Outrunning diabetes

By Pauline Arrillaga

Associated Press

BAPCHULE, Ariz. – “Move those feet! Make some dust!”

Sister Martha Mary Carpenter straddles the pitching mound on the field next to St. Peter’s Indian Mission School, more coach than nun at the moment. Clipboard in hand, she marks off laps as dozens of children round the dirt track before the morning bell.

A rotund kindergartner scampers by, passing up a group of older kids barely strolling along.

“Hey, you lazy boys,” Carpenter demands, “get going!”

The 220 students who attend St. Peter’s – all American Indians – are required to run or walk at least a mile before school starts. A few hours later, each class heads out on another mile-long hike.

On top of that are three weekly physical education classes and a host of diet restrictions: No desserts except fruit. No candy, cookies or cake at class parties. No vegetables left uneaten at lunch.

“Our children have limited freedom,” Carpenter says.

They also, for now, have no diabetes. And in the Gila River Indian Community, that’s no small feat.

The reservation of 12,000 Pima Indians south of Phoenix has one of the highest rates of diabetes in the world. Half of the adult population has the disease, while 5 percent of children 15-18 years old are diabetic.

The Pimas represent the extreme of an epidemic sweeping the country’s Indian communities.

About 9 percent of American Indians and Alaska natives 20 and older, some 65,000 people, have diabetes. That’s nearly three times the rate for whites.

Worse yet, the rates are rising while the age at which Indians are contracting the disease continues to fall. On the Gila River reservation, it’s no longer shocking to find a 3-year-old diabetic.

Due to persistent disparities in income, treatment and access to care, Indians suffer higher rates of numerous illnesses, ranging from tuberculosis to alcoholism, pneumonia and heart disease.

The diabetes problem has been researched for decades. Yet only in recent years has the focus begun to shift from treating the sick and burying the dead to trying to prevent diabetes from the outset.

A recent study showed exercise and weight loss can dramatically reduce the chance of getting diabetes, and Indian communities are beginning to take action.

For some, that’s meant a return to traditional foods grown in community gardens. Others have launched talking circles that combine prayer with presentations on diet and exercise. Some communities have started workout programs or organized walking groups.

“It’s just a matter of empowering people with the knowledge that they can live longer if they’re healthier and eat right,” said Sarah Rosenbloom, a diabetes nurse educator on the Gila River reservation.

Diabetes was rare among American Indians until after World War II. By 1954, however, 254 cases had been documented on the Gila River reservation, a rate “appreciably higher” than that of the U.S. population, said Dr. Peter Bennett of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Bennett was part of the research team that began intensive studies of diabetes among the Pimas back in 1965. At that time, 500 people were diagnosed.

NIDDK, a branch of the National Institutes of Health, launched a long-term study of the Pimas.

Previously, researchers believed diabetes stemmed solely from the inability to produce insulin, a hormone that moves sugar from blood into cells. When sugar builds up in the blood, cells become starved for energy. High blood sugar levels can damage the eyes, kidneys, nerves or heart.

The Pima research showed that many diabetics produce insulin, but that their bodies don’t use it properly. That resulted in the designation of Type 1 and Type 2 diabetes. A person with Type 1 diabetes, once known as juvenile diabetes, does not produce any insulin, while those with Type 2 diabetes, sometimes called adult-onset diabetes, don’t make enough insulin or don’t use it properly.

Type 2 accounts for up to 95 percent of diabetes.

The research also helped answer the question of why the Pimas and other Indians develop diabetes at higher rates. The primary theory is that Indians developed a genetic predisposition to diabetes during times of famine, in which their bodies were conditioned to store fat.

When food then becomes abundant, “people whose bodies adapted to that store fat as if they’re expecting a famine and become obese, and that’s what we’ve seen in American Indian communities,” said Dr. Kelly Acton, director of the Indian Health Service’s National Diabetes Program.

Another factor is the shift in diet that occurred after World War II, with the onset of government commodity programs. Traditional foods, such as homegrown squash and corn, were replaced with fried and processed foods high in sugar and fat.

In the mid-1990s, a major study began on the prevention of Type 2 diabetes. The results, released in August, showed that moderate exercise and losing about 15 pounds helped those at risk of developing Type 2 diabetes cut the odds by 58 percent.

“For the very first time, there is unequivocal evidence that changing lifestyle is an effective means of prevention,” Bennett said.

Congress appropriated $100 million a year from 2001 to 2003 to the Indian Health Service to establish a grant program for diabetes treatment and prevention in Indian nations.

Grants also have been made available through other federal agencies, such as the Centers for Disease Control and Prevention and the Department of Agriculture.

In Wisconsin, the Chippewa tribe is encouraging a return to its gardening heritage by using grant money to buy 300 apple, pear, cherry and crab apple trees to plant in members’ yards. A small community garden also was planted, with plans for a five-acre plot next spring.

In Arizona, a $1 million wellness center opened its doors in the heart of the Gila River reservation earlier this year, featuring shiny new exercise equipment, yoga classes and nutrition counseling.

Harold Osife, who weighs 384 pounds, hits the workout room twice a week. Osife, 37, was diagnosed with diabetes 10 years ago. He used to down six supersize Pepsis a day, while his diet consisted of steaks, hamburgers and doughnuts – “mostly all takeout.”

These days, he’s cut out chips and sweets and incorporated fruits and vegetables into his diet. The exercise also has helped. Blood sugar levels that once soared into the 400s range from 160 to 180.

As for the soda, Osife added: “I’m drinking diet now.”

Yet even in the Gila River community, prevention has been hard for some to embrace.

Years ago, every school on the reservation had an exercise and diet program similar to the one at St. Peter’s. Several scrapped it after parents complained their children were going home hungry. Today, St. Peter’s alone participates.

Fourteen-year-old Codylynn Terry attended St. Peter’s through the fourth grade, then left saying she didn’t like the food or the exercise they were forced to do, Sister Carpenter said.

Not long after she transferred, Codylynn was diagnosed with diabetes.

Nowadays, she tries to exercise a few times a week. But she admits having a hard time controlling her diet and even remembering to check her blood sugar level, which on one recent day was 270. The range should be 75-150.

“We try, but sometimes it’s hard staying away from sweets and everything,” said her mother, Ruby Terry, herself a diabetic. Codylynn’s father also has the disease, as do Ruby Terry’s father and brother. Her mother died of diabetes complications several years ago.

Some Indians have become fatalistic, simply accepting the idea that one day they’ll be diabetic, said Brenda Broussard, coordinator of Awakening the Spirit, an American Diabetes Association program focusing on treatment and prevention in Indian nations.

“Too many people are really discouraged. They haven’t gotten the message not only of hope but that you can do something about this,” Broussard said.

“You can live long, live well, feel great and still have diabetes,” she said. “It’s not a death sentence.”

The National Diabetes Information Clearinghouse maintains a Web page that details the disease’s effects on American Indians and Alaska Natives. www.niddk.nih.gov/health/

diabetes/pubs/amindian/

amindian.htm

Copyright ©2001 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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