Indian School Keeps Diabetes On the Run

“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, from toddlers to teenagers, amble around the dirt track before the morning bell.

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

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

The goal is a mile, and at this school that’s not negotiable. The 220 students who attend St. Peter’s--all of them 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 veggies left uneaten at lunch.

“Our children have limited freedom,” Carpenter admits.

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, and 5% of children 15-18 years old are diabetic.

The Pimas represent the extreme of an epidemic sweeping the country’s Indian communities. About 9% of American Indians and Alaska Natives 20 and older, some 65,000 people, have diabetes. That’s nearly three times the rate for white people, and experts note the numbers are substantially higher in some communities such as Gila River.

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 or see a 12-year-old on dialysis.

The disease is one of a host of health care challenges facing Indian communities today. Due to persistent disparities in treatment, accessibility and income, Indians suffer higher rates of numerous illnesses, ranging from alcoholism to tuberculosis, pneumonia and heart disease.

The diabetes problem has been researched for decades, as Indians were poked and prodded in pursuit of a cause. 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.

Buoyed by a recent study proving that exercise and weight loss can dramatically reduce the chance of getting diabetes, Indian communities are beginning to rise up against the disease considered among the most serious modern-day threats to their survival.

For some, that’s meant a return to traditional foods by way of planting community gardens. Others have launched talking circles that combine prayer with presentations on diet and exercise. Some communities have started workout programs similar to St. Peter’s, or organized weekly 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, where the problem is so profound that “anyone who lives here knows someone with diabetes.”

“Imagine if your mom had diabetes, your dad had diabetes, your grandmother had diabetes,” she said. “It needs to be decreed that diabetes is an epidemic, and we are going to fight it as best we can.”

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 in 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, after discovering a high frequency of the disease during an unrelated arthritis study. At that time, 500 people were diagnosed--about 10 times higher than anywhere else in the world.

“That was really sort of a sledgehammer to say this is a very, very real problem,” Bennett said.

Yet little was known about diabetes back then. Only about 1% of the overall population had the disease, and there had been no comprehensive study of diabetes. Researchers, therefore, were confounded as to the cause of the more widespread problem among the Pimas.

NIDDK, a branch of the National Institutes of Health, launched a long-term study of the Pimas, testing anyone 5 and older. That research eventually helped lead to the diabetes classifications used today, and also shed some light on why American Indians may be more susceptible to the disease.

Before the studies, 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 is the most common form of the disease, accounting for up to 95% of diabetes patients, including the Pima cases.

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 home-grown squash and corn, were replaced with fried and processed foods high in sugar and fat.

By the mid-1980s, researchers suspected that diet and exercise could help prevent diabetes, yet there was no research proving it, and much of the NIDDK’s funding was locked up in a study related to the less-common Type 1 diabetes.

Only when that trial was completed in the mid-’90s did the government begin a major study of 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%.

“For the very first time, there is unequivocal evidence that changing lifestyle is an effective means of prevention,” Bennett said. “There’s a message here, not just for the tribes but for the country as a whole. This is a bigger problem than cigarette smoking ever was. It kills a lot more people than lung cancer ever did. And we need at least as great a public health effort to combat it.”

To help in that cause, 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 U.S. Department of Agriculture.

Armed with dollars and determination, Indian communities throughout the nation are fighting back.

In Montana, the state health department has launched a project aimed at reducing obesity in Indian children through nutrition and exercise programs.

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, an expansive man of 384 pounds, hits the workout room twice a week for the treadmill and weights. Osife, 37, was diagnosed with diabetes 10 years ago. He used to down six super-size 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, among the most-researched, most-ravaged diabetic population in the world, prevention has been a concept some simply refuse 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, 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.

The disease remains so endemic among Indians that some 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 Assn. 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, adding that even if someone fails to prevent diabetes, they still can survive it.

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