Diabetes: A tribal epidemic

Devastating illness can be fought through education, prevention

By Jennifer R. Pigeon

Many Native Americans are living in a world of constant anguish. They are hurting, aching, and in some cases dying, all from a disease that affects an enormous number of the native population. Diabetes is a very serious disease for many people, and is especially prevalent among tribal members. It is a world filled with constant monitoring of food, blood sugar levels, doctor’s visits, medication, and needles. For many Native Americans this disease is a risk they live with everyday. Many are suffering either in their own life or are being forced to experience the suffering of family members.

Native peoples are extremely vulnerable to diabetes. Current studies, using the Thrifty Gene Theory, suggest that Native Americans, who historically live off the land, are now living a different lifestyle. This has affected their ability to convert sugars into energy. But the theory is still being heavily researched.

The American Diabetes Association states that on average, Native Americans are 2.2 times more likely to be diagnosed as a non-Hispanic white person of the same age. Diabetes is a disease that is extremely serious but in a culture where it is prevalent, seems to be thought of as simply a risk of life, like the possibility of being hit by a bus. However, the truth is that diabetes is the fifth deadliest disease in the United States. It is an illness with no real cure, and in most cases is handed down through simple genetics.

Diabetes is a complex disease because there are differing types and a wide array of complications due to the disease. Diabetes is classified as a group rather than one disease. The American Diabetes Association defines diabetes as a group of diseases characterized by high levels of blood glucose resulting in defects in insulin production, insulin action, or both. Type 1 diabetes is also known as juvenile-onset diabetes. This type of disease develops when the body’s immune system destroys pancreatic beta cells. Beta cells make insulin, a hormone that regulates blood glucose. Though this disease is no less serious than other types of diabetes it only accounts for 5 to 10 percent of all diabetic cases. Type 1 diabetes is more common in children and adolescents, but can be diagnosed at any age. A number of factors can lead to the onset of Type 1 diabetes like autoimmune and environmental factors. The most likely cause seems to point towards genetics.

The most common and predominant form of diabetes is Type 2. This type of diabetes is usually diagnosed in adulthood and counts for 98 percent of all diagnosis of the disease. Instead of the body destroying beta cells, it simply begins a shut down process by resisting insulin. The body then begins to inappropriately use insulin, causing a rise in the need for insulin in parts of the body that regularly require the proper use of insulin, like the pancreas. Eventually without the proper use of insulin, the pancreas can lose its ability to make the insulin it needs. Insulin is a hormone needed in the body to break down carbohydrates and sugars in the blood. Type 2 diabetes is a gradual disease that is affected by metabolic rate, weight, physical inactivity, impaired glucose tolerance, and above all, family history.

Gestational diabetes is also a major concern for Native American women. This form of diabetes occurs during pregnancy and disappears when the baby is born. However many women who are diagnosed with gestational diabetes find they are at a much higher risk for a full-blown Type 2 diagnosis in the future.

There is no cure for diabetes, but with aggressive studies, treatment of the disease, is available. Controlling the effects of diabetes is a matter of monitoring. Many victims of Type 2 diabetes can curb the effects of the disease through weight loss, diet, and exercise. More and more studies are now testing the notion that digression of diabetes is possible with immediate intervention. Others require more extreme measures like oral medication or insulin injections. Those who obtain a Type 1 confirmation require a more radical treatment of insulin injections in order to maintain survival. Years ago a Type 1 diagnosis could mean a death sentence in a world where diabetes and its effects were unknown. Because of medical advances and technology, many Native Americans do not have to suffer with a disease their ancestors knew nothing about.

Many complications can stem from a diabetes diagnosis. Patients who acquire the disease are at risk for circulation problems, weight fluctuations, high blood pressure, heart disease, blindness, problems with the feet and legs, possible amputation, and can even suffer from stroke. Diabetic research has made great discoveries about the benefits of intervention. Simple weight loss and an increase in exercise can make a great difference in the progression of Type 2 diabetes. By also changing lifestyle habits like diet, attitude, and exercise schedules, tribal members can reduce their risk of getting the disease and also reduce the risk of complications due to diabetes.

The need to educate tribal members about the dangers of diabetes can be a great task, especially since the number of diabetic diagnoses is steadily rising. Though many people within a Native American tribe have been affected in some way by diabetes, many lack the knowledge needed to avoid the disease. Diabetes is not a disease that is acquired overnight. The body produces signs and warnings that lead up to a diabetic diagnosis.

The Muscogee (Creek) Nation is making great strides in its attempt to educate its people about the threat of diabetes. The tribe operates its own Diabetes Health System located in the city of tribal headquarters- Okmulgee, Okla. The health system offers the education needed to prevent future epidemics of diabetes. The Diabetes Health System is the base for diabetes health clinics located all over the Muscogee Nation. Centers located in Okemah, Eufaula, Okmulgee, and Sapulpa were all created with the need for education in mind. Muscogee (Creek) Nation Diabetes Program Coordinator, Johnnie Brasuell, says the diabetes education program is funded by a $1.6 million grant given by Congress to the Indian Health Services and then distributed to tribes for the sole purpose of establishing and developing diabetes assistance for Native Americans. The program created is called EPIC (Educating Partners in Care). It is a nationally recognized self-management education program.

The diabetic facilities not only educate tribal members of the risk of developing diabetes, they also monitor the progress of those already diagnosed with the disease, and provide a more positive outlook on the diagnosis of diabetes for the patient. Each clinic is able to annually monitor patients for problems with their feet, eyes, kidneys, teeth, and heart. The program and its facilities are now operating under a Level 3 status, which is the highest rating given by Indian Health Services.

Programs managed and operated by tribes have the best chance at reaching those in the most need of diabetes intervention. The disease is incredibly complex and when taken seriously can be overcome, if not cured. Research and manageability are the first steps to combating this disease. For those at greater risk along with those already diagnosed, education and self-management has become the best proven method of treatment. The more tribes attempt to educate its citizens about the warning signs and prevention methods of diabetes, the less likely the disease will become the fate of larger portions of tribal members. Experts and educators are working together to spread the notion that diabetes is controllable and preventable. It is the first step to ensuring the healthiness and well being of the younger generation and the future of Native American tribes.


Jennifer R. Pigeon is a member of the Muscogee (Creek) Nation.