history of diabetes during pregnancy or gave birth to a baby weighing more than 4kg, you are at increased risk of getting type 2 diabetes.

Polycystic ovarian syndrome – You have a higher risk of developing type 2 diabetes if you have polycystic ovarian syndrome.

Modifiable risk factors

Modifiable risk factors for type 2 diabetes are risk factors that can be managed or reduced. These include:

Being overweight – Being overweight or obese increases your chances of getting diabetes. The risk of type 2 diabetes is higher in people with a lot of abdominal fat. Having a lot of fatty tissue makes your cells more resistant to insulin. Research shows that more children and young people are developing type 2 diabetes because of obesity.

Living a sedentary lifestyle – Being physically inactive or exercising less than three times a week raises your risk of getting diabetes. Physical activity makes cells more sensitive to insulin and helps control weight.

Unhealthy diets – Eating a lot of fats, carbohydrates and highly processed foods which contain a lot of sugar and refined carbohydrates raises your risk of getting diabetes.

Blood lipid levels – High cholesterol levels and high triglyceride levels in the blood increase your risk of type 2 diabetes. Low HDL cholesterol or good cholesterol levels (less than 40mg/dl for men and 50mg/dl for women) increases your risk.

High Blood Pressure – High blood pressure raises your risk of developing diabetes. People with diabetes and hypertension should aim to maintain a blood pressure of less than 130/80mmHg

Prediabetes – Prediabetes is a condition where the blood sugar level is above normal but not as high as the levels for diabetes. Prediabetes often progresses to type 2 diabetes if untreated.

Alcohol – Drinking too much alcohol is associated with an increased risk of type 2 diabetes. Moderate alcohol consumption is consuming one drink a day for women of any age and men over 65 years old and two drinks a day for men under 65. One drink equals a 12-ounce beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

Smoking – People who smoke are 30% – 40% more likely to get diabetes than people who don’t smoke. Smoking also increases your risk of other medical conditions such as cancer and heart disease.

Type 2 diabetes has no cure. Managing the risk factors can help reduce your risk or delay the onset of getting the disease. If you already have type 2 diabetes, lifestyle changes such as eating a healthy diet, exercising and losing weight along with diabetes medications or insulin therapy will help you manage the disease.

References

American Heart Association. Diabetes risk factors. (https://www.heart.org/en/health-topics/diabetes/understand-your-risk-for-diabetes)

U.S Centers for disease control and prevention. Diabetes risk factors. (https://www.cdc.gov/diabetes/risk-factors/index.html)

U.S Centers for disease control and prevention. Smoking and diabetes. (https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html)

Diabetes UK. Diabetes risk factors. (https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-2/diabetes-risk-factors)

Mayo Clinic. Type 2 diabetes. (https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193)

Breast Cancer Awareness Month, which is marked in October annually, aims to promote screening and prevention of breast cancer, which is the most common cancer worldwide and the most common cancer in women, accounting for 25% of cancers in women globally. Breast Cancer is also the most common cancer among women in Ghana.

Early detection is the key to reducing mortality from breast cancer. Screening methods to detect breast cancer include breast self-examination, clinical breast examination by your doctor and mammography. In this article, we discuss how to perform breast self-examination to help you detect breast cancer for early treatment and to reduce the risk of dying from the disease.

Monthly Breast Self-Exam

Inspect both breasts with your arms at your sides. Look for any changes in symmetry, size, shape and colour. Look for changes in breast swelling, redness, soreness, any visible rash and dimpling or bulging of the skin. Check for changes in the position of the nipples and whether they are retracted inwards.
Raise your arms slowly high over your head and check for changes in your breasts and nipples as above.
Place your hands on your hips, flex your chest muscles and compare both breasts, looking for the same changes again. Look for signs of any discharge from your nipples.

Manual Breast Exam while standing

Feel your breasts for lumps while standing. This step can be done in the shower.
Extend your right arm upward and examine your right breast with your left hand.
Extend your left arm upward and examine your left breast with your right hand.
With the pads of your fingertips and keeping the fingers flat and together, examine both breasts by pressing down with your fingers and moving them in a circular motion over the entire breast and armpit.
Examine your entire breast from your collarbone to just above your abdomen and sideways from your armpit to your cleavage. Feel for lumps, swellings and any abnormalities. Squeeze your nipple to check for discharge.
Use light pressure to feel the skin and tissue just underneath, medium pressure to feel the tissue in the middle of your breast and firm pressure for the deep tissue in the back close to your ribcage.

Manual Breast exam while lying down

Next, lie down on a bed or the floor on your back. Place a pillow under your right shoulder to flatten your right breast. Place your right arm under your head.
Examine your right breast with your left hand. Check for lumps and any abnormalities in your breast and armpit following the same process as described above. Feel your entire breast and armpit.
Finally, place the pillow under your left shoulder to flatten your left breast. Place your left arm under your head.
Examine your left breast and armpit with your right hand.

A breast self-exam helps you become aware of the natural look and feel of your breasts so that you can detect any changes in your breasts. A self-breast examination is not a diagnostic tool for breast cancer. It should, therefore, not replace a clinical breast exam and mammogram, which is the best screening tool to detect breast cancer.

Examining your breasts should be done once a month, 2 – 5 days after your menstrual period. See your healthcare provider if you notice any lumps or abnormalities such as skin changes, changes in the position of your nipples or any watery, milky, yellowish or bloody nipple discharge. Bear in mind that menstruation can make your breasts feel lumpier.

References

Breastcancer.org. How to do a breast self-exam: Five steps for checking for breast cancer at home. (https://www.breastcancer.org/screening-testing/breast-self-exam-bse).

MedlinePlus. Breast Self-Exam. (https://medlineplus.gov/ency/artic

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Erectile dysfunction or impotence is the persistent inability to achieve or maintain a penile erection firm enough for satisfactory sexual performance. A man has to have good nerve function, hormone (testosterone) levels, adequate blood flow, and a willing mind to have normal erections. Problems with any of these factors can result in erectile dysfunction. It is, however, normal to occasionally fail to get or maintain an erection when you are tired, stressed, anxious, feeling nervous or drinking too much alcohol.

Risk factors of erectile dysfunction

You have an increased risk of getting erectile dysfunction if you are:

40 years and older
Overweight or obese
Physically inactive
Smoke
Drink alcohol
Have medical conditions such as diabetes and hypertension and have psychological conditions such as depression and anxiety
Taking certain medications, including antihypertensives, antidepressants and antihistamines.

Types and causes of erectile dysfunction

Vascular erectile dysfunction

The penis needs sufficient blood flow to become erect and maintain an erection. There are also valves in the penis that close when the penis is filled with blood. Abnormalities of the penile arteries, veins or valves can lead to erectile dysfunction. This is the most common cause of erectile dysfunction, especially in older men. The common vascular causes of erectile dysfunction include:

Atherosclerosis
Hypertension
High Cholesterol
Diabetes Mellitus
Trauma e.g. Penile fracture
Radiation and surgery for prostate cancer
Peyronie’s disease
Smoking

Neurogenic erectile dysfunction

The brain plays a key role in triggering the processes that cause an erection. The brain sends signals that travel along nerves to the penis to cause an erection. Damage or disease to those nerves can cause erectile dysfunction. Some common causes of neurogenic erectile dysfunction include:

Stroke
Spinal cord injury
Diabetic neuropathy
Alzheimer’s disease
Multiple sclerosis
Parkinson’s disease
Radical pelvic surgery
Pelvic injury
Chronic alcoholism

Hormonal-induced erectile dysfunction

Hormones are chemical messengers in the body that inform the body to perform specific functions. Hormonal disorders such as testosterone deficiency, decreased or increased levels of thyroid hormones, increased prolactin, steroid abuse by bodybuilders and hormones to treat prostate cancer can cause erectile dysfunction.

Drug-induced erectile dysfunction

Erectile dysfunction is a common side effect of many prescription drugs. Drugs associated with erectile dysfunction include:

Antihypertensives
Antidepressants
Anticonvulsants
Antihistamines
Antipsychotic agents
Antiparkinson agents
Antiseizure medications
Diuretics
Chemotherapy drugs
Lipid regulators
Prostate cancer drugs
Gastrointestinal reflux disease and ulcer-healing drugs

Psychogenic erectile dysfunction

Psychological conditions that affect your mental health contribute to erectile dysfunction. Some causes of psychogenic erectile dysfunction include:

Depression
Anxiety
Stress
Inadequate interpersonal relationships
Fear of intimacy
Relationship problems
Low self-esteem

Symptoms of erectile dysfunction

Symptoms of erectile dysfunction are:

Persistent difficulty in getting an erection.
Persistent difficulty in maintaining an erection.
Complete inability to get an erection.
Reduced sexual desire.
Requiring a lot of stimulation to maintain an erection.

Diagnosis of erectile dysfunction

To diagnose erectile dysfunction, your doctor will take a medical and sexual history and perform a physical and psychosocial examination. Your healthcare provider would ask about your drug history, whether you have any chronic medical conditions and ask questions about your mental health as part of your medical history. The doctor may also ask to talk to your sexual partner. A physical examination would include an examination of your nervous system, secondary sex characteristics such as male hair distribution pattern to rule out hormonal problems and an examination of your penis and testicles. Your healthcare provider may order blood tests, urine tests and a penile Doppler ultrasound to confirm the diagnosis.

Treatment

There are different treatment options for erectile dysfunction depending on the cause and severity.

Lifestyle modifications

Some lifestyle changes can help in the treatment and prevention of erectile dysfunction. These include:

Eat a diet rich in fruits, vegetables, whole grains and fish and reduce highly processed foods such as red, processed, meats and refined grains.
Quit smoking.
Avoid substance abuse.
Reduce or stop drinking alcohol.
Reduce your cholesterol.
Engage in aerobic exercise such as brisk walking, jogging and running. Research shows that moderate exercise can help restore sexual performance in obese middle-aged men with erectile dysfunction.
Lose weight. A man with a waistline of 42 inches is 50% more likely to have erectile dysfunction than a man with a 32-inch waistline.
Get quality sleep.
Reduce stress and anxiety.

Oral Medications

Drugs known as phosphodiesterase-5 (PDE-5) inhibitors are used to treat erectile dysfunction. These medications are taken orally before sex. They start to work within an hour and help you get an erection with sexual stimulation. They work by increasing the blood flow to your penis. Some of these drugs are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). You can buy Viagra online, but you need a prescription for the other drugs.

Vacuum device

A vacuum device or penis pump is a hollow tube placed over your penis to aid blood flow to the penis. It has a pump which is used to suck out air from the tube. This creates a vacuum that pulls blood into your penis, causing an erection. Once you get an erection, you place an elastic ring around the base of your penis to maintain the erection and remove the vacuum tube. After sexual intercourse, you remove the ring.

Surgery

Surgery is not common in the treatment of erectile dysfunction, but sometimes it may be indicated. An example of a surgical technique in the treatment of erectile dysfunction is the use of penile implants. In this procedure, a malleable or inflatable device is inserted into the penis to help you have an erection.

Treating the cause of erectile dysfunction

There are also treatments for the underlying cause of erectile dysfunction. Some of these are:

Medication change. If you are on long-term medication associated with erectile dysfunction, your doctor will change to an alternative drug with a lower risk of erectile dysfunction.
Hormonal therapy for hormonal problems.
Treating high blood pressure, high cholesterol and diabetes with medication.
Psychological counselling and therapy for mental health conditions such as stress, anxiety and depression.

References:

John Hopkins Medicine. Erectile dysfunction. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction).

Harvard Health Publishing. Harvard Medical School. 5 natural ways to overcome erectile dysfunction. (https://www.health.harvard.edu/mens-health/5-natural-ways-to-overcome-erectile-dysfunction).

WebMD. Erectile Dysfunction. (https://www.webmd.com/erectile-dysfunction/understanding-erectile-dysfunction-basics).

Mayo Clinic. Erectile dysfunction. (https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776).

MyClevelandClinic. Erectile Dysfunction. (https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction#symptoms-and-causes).

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