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The war against diabetes

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RAPID CITY, S.D. ? More than any other community or any other country, the American Indian community is fighting for its life against a dreaded disease, diabetes.

Study after study comes up with data that shows there are more cases of diabetes within the American Indian population than any other in the country by a large percentage.

Why does this happen in this community? Is it curable?

Change in cultural traditions, lifestyles and eating habits caused the disease to increase and the return to what may be considered ancestral heritage can turn the effects of diabetes around, says Richard Iron Cloud, director of the Porcupine Clinic on the Pine Ridge Reservation.

Studies show youth at risk for diabetes represent 12.6 percent of the population on the Pine Ridge reservation. There are 2,200 people on the reservation with diagnosed diabetes, and there may be more, Iron Cloud said.

'There a lot of people not registered. They don't want to go in. Many people are in denial.'

He spoke one person who had diabetes for 10 years and didn't come to a clinic until the kidneys shut down.

'There is a part of us that doesn't want to deal with this.'

Diabetes is curable, he said. But, it takes time and it is difficult to make the adjustments in lifestyle, which includes a change in diet.

A screening process across the Pine Ridge reservation, as on most large reservations, is checking children from Head Start to 12th grade. One of the most obvious indicators of a child at risk for diabetes is a blackening on the back of the neck. Iron Cloud said in the past grandmothers would try to wash the blackened area away and not report it to health authorities.

Outreach workers visit homes of children at risk. The program receives mixed response from families. Some are resistant to change, but the outreach workers establish a baseline of diet and activity that will provide data for future studies of the youth.

The big change in the families with children who are at risk is a change in the diet and physical fitness.

The diet is changed to low fat, low starch and higher in protein. Getting the family to change from whole milk to skim and reduce the amount of fatty meats can take a long time, Iron Cloud said. Most youth are used to drinking sugared soda pop, but a change to the diet version can be difficult.

'My two youngest children are at risk. It took two years to change from whole milk to skim. We don't eat sugar, we use a sugar substitute, and we changed to diet pop. For me it was rough. I drank a sugar cola. I stopped altogether for a while and now I drink only diet. These are small changes that make a difference.'

Education on the reservation is probably one of the most important tools to combat diabetes. Iron Cloud participates in a radio program on KILI radio that broadcasts throughout the entire Pine Ridge reservation. The key to its success is that it is broadcast in the Lakota language.

'An awareness had developed and we have received positive results from the radio show. Harvey Iron Boy, who has diabetes, will tell what he has learned in the Lakota language,' Iron Cloud said.

Fitness is a major factor in reducing glucose in the blood. A regular regimen of walking will help. On the Pine Ridge reservation, some community leaders organized groups that walk on a regular basis and they developed walking paths throughout the communities.

Iron Cloud has a sign on his wall that says 'Walk your Talk.'

'It's easy to talk about, but you have to walk the talk. We are humans and are fallible, we all fall down. We like fry bread and cake.'

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Iron Cloud is optimistic about the future. More is being learned about diabetes and the stigma of the disease is slowly fading. There are nearly 60 people on the Pine Ridge reservation who regularly spend from 10 to 15 hours on dialysis machines. There are more who need dialysis, but they are capable of doing the process in their homes or go to other locations off the reservation.

'There is hope for the future. During a ceremony, the spirits told us there will be cure for the disease, maybe in 10 years. The more I learn about the disease, the less I'm afraid. The cure takes a change in the lifestyle.'

Iron Cloud said his mother may still be alive had she not been sent to a boarding school at an early age. One of her brothers stayed at home and lived a traditional lifestyle with plenty of physical activity and proper diet. He did not acquire diabetes.

'My mother tried to change. If the family had changed together, I would still have my mother. The family is a powerful unit, it can have an impact on the disease.'

The White Face Tiospaye of Porcupine participated in the Talking Circle program started by Lorelei DeCora on the Winnebago reservation. The family continues to participate and promote a healthy lifestyle for its members, Iron Cloud said.

The popular 'How Sweet It Is' program on the Pine Ridge reservation makes people aware of what high glucose is and also detects people at risk while enjoying pancakes. It's a pancake breakfast or supper that increases the starch intake for the person. After the meal the blood is checked for glucose level and after a two-hour rest it is checked again. If the person's glucose does not go down significantly, there is a risk for diabetes.

Those people are tracked by the health care professionals and by doing so their diabetes is caught before it gets worse or prevented altogether.

Fitness centers on reservations are becoming popular. The Porcupine fitness center at the clinic sees at least 15 people a night. In Pine Ridge some 30 people a night use the facilities, Iron Cloud said.

On the Winnebago reservation The Whirling Thunder Wellness Center promotes nightly activities in the gymnasium. Basketball leagues for all ages are a hotbed of activity and fitness equipment is available.

The program has grown to the extent it takes 40 adults to coach teams that range in age from 6 to adult. Even the over-the-hill gang of adult men who left their youth on the basketball courts of high school play the game with playoff intensity. Their slightly overweight bodies are tuning up and slimming down.

Statistics show that exercise will reduce type II diabetes by about 45 percent. Exercise at a young age can prevent the onset of type II diabetes and at the age when the diabetes has developed it can reduce the effect, health professionals agree.

'If a person develops more muscle the insulin becomes more effective,' Iron Cloud said. 'You can do weight training at any age. The purpose is to get your blood moving.'

Health care advocates are trying to undo three or four decades of behavior and bad eating habits.

'We never had cake before, it's here now. It's how a culture changes. It incorporates a lot of unhealthy things.

'With diets you need to keep it simple ? reduce the fats and eliminate the sugar and get the children off pop,' Iron Cloud said.

The fight against diabetes is growing into one of the most important parts of life on most reservations. Each reservation has a priority factor in the fight against the disease from prevention to just keeping people alive. It may take a transportation system like one implemented on the Red Lake reservation in Minnesota that makes sure people get to clinics for testing and other preventative procedures, to delivering insulin and other drugs to people's homes and to in-home outreach education.

Most medical statistics indicate that for all the efforts made by the health care industry, diabetes is still on the rise on reservations despite efforts to curtail its expansion. Those which make it a family and tiospaye matter and then a community matter seem to be the most hopeful impacts, health care officials say.

Diet and exercise are the most important factors in the prevention of diabetes, all health care professionals claim. That's why the American Indian community is encouraged to look at their ancestors' diet of buffalo and wild vegetables and berries for survival. Tribes, such as the Winnebago and Oglala Sioux Tribe and many others, are nurturing buffalo herds as a low-fat high protein substitute for the more modern beef and pork.

'We may need to the move back to the low-fat soups, buffalo meat and the tongue, but not the cake,' Iron Cloud said.