Tiffany Scott: Take That First Step

Diabetes prevention is possible. “Here in our area, nobody’s alone with diabetes. Any street corner you turn down, every grocery store aisle, every church pew— you know, you’ve probably got somebody sitting right there with you who is battling it, or a close family member who is,” says Tiffany Scott. But, she adds, the Appalachians in Control (AIC) diabetes research and outreach project she coordinates in Letcher County, KY has demonstrated that people can delay, or even prevent type 2 diabetes, simply with diet and exercise plans. Listen to Tiffany’s story to find out more.


My name is Tiffany Scott, and I’m from Letcher County; lived in Letcher County my entire life!  I am the project manager for the University of Kentucky, for their community research-based project called Faith Moves Mountains. I come on board in 2017, with the launch of their newest project, which is diabetic research project that we have named ‘Appalachians in Control,’ playing off A1C, which is the test your doctor does to kind of measure what your blood sugar’s run over the last three months.


And what we do is, we are looking for people who have a diagnosis of type 2 diabetes, or people who have a high A1C level— and the cutoff that we’re using is 6.5. So what we do is we go into a church, or a community center, or, you know, whatever group we’re working with. And we’ll do a free A1C test; we do height, we do weight, we do blood pressure, waist circumference, and body mass index. And then, once we see if they’re eligible, they can choose whether or not they would like to participate with us.


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There’s two arms of our study. The first step of the study would be for that person who was eligible to complete a one-hour interview with us. And that interview is a series of diabetic knowledge-based questions. And then, the next step of our project would be to offer them an intervention. It’s called DEEP: Diabetic Education Empowerment Program. And it is a self-management program: it involves six weeks of Diabetic Self-Management classes; we meet one day a week for six weeks. And they’re very interactive classes, it’s not like being lectured at: they’re very hands-on; there’s activities; there’s engagement.

And then, three months from that original eligibility screening, we bring those folks back in and we re-screen them again. So, we offer another free A1C test, and we check their blood pressure, and their weight, and their height, and their waist circumference, and their body mass index. And we also repeat that interview. And the interview’s a little bit different, but it really is designed to check their diabetic knowledge again, to see if they learned anything. And then, three months later, at the six-month mark, we do it again. We do that again at the nine-month mark. So, what we’re doing is we’re measuring: if they learned anything, if they retained it, and then if they put it into action, and if those actions reflect on that biometric data.

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You know, our curriculum, one of the things we have them do is called a weekly action plan. And it’s a thing they can hang on their fridge, that says ‘this week I’m gonna commit to a, b, c.’ And we don’t ask them to say ‘I’m gonna run a marathon this week.’ We ask them to be realistic. You know, an example would be to park farther away at Wal-Mart, park farther away at Food City— don’t look for that closest parking spot, look for the farthest-away parking spot. You know, making an extra lap through the grocery store before you leave. You know, just any little thing these folks can do is gonna make a difference.

Another thing is, just— we talk about people’s diet. You know, when you think about sugar—as we like to call it here in eastern Kentucky—people think, ‘Alright, well, i have sugar, I have diabetes, so as long as I don’t eat sweet things I’m okay.’ And— that’s true, you know, people with diabetes, they definitely need to watch their sugar intake. But at the same time, they have to watch the carbs.

Because when you think about a Big Mac— nothing is sweet about a Big Mac, right? I mean, it’s not a piece of cake. But it’s loaded in carbs. And your body does have to turn that into energy, and so when it breaks it down, it makes your blood sugar go up. French fries—nothing sweet about french fries. But they’re loaded in carbs. A baked potato, even from Wendy’s— that potato is not sweet. But for a diabetic, you know, it’s like cutting that potato open and filling it full of sugar.

So, you know, teaching that misconception— I mean, we’re seeing people in our classes that have been diagnosed with diabetes for years, and it’s still like sitting in a classroom full of kids sometimes and watching lightbulbs go off on things that they’re being told. You know, we had a participant recently who— he has lost about 25 pounds. You know, and just because, he said, ‘You know, I’ve learned things through this curriculum I didn’t know!’

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We see a lot of high diabetes rates in our area. Diabetes runs rampant in Appalachia and Eastern Kentucky. You know, so, it’s something we see left and right; there is family history. And, some things in life we have no control over. Some people are going to get type 2 diabetes because of genetic reasons, and there’s nothing we can do about that. But, a lot of times, people can delay or even prevent type 2 diabetes, simply with their diet and exercise plan.

And, you know, that is a misconception—that, you know, a lot of people think, ‘If I’m gonna get it, I’m gonna get it.’ But there are so many things you can do to try to reduce your risk! Just by making those healthy food choices, and by moving, you know, all those different things. I went around the room at one of our last classes, and I said, ‘Who wants to share a change you’ve made?’ One change that a lady made in particular— she said, ‘I quit drinking regular pop.’ And that’s huge for anybody. But when you’re talking someone drinking regular soda, who is diabetic, to make that change— that’s huge. We had couple tell us—it was a husband-and-wife team—and they said ‘We’ve quit buying white bread.’ That’s huge! And those are small steps.

You know, I think the biggest thing for us is trying to teach moderation. It’s not like they’re never gonna eat a piece of birthday cake again. Or, it’s not like they’re going to not order McDonald’s french fries, or a baked potato; they’re going to do that. But we have to teach them how to compensate, that can’t do it every day. It’s got to be a lifestyle change, in order to prolong their life, and to keep them free of the complications that could arise if they don’t.

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My father is diabetic; my grandmother was diabetic. You know, diabetes runs in my family rampantly. So that’s a concern of mine obviously as well. But I will tell you a story about my step-grandfather. He had diabetes, and he went to the grocery store back when Piggly Wiggly was open in Cumberland. And he went to get a can of corn, and dropped the can of corn on his foot. And he hid it from my grandmother, he didn’t tell her about it. And he kept it quiet until, I guess, he couldn’t keep it quiet any longer, and he had to go to the hospital. And his foot had already turned black around the toes, and it set up infection. I’m sure the odor was probably unbearable, and that’s probably how my grandmother found out about it. And, so, they end up amputating toes, and he went home, and it didn’t heal. When you’re diabetic, you don’t heal like a normal person does. And, a very long story short, he ended up back at the hospital with gangrene. They took his entire foot off. Never left the hospital— the gangrene continued to spread, took it off at the knee, and he died at the hospital. All from diabetic complications over a simple can of corn falling on his foot.

So, you know, folks don’t realize the severity of diabetes a lot of times. We play it off as, ‘Ah well, just, they can’t eat sweets; they can’t eat this; they can’t eat that.’ But when you’re looking at the complications of the kidney failure, the glaucoma; you know, you’re at a higher risk for a heart attack, or a higher risk for a stroke; or losing your life over a can of corn. And you don’t want to scare people to death, but you want to be realistic and let them know, ‘Hey, if something doesn’t change, this is the path you’re heading down. This is what could very well happen.’

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You know, change can be overwhelming. No matter what it is. You think about our food, here in the area, it’s so easy to pop open something out of the freezer section. You know, for someone who’s used to doing that for years— to going to the fresh veggie section and saying, ‘Alright, what do I do with this? What do I do with this squash that I’ve not ever cooked fresh before?’

You know, I think we’re heading in the right direction— the Farmacy program Mountain Comp [Mountain Comprehensive Health Corporation] does with the fresh fruits and veggies, the Walking Trail program, and all the different things that they’re doing. Sometimes starting is the hardest thing, and the biggest challenge to overcome is just making that very first step.

And, support! The big part of our class is, we talk at the end, our last week, we talk about mobilizing family and friends that you can get involved with you. Whether it’s to go walking with you, or sharing recipes, or taking somebody to the doctor with you just to better understand what’s being said. You know, here in our area, nobody’s alone with diabetes. Any street corner you turn down, every grocery store aisle, every church pew: you know, you’ve probably got somebody sitting right there with you who is battling it, or a close family member who is.

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I’m from Letcher County. This is my home, I’ve lived here my entire life. So, I’m not someone coming in and collecting data and leaving. This is home to me. These people are my friends and neighbors and my family members, just like they are so many others. And so this is a project for me that goes far beyond a paycheck. You know, anything we can do to improve the lives of folks in our communities— I don’t think it gets any better than that!


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