Indians hard-hit by diabetes

Cliff SiJohn was diagnosed with diabetes nearly 27 years ago, when he was 35. It destroyed his eyesight and ruined a kidney.

A transplant from his wife a few years back helped restore his health, but after watching family members succumb to the disease “limb by limb” and observing its effects on other members of the Coeur d’Alene Tribe, he worries about the toll the disease could have on the Indian population.

“I really believe it is like a rat that is crawling. Every day it is stronger and stronger and touching more people,” SiJohn said. “Is this the second coming of the smallpox? Is this going to kill us?”

As it is with all Native American tribes, the rate of type 2 diabetes – the most common form of the disease – is extremely high in the Coeur d’Alene Tribe.

The diabetes problem in America has worsened over the years as the number of obese people grows. But thanks to a federal grant, the Coeur d’Alene Tribal Wellness Center in Plummer, Idaho, offers a diabetes prevention class. It aims to help those who are considered pre-diabetic keep their weight down through healthy eating and exercise.

Another health care center, NATIVE Health of Spokane, offers similar classes and holds monthly community dinners featuring healthy food. The idea is to show Native Americans that healthy eating is possible and that a diabetes diagnosis isn’t inevitable.

“We try to give them knowledge,” said Candy Jackson, a nutritionist and dietitian with NATIVE Health. “But you have to have them committed to making some changes.”

Scope of the problem

No one knows for sure what causes diabetes or why the rate is so high in the Native American population. Most health care officials and tribal members attribute it to the change in diet over the past century or so. Indian people traditionally ate a protein-based diet, but that changed about two generations ago, SiJohn said.

“It just blasted us with diabetes,” he said.

The diabetes infection rate for Native Americans nationwide is about 15 percent, according to the American Diabetes Center. Local diabetes experts say the rate can be much higher depending on the tribe.

Toni Lodge, executive director of NATIVE Health, said between 30 percent and 50 percent of Native Americans are diabetic or at risk of becoming diabetic. Lodge estimates that nearly 30 percent of the 12,000 Native Americans living in Spokane County are at risk or already have the disease.

It’s difficult to quantify the number of tribal members with the incurable disease because not all of them seek treatment. Of the Coeur d’Alene Tribe’s nearly 2,000 members, 90 are registered diabetics with the wellness center. But that doesn’t include those who seek treatment elsewhere or don’t seek treatment at all.

Coeur d’Alene Tribal Council member Norma Peone said she fears the actual number of diabetics is higher than anyone would want to imagine.

“I think we’re just hitting the tip of the iceberg right now,” Peone said.

Nearly 140 other Native Americans not affiliated with the Coeur d’Alene Tribe are registered diabetics with the wellness center in Plummer.

Peone first became a promoter of diabetes awareness several years ago after watching a documentary with her daughter that discussed the high diabetes rate among Dakota tribes.

It was sad and depressing to see the toll the disease took, she said. But what really hit home was what her daughter said after the program. “She says, ‘Well, that’s what I have to look forward to, huh Mom? My dad has diabetes, I’ll probably have it, too,’ ” Peone recalled.

The comment shocked her. “I had not even given the message to my own daughter that she doesn’t have to accept that,” she said.

The disease is hereditary, something to which people like SiJohn and Peone can attest. Both have more than a few family members with the disease and know they’re at a greater risk because of it.

Diabetes often affects the nerves and the circulation to the nerves, so many diabetics lose limbs to the disease. SiJohn said he saw family members succumb to the disease that way, including his own mother.

“It just ravaged her,” he said. “She always reminded us (that) it’s a gene inside the Indian people.”

Ways to address it

The hereditary factor was what prompted St. Maries resident Patti Colhoff to encourage her daughter, Marlena “Starr” Pluff, of Plummer, to get tested for diabetes. Pluff is half Native American and her husband is full. Diabetes runs in her family – her grandfather recently lost a toe to the disease. Her blood-sugar level was high enough to qualify as pre-diabetic, and Pluff now is enrolled in the same pre-diabetes classes at the wellness center that Peone credits with helping change her lifestyle.

The diet changes Pluff has had to make have been difficult, she said, but the thought of being diabetic and having to give herself insulin shots every day is the motivation she needs to make needed changes.

“I just thought, ‘Holy crap, I don’t want to be like that,’ ” she said.

A 27-year-old mother of three, Pluff attends the weekly diabetes prevention classes and is trying to cook healthier food at home. She’s had to eliminate soda from her diet – not easy for a “pop junkie” like herself, she said – and is tracking her food and fat gram intake as required.

“It’s going to seem really hard at first to write all this stuff down but the first step to changing your eating habits is being aware of what you eat,” said Yvonne Hill, the class teacher and diabetes prevention program coordinator at the wellness center, told the class at one of its evening meetings last month.

If people follow class directions and monitor their fat intake to keep it at the recommended levels, they will lose weight, Hill said.

“I know that because I saw it with the first class,” she said.

One of the classes’ success stories is Peone. Once considered pre-diabetic, Peone is a graduate of the tribal wellness center’s first diabetes prevention class, the Lifestyle Balance Program. Now in its second round, the 16-week class helps those considered pre-diabetic to keep their weight down through healthy eating and exercise.

Peone agrees she’s a poster girl for the classes. After 16 weeks in the class, she dropped two dress sizes and saw her blood sugar level drop from sky-high to healthy. She is no longer considered pre-diabetic but works hard to maintain her weight and stick with the diet changes the classes helped her make.

“I’m going to eat what I want when I want, but I’ve learned to pick and choose how I do that,” she said.

Outspoken and charismatic, Peone used her success to encourage others to look into the free classes. Those who are interested must take a blood test to determine if their blood-sugar level is high enough to put them at risk of diabetes.

The main thing the class emphasizes is counting fat grams. Those in the class are encouraged to be “fat detectives” and are given a book detailing the nutritional value of virtually every food.

Lodge said NATIVE Health focuses on helping patients make small lifestyle changes. A person who is used to drinking a six-pack of soda every day might not eliminate soda from his or her diet right away, but a few less cans makes a difference, she said.

Slow success

Hill said one of the biggest challenges is getting people aware that they are at risk, and that there is a way to stop from becoming diabetic.

One of the challenges of working with people at risk for diabetes, Lodge said, is teaching them that they don’t need to make drastic changes right away to make a difference in their health.

Some people who weigh 300 pounds think they need to shed 150 to get healthy, when in fact a mere 20 pounds could make a huge difference, Lodge said.

“So many people – one in six – don’t realize they’re diabetic,” said Jackson, the dietician and nutritionist at NATIVE Health. “They attribute it to just being tired.”

SiJohn said he knows of many people who simply let themselves succumb to the disease instead of seeking treatment. It may be fear, or pride, but some diabetics would rather die than seek treatment or lose a leg or arm, he said.

“We’ve had elders who have contracted diabetes and that’s it, they just wait it out,” SiJohn said. “Some of them see no hope. They just say ‘to hell with it’ and complicate the disease by alcohol, drugs.”

“Diabetes doesn’t care,” he continued. “Diabetes has no appreciation of a person’s life.”

SiJohn has changed his diet and is functioning well with the disease. He works as the cultural awareness director at the Coeur d’Alene Casino, teaching new employees about Coeur d’Alene tribal traditions and cultural traits. Motivation to fight the disease is the key to living with it, he said.

“If I don’t have that edge, then I might as well lie down and cover myself with buffalo robe,” he said.

That’s something that the diabetes information pamphlets and nutrition classes can’t teach you, SiJohn said – the need for motivation from deep in the soul.

The Coeur d’Alene Casino’s insurance plan for employees covers diabetes care, and advertisements for the diabetes prevention classes appear on staff bulletin boards throughout the building. Participation in the classes increased this round, and Hill and Judy Gordon, the diabetes case manager at the Benewah Medical Clinic, are hopeful that will continue. Periodically the center puts on free diabetes screenings at the casino, and word of mouth from success stories like Peone’s have boosted interest, they said.

“It’s really looking like the word is starting to spread,” Hill said.

Lodge said the success of NATIVE Health’s diabetes prevention campaign can be seen in how many of its clients have undergone amputation in the past seven years: none.

The more success stories that emerge, Jackson said, the more word will spread that there are ways to stop diabetes and live a healthy life.

“Really, there’s a lot of people that are living very well with it, and those are the people we are hoping can be leaders in this area,” she said.