Diabetes

Cases of Diabetes expected to triple

By Louise Elliott
Windspeaker Contributor
SAN DIEGO, California

Fear about the spread of diabetes in Canadian Aboriginal communities and hope for their prevention were served up in equal measure by participants at the Fourth International Conference on Diabetes and Indigenous Peoples held Oct. 8 to 11 in San Diego.
Medical experts from Manitoba sounded the alarm about the number of Aboriginal adults with diabetes, which in that province is expected to triple by the year 2016. They stressed the disease is also starting to appear in children as young as six years old.

Type 2 diabetes - non-insulin dependent diabetes - is showing up in First Nations children in Ontario, Manitoba, and Saskatchewan at an increasing rate, and health experts are not equipped to address the problem, said Dr. Heather Dean of the Children's Hospital in Winnipeg. The disease had traditionally been thought to affect only adults, she said, and the new development has physicians and health care workers baffled as to how to treat it.

"Most physicians are disbelievers. It's important to help them understand this exists," she said, adding she saw her first child patient with Type 2 diabetes in 1983. Since then provincial health records show 58 cases have been detected in children under 14 in Manitoba. The number of new cases has risen from one or two per year to 11 in 1996, she said.

Type 1 diabetes patients display dramatic symptoms which are treatable by insulin injection, Dean said, while Type 2 cases go undetected or are often misdiagnosed by physicians. The error can lead to blindness, amputations, kidney failure and heart disease in young adulthood.

Bertha Flett, a First Nations registered nurse from Manitoba, described the experience of her daughter, who was misdiagnosed with Type 1 diabetes in 1981 at the age of eight. In 1995 at the age of 22, the woman went blind and developed end-stage renal disease (kidney failure).

"She always says, 'now I'm in dialysis, I'm going to die,'" Flett said. Flett is now working with Native children in Manitoba to try to develop better prevention and treatment strategies.

Another report, presented by Winnipeg epidemiologist Chris Green, estimated that the number of Native people with diabetes in Manitoba will triple to 20,000 from 6,700 by the year 2016, or from 16 to 27 per cent. A similar study cannot be conducted in other provinces, Green said, because most provincial patient records do not designate whether a patient is First Nations or non-First Nations.

The conference, which included 600 delegates from Canada, the United State, Australia and New Zealand, featured solutions ranging from successful community-based programs like Canada's Kahnawake Schools Prevention Project, to medical intervention programs such as the American Indian Health Service's staged management system, an American nationally-standardized care program. Canadian presentations dominated the conference agenda, occupying two full days of plenary sessions.

A presentation by representatives of Ontario's Sandy Lake First Nation focused on that community's efforts to stop the spread of the disease. Sandy Lake First Nation Deputy Chief Harry Meekis described how his community initiated a diabetes study which found Sandy Lake to have a diabetes rate of 26 per cent - the third highest rate in the world.

"The fact that Sandy Lake holds a record, of sorts, as having the third highest prevalence of diabetes in the world is more a tragedy than a source of prestige," Meekis told more than 250 delegates. "It is imperative that we salvage the next generation from the ravages that are plaguing this generation. The preventable nature of this complex combination of physical and social calamity demands action."

Meekis stressed the importance of prevention measures such as a change toward lower-fat, lower-sugar diets and more active lifestyles, in order to decrease the impact of the disease on both older and younger generations.
"The most cost-effective approach to addressing the issue of declining health of a population would be to fund changes in lifestyle through early counselling and support," he said. "Treatment facilities alone are not sufficient to address the complex problem."

The prevention stage of the project is now underway, Meekis said, after having received funding in July. It will include a Grade 4 education program as well as an adult education program.

In a keynote address, Brenda Thomas of the Assembly of First Nations emphasized that only a combined effort by all members of Canadian Native communities would stop the spread of the disease to younger generations.

"As First Nations people, we have a responsibility to ourselves, our loved ones and our children now and in future generations, to help each other in our journey to wellness," she said. "We can do this by informing and educating each other, sharing information, healing strategies, and re-gaining the traditional knowledge of our forefathers."

Diabetic dilemma: Traditional or Western medicine?

By Joan Black
Windspeaker Contributor
EDMONTON

Although there is no cure for diabetes, people who have it can improve their chances of living an almost normal life by taking responsibility for their health. The trouble is, by the time you notice the symptoms and are worried enough to see a doctor, you may already be very sick.

Maybe you've heard there are herbal remedies or "natural" medicines around. Somebody wants to put you in touch with a medicine man or woman. Or maybe you have already put your faith in Indian medicine and have been feeling all right. Now suddenly you're having complications, and your family wants you to see "a real doctor." Is it safe to keep taking your herbs along with insulin?

Windspeaker talked to three traditional medicine people, as well as to representatives of the Canadian Diabetes Association, the Aboriginal Diabetes Association, the Aboriginal Diabetes Wellness Centre at the Royal Alexandra Hospital site in Edmonton, and others who counsel diabetic clients.

They all said diabetes is a serious disease with no cure and no single plan of treatment to fit everybody. But most observed a degree of caution in expressing their opinions for publication in areas they know are controversial. There is a gulf of misunderstanding and, in some instances, misrepresentation of the aims and methods of "the other side", whether Western or traditional. All those who would go on record, however, were unanimous in saying that diabetic clients on pills or insulin should never, ever change or stop taking their medication without a doctor's advice.

Maryann Hopkins, a nurse who works in Ottawa, spoke about herbal remedies at a diabetes conference in Calgary last October. She says until that time, "I was not familiar with the Aboriginal approach to wellness and I did not understand it."

Hopkins said she considers complementary medicines to be exercise and diet. She sees only a minor role for "herbals," and says some of the "alternative" products can be classified as "traditional herbs" if they have gone through a rigorous process of certification, but even then "the indication has to be for something minor."

Hopkins said the reason for this is that there are a lot of "fly by night" companies, and said she knows of one example where blue-green algae was being sold as an anti-oxidant and health promoting product, when it had high toxin levels in it. In addition, she said there may be five different brands of a herbal on health store shelves, but there is no quality assurance or "checking" of the stores or origins of the products.

Hopkins said that in Canada, products which "fall under the rules" can display a DIN number allocated by the Health Protection Branch, which means "someone is looking at the information provided by companies and is doing post-marketing surveillance." The fact that Health Protection Branch has been publicly criticized for what prominent scientists who formerly worked there say is improper approval of some drugs doesn't sway Hopkins.

"Normally, by the time Type 2 diabetes is diagnosed, usually the eyes are affected. [These people] can't be helped by herbals," Hopkins said.

This attitude frustrates 49-year-old Russell Willier, a Cree healer from northern Alberta, who has been treating a variety of ailments with herbal treatments for 20 years. On the one hand, Willier wants recognition for the value of what he and others like him do, yet he does not keep written records of his treatments. Similar to most other traditional medicine people, he will not reveal the exact ingredients in his herbal "combinations," either.

In the mid-1980s, Willier participated in a research project with anthropologists from the University of Alberta to show that Indian medicine works. David Young, who is retiring as head of Anthropology at the university, said there is no doubt in his mind that Willier is able to help some people. He said he has seen patients respond very well to Willier's treatment of leg ulcers, for instance.

That the medical profession was not persuaded that the healer's methods work may be because of the limitations of the research project itself. They kept one foot in the boat throughout: the test was only designed to treat psoriasis, a chronic and sometimes serious skin disease, which sometimes affects diabetic patients. Skin ulcers resulting from impaired circulation, on the other hand, which are a frequent complication of diabetes, were deemed too dangerous to allow Willier to treat in a controlled setting.

In addition, Willier stresses the component of belief and respect for the teachings that accompany the use of plants is as important as their medical benefit. That view is central to the teaching of the other medicine people too. Yet Willier was unable to get any Aboriginal people to volunteer for the project. All 13 were non-Natives. Two were test cases; of the main sample of 11 people, one dropped out at the beginning. The anthropologists' reports indicate that many, if not all the subjects, stopped using all their topical medicines some of the time because of the bad smell. In addition, treatments were conducted in Edmonton instead of in Willier's home, which curtailed his normal way of doing things and in some instances probably shortened the treatment he could offer. In addition, the sweat lodge ceremony was delayed. In the end, the anthropologists' report said six people benefited from treatment to varying degrees.

Willier once hoped to get a healing centre started, so he could have others handle the paperwork while he doctored full time. That dream is all but gone now; his letter sent out to all of Alberta's chiefs and councils did not elicit one reply, he said. Still, he treats about 40 people a year all over Alberta, British Columbia, the Northwest Territories and Yukon. In 1997, he was invited to explain Aboriginal medicine at Queen's University in Kingston, Ont. In addition, Willier has taught apprentices from the Alexander reserve in Alberta and from Isle la Crosse in Saskatchewan. But most of the time, he finds himself "working around the doctors," even when family members ask him to visit their relatives in hospital. Sometimes patients ask him for his herbal drink, which he says has regulated blood sugar when Western medicine has failed.

Willier's main complaint is with the approach of Western doctors. He suggests they are not prepared to put the time into healing obstinate chronic conditions.

"They want to cut [legs off] to prevent gangrene spreading or when ulcerative conditions are almost at the gangrene stage," he said.

Other than to say they use "a traditional approach," nobody at Edmonton's Diabetes Wellness Centre wanted to talk about the traditional medicine. Spokespeople there said it was "political," and deferred to the Elders on staff, who they said might or might not want to talk to the press.

One did. Madge McCree, from Slave Lake, looks after the spiritual aspects and leaves the doctoring to others. She said circles are held at the wellness centre, where people can express themselves, and prayer is part of each day.

"We teach them - we plant the seed to take responsibility for themselves," McCree explained. "We start by awakening the spirit, then the mind works." The difference is that the centre" [doesn't] teach fear-based, AKA Western, medicine," she said. Instead they "work on the seven grandfathers" to create the balance she said is missing from people's lives.

McCree said some Elders think diabetes among Aboriginal people is caused by "a lot of things in the past - grieving," from a lot of the hurt they have been through since the Europeans got here. Still, she leaves the choice about whether or not to take Indian medicine up to the individual, and "we never tell them not to take [insulin]" she said.

Sometimes, McCree added, if they see clients before they become insulin-dependent, traditional medicines can help them avoid it.

"We advise them if they take traditional medicine, check their sugar more often." The healers have consensus on this point, as all said that traditional medicines often lessen the need for insulin or Western oral medications.
The big difference between her approach and that of Western herbalists, McCree added, is prayer. She said she has seen that even if someone takes the same medicines Aboriginal people use, that they obtained commercially, more success occurs where "protocol - the offering of tobacco - is observed and the client "wants something from the heart.

"If the sacredness is gone, healing stops," McCree concluded.

That is the view of Derrick Pitawanakwat of Manitoulin Island in Ontario, too. He also relies on the seven grandfathers to treat illness. But Pitawanakwat seems to have the respect of the doctors, dietitians and others with whom he works on the island and who sometimes give him referrals. There he is welcomed to treat in the hospital when Aboriginal patients request it. Like Willier, he uses internal and external medicines.

His brew to help cardiovascular complications does not remove plaque in arteries, he said, but it prevents clots and permits better blood flow. He also treats psoriasis and other skin conditions with four herbs in an external application. The past five years, Pitawanakwat said, he has restricted his medicine to the treatment of diabetes and has 152 clients whom he sees regularly. He only treats Aboriginal people and thinks genetics is the main cause of diabetes among them.

Unlike Hopkins, Pitawanakwat does not see proper diet and exercise as "complementary" aids to diabetes treatment, but an essential component of it. Like Willier, he said "Western doctors' only solution to gangrene is to cut the leg off."

Pitawanakwat took training for more than a year as a diabetes educator at a community college in Ontario, and has adapted that knowledge to suit the ways Aboriginal people learn. The 61-year-old healer has taught about 80 students and currently has eight, he said. He has a proposal before the minister of health to hire nurses and do more teaching and follow-up.

"If I can get them to understand they need to change their lifestyle, even tough cases will respond," Pitiawanakwat said of his methods. Like McCree and Willier, he stresses , that belief and the proper respect for the gifts from the Creator make all the difference.

Irene Csotonyi, who operates a herbal remedy store in Edmonton, disputes the statement of many doctors, nurses and pharmacists that most natural medicines are sold by uninformed lay people who may put your health at risk. She stresses that people need to take the responsibility to research and learn and ask questions before deciding on herbal remedies. Like the other interviewees, Csotonyi said there is no "quick fix" for diabetes and no one remedy for everybody. Although she does not work with physicians, Csotonyi said she was trained as a medical doctor in her Native Hungary and has taken training in natural medicines by correspondence and other means here in Canada.

Csotonyi described in detail several products that she can offer to help regulate blood sugar, reduce the need for insulin, boost the immune system and increase energy. Still, she said "Diet is the most important thing. Look at diet first.

"Self-diagnosis is out," Csotonyi added; "I always recommend they see a doctor first."

The businesswoman adds that she is not opposed to government getting involved to better regulate natural products, provided "they hire people in the Health Protection Branch who have had training in and understanding of natural medicines." 

Healing Trail promotes diabetes awareness

Cheryl Petten,
Windspeaker Staff Writer,
Dryden Ontario

The Healing Trail program has been up and running for less than a year, but has already met and exceeded many of its goals.

The program, a three-year pilot project funded through Health Canada, was launched in June. The program is aimed at Aboriginal and Métis people in the Dryden area, but everything being done through the program is designed to be adopted and adapted by other communities.

Each project is developed, then run in the Dryden area and, if it's deemed successful,
it's made available to other communities to use.

"Our philosophy is not to reinvent wheels. Too much of that has been happening, and its leaving us with no resources," said Vicki Scherban, community liaison with The Healing Trail program.

"The project is well on its way. It's actually exceeded its goals and objectives in six months, so it's going very, very well," Scherban said.

"It started with a very unique partnership with the Ontario Métis Aboriginal Association, the Dryden Native Friendship Centre, and the

Dryden Regional Health Centre, which is the hospital that serves the district, and the Dryden Diabetes Centre. And the four organizations grouped together to develop a promotion/prevention program, which is funded by Health Canada, under their Mohawk program."

One of the goals of the program is to increase awareness about diabetes among the Aboriginal community. This has been done through a poster campaign, a radio campaign, articles in local newspapers, and through participation in community trade shows.

The program has also recently opened an office, which is open three days a week.

The Healing Trail has had a lot of success in reaching its target audience, and getting its message out.

"We've reached over 110 individuals just through community workshops. We had over 3,500 visit our booth at a trade show. Just in this area, this small region. We're optimistic that the word is getting out there. We have phone calls coming in continuously," Scherban said.

A number of different projects have been launched through The Healing Trail, many done in partnership with community organizations, or corporations.

"We're in the process of launching, in partnership with Lifescan Canada, which is the Johnson and Johnson company, another partnership in providing meters to urban Aboriginals and Métis. And in doing that, we receive dollars back from registering them and monitoring them, from Lifescan, to develop more resources. Because resources are far and few between. A lot of one-time printings, and then the resource dies off. So we're trying to develop some sort of partnerships where we have some revenue to continue to develop our materials," Scherban said.

One of those resource materials being developed is a "how-to" community manual.

"It's going to consist of eight workshops for nutrition, and eight workshops in the prevention of diabetes and the understanding of Type II diabetes. And so there'll be 16 community workshops. And it's being developed and ready for market by March, we're hoping, for other communities or organizations to implement in their communities. We've tested them in ours, and they've gone well. They consist of a lot of Aboriginal content. So that's what we're trying to do. Because there's very little of that. There's lots of Type II diabetes information, but with respect to Aboriginal and incorporating the thrifty gene, etc., you know, we're doing all of those things," Scherban said.

Another initiative launched through The Healing Trail is an Aboriginal diabetes outreach worker program, being offered through the local hospital. The first offering of the program has seven participants, representing a number of Aboriginal organizations, including the Ontario
Métis Aboriginal Association, the Métis Nation of Ontario, the Dryden Native Friendship Centre, and the Red Lake Ontario Métis Aboriginal Association.

"We are training outreach workers that work for urban Aboriginal organizations in their current positions, in either long term care or community health outreach. And it started in September. It runs through until March, and it will provide them with a really solid foundation in diabetes education. And The Healing Trail felt that was probably one of the key areas to address, because those organizations then can take some ownership in ongoing prevention programs."

If the first offering of the outreach training program is successful, it could form the basis of an apprenticeship program for use in communities across the province, Scherban said.

"We have had preliminary discussions with the Ministry of Education and Trade regarding an apprenticeship program. We would like to proceed in that area once we have tried this trial. We are creating a new curriculum that is Aboriginal-sensitive and culturally appropriate. So again, we are going to have another model that can again be mirrored in other communities by simply obtaining an RN or RD, a Registered Nurse or a Registered Dietitian, and an Elder to deliver the program.
"Our reserves are very close to our communities. We have about six communities we're focusing on here. And then the reserves are minutes apart from these, and we have four reserves in this area, directly. And this is just a small urban project. What we would like to do is partner with them to do an assessment across the board, to come up with some hard, fast numbers so we know where to start directing our attention.

"Sandy Lake's not far from here, so we know that if the statistics are 29 per cent or more in Sandy Lake, those numbers are probably not far off most of the Aboriginals residing in northwestern Ontario, this far anyway. But we really would like to do an assessment, and they agree that that would probably be a good area to go towards, to focus on," she said.

"We're walking before we run. We want to complete our first year pilot. But to date, we've totally exceeded expectations, both of our community and Health Canada," Scherban said.

As for the long term, she'd like to see the program create a number of resources that will continue to be available once the pilot project has ended.

"I think the long term goal would be to have raised enough awareness that we have changed the way that we're eating in our communities, and our activity levels. But most importantly, is that we've developed the resources that could be accessible, and be able to market those resources to become self-sustainable to continue to provide these services. Because they have to be ongoing. We just can't do a news flash. It just doesn't work. And I mean, we're diagnosing them as young as five out here. So we have a serious epidemic facing us. So I think it has to be an ongoing process. And that's why we've always directed our resources at developing items that could be either marketed or renewed easily and cost effectively."

For more information about The Healing Trail program, visit the program Web site at www.diabeteshealingtrail.ca or call 807-223-8238.

"So we're trying to, in the same time, look to our neighboring communities that have not created a program yet. All of these programs will be set up so that they can be utilized in other communities," Scherban said.

Another project being launched by The Healing Trail is aimed at getting diabetes information out to Aboriginal youth. The new pilot project is being launched at Wabigoon school. The urban school is located in Wabigoon, a community about 15 minutes east of Dryden that has a high Aboriginal population.

"We will be attempting to screen the children there, in partnership with the Dryden Diabetes Centre. And we will also be providing workshops toward adopting healthy lunch programs. And we will also have materials and programs implemented into their class curriculum that are Aboriginal appropriate again, and culturally appropriate," Scherban said.

Scherban indicated there is no statistical information available regarding the prevalence of diabetes among the area's Aboriginal community. That, she said, was another thing the program hoped to address.

"We know the statistics are high. We don't have any data. I had just had a discussion with Health Canada with respect to, in our last three or four months, accessing some sort of resources to do an assessment off-reserve and on-reserve.

"Our reserves are very close to our communities. We have about six communities we're focusing on here. And then the reserves are minutes apart from these, and we have four reserves in this area, directly. And this is just a small urban project. What we would like to do is partner with them to do an assessment across the board, to come up with some hard, fast numbers so we know where to start directing our attention.

"Sandy Lake's not far from here, so we know that if the statistics are 29 per cent or more in Sandy Lake, those numbers are probably not far off most of the Aboriginals residing in northwestern Ontario, this far anyway. But we really would like to do an assessment, and they agree that that would probably be a good area to go towards, to focus on," she said.

"We're walking before we run. We want to complete our first year pilot. But to date, we've totally exceeded expectations, both of our community and Health Canada," Scherban said.

As for the long term, she'd like to see the program create a number of resources that will continue to be available once the pilot project has ended.

"I think the long term goal would be to have raised enough awareness that we have changed the way that we're eating in our communities, and our activity levels. But most importantly, is that we've developed the resources that could be accessible, and be able to market those resources to become self-sustainable to continue to provide these services. Because they have to be ongoing. We just can't do a news flash. It just doesn't work. And I mean, we're diagnosing them as young as five out here. So we have a serious epidemic facing us. So I think it has to be an ongoing process. And that's why we've always directed our resources at developing items that could be either marketed or renewed easily and cost effectively."

For more information about The Healing Trail program, visit the program Web site at www.diabeteshealingtrail.ca or call 807-223-8238.

Heart disease trend alarms doctors

By Joan Taillon
Windspeaker Staff Writer
TORONTO

Hospitalizations for ischemic heart disease in Native people have doubled in the past two decades, while the rate has decreased for others, according to a study published in the June 26 issue of the Archives of Internal Medicine. Toronto doctors who conducted the 17-year Ontario heart study are calling these findings an "alarming trend in Native health," which urgently requires "further research and targeted intervention."

The biggest contributing risk factor for heart disease is diabetes, they say. The rate of diabetes among Native people is currently at least three times higher than for the general population and is believed to be associated with a sedentary lifestyle and high-fat diet.

Dr. Bernard Zinman was one of the heart study's principal researchers, along with doctors Baiju R. Shah and Janet E. Hux . All three are associated with the department of medicine at the University of Toronto and major Toronto teaching hospitals.

Zinman explained that ischemic heart disease is a general term that encompasses all kinds of heart disease resulting from atherosclerosis or hardening of the arteries. Ischemia refers to decreased blood flow to the heart when coronary arteries are blocked.

"What we are shocked to find is that the rates for those Native communities (covered by the study) were much lower in 1980 and 1982 compared to the provincial average, almost half for heart attack rates, but now they've surpassed everybody and are far above the provincial average," Zinman said from Mount Sinai Hospital on July 4.

What's to blame?

"It's almost all diabetes," said Zinman.

He said they examined the health records of 41 communities, 39 of which were in Northern Ontario, that identified a Native population of at least 95 per cent. They found heart disease rates among Native people rose to 186 per 10,000 hospital admissions in 1995 from 76 per 10,000 in 1984.

In the general population in Northern Ontario, the rate decreased from 129 per 10,000 to 110 per 10,000 during the same period.

The rate for all of Ontario currently is 82 per 10,000.

The downward trend among non-Natives is a "common story," Zinman said.

"In the United States and Canada, the rates of heart disease are going down, whereas in this community (Native people) they're going in the opposite direction, and based on other information from other studies, you don't get heart disease if you're a Native unless you have diabetes. It would be very unusual.

"And that is why (Native people) were protected previously," Zinman said. "They almost had lower rates. And so diabetes seems to be the major risk factor for Native people, whereas, Caucasian people-diabetes is a risk factor, so is smoking, so is a bunch of other things.

"So if went into a unit where there were 100 Caucasian people with heart attacks, I would find that about 20 to 25 per cent had diabetes. But if I went into the Native population where there were 100 Native people with heart attacks, I would find that about 80 to 85 per cent had diabetes," Zinman said.

To turn it around, he said a three-pronged intervention is needed.

"One, you've got to try to prevent diabetes," by improving diet and increasing exercise, Zinman said.
"But, that's not enough, because there are lots of people that already have diabetes, so diabetes also has to be treated effectively.

"And the third thing is that people with heart disease must have appropriate access to the good therapies. Just because you have heart disease doesn't mean you are going to die. It means you need, maybe, bypass surgery, you need good drugs, you need effective therapy."

All three are probably deficient in northern communities, Zinman concluded.

Margot Geduld, a spokeswoman for Health Canada in Ottawa, said the government is aware of the study and is "concerned," but Health Canada's programs usually only address factors related to heart disease, such as non-traditional tobacco control and nutrition initiatives to improve diet "in collaboration and consultation with" Native people.

Whether the study will change the way Health Canada deals with the problem of heart disease in Native communities, Geduld said she's "not sure." She indicated they will likely only change what they pay for if Native communities redefine their own health priorities to the federal government.

Geduld pointed out that Health Canada funded a 28-month diabetes research project undertaken in the Sioux Lookout Zone of northwestern Ontario in 1991. Dr. Zinman and Dr. Stewart Harris, medical director of the zone hospital, spearheaded that work.

Sandy Lake First Nation, with a population of 1,500, was the base for the study that encompassed 30 communities.

Chief Ennis Fiddler of Sandy Lake said following the diabetes study they got some federal funding to hire two people to work on prevention programs that include a radio program.

The workers also have just completed a year-long program to develop an elementary school curriculum in conjunction with the school board in Sandy Lake.

The other thing the community has developed is a walking trail that surrounds their large reserve, as well as programs to encourage its use.

"And recently the program has ordered pedometers that record how many steps you take and how far you walk, the chief said. So far 160 are in use and the workers hope to order more.

Fiddler said it is not as difficult as it once was to get a selection of good food, since it is flown direct from Winnipeg. Food is still "twice as expensive" as it would be in Winnipeg, though, he said.

"I think people are starting to be aware about the diabetes itself and also what they can do to make themselves combat the disease," the chief said. "Ten years ago, people didn't care what they ate . . . all they knew was that today they were okay and they were eating this fat. Today people are starting to think about that. People are making a conscientious effort to make sure they no longer eat that kind of diet." He said foods like cheese and vegetables are becoming more popular, but the community still has work to do on getting people to leave their vehicle behind and walk.

Fiddler said he is concerned they still have nothing to offer community members who are already seriously affected by diabetes and whose mobililty may be limited. He said the community has set its sights on getting kidney dialysis set up in Sandy Lake and maybe establishing a nursing home. Currently band members have to move to Sandy Lake or Thunder Bay, 200 and 500 km away, for dialysis.

The chief was aware a study had recently been concluded on heart disease and said the findings would be shared with the community when they got the report.

One of the Sandy Lake diabetes workers, Roderick Fiddler, had also heard of the heart study but had not yet seen it. He said the community was becoming more aware of both diabetes and heart disease and prevention.

He said they have an "ongoing community intervention program" that involves home visits to teach about all aspects of diabetes. Also their hour-long weekly radio programs address different related topics, such as foot care, nutrition and wild game, and eye care.

"I think we're going in the right direction right now," Roderick Fiddler said.

Nation takes a healthy approach to fighing diabetes

Inna Dansereau,
Windspeaker Contributor,
Paul First Nation Alberta

Eighteen four-person teams came out to golf for a good cause despite the cold, windy weather on Sept. 7 -the second annual diabetes awareness golf scramble at the Paul First Nation.

The money goes to the Three Feathers Research Foundation, which is an extension of the Arnold J. Brant Scramble for Diabetes Golf Tournament organized by members of the Tyendinaga Mohawk Territory.

The mission of the foundation is to find and support research of clinical projects directly related to health issues affecting Aboriginal people.

"A Mohawk guy lost his brother to diabetes, and he started the foundation," said Henry Arcand, one of the organizers of the Paul First Nation tourney. In February, the foundation will be requesting proposals from different institutions, including the University of Alberta, for projects trying to stop the increasing diabetes problem in Aboriginal communities.

Assembly of First Nations vice-chief Wilson Bearhead was another organizer at the tournament at the Ironhead Golf Club, located west of Edmonton.

"For too long we've relied on the government to save us. From now and in the future we have to work together. We have to insure that those who have diabetes overcome it, and that our young people who don't have it now don't get it." Bearhead is diabetic.

"We came here (to the tournament) to support the foundation to fight this disease," he said. Victor Buffalo from Samson First Nation said the tournament was a very good initiative.

"My brother died in May of a heart attack; he was diabetic, so am I," he said.

According to the National Aboriginal Diabetes Association, the risk of diabetes among Aboriginal people is three times greater than among the general population. About two-thirds of the First Nations people with diabetes are women.

Recently, children aged five to eight have been diagnosed with Type II diabetes in central Canada. Diabetes occurs when the body can't control its blood sugar level. Symptoms of the disease include unusual thirst, frequent urination, unusual weight loss, lack of energy, blurred vision, frequent infections, numbness in hands or feet, and slow healing of cuts and bruises.

Sometimes, people don't show the symptoms. If left untreated, high blood sugar levels can damage blood vessels in the body, causing heart problems, high blood pressure, strokes, kidney disease, blindness, and limb amputations.

A healthy diet, weight control, exercise and stress reduction are prevention measures. Medications may be needed to assist the body in using insulin, which ensures energy needs are met.

Prevention needs to play a bigger role

By Marie Burke
Windspeaker Staff Writer
EDMONTON

Prevention is a key factor for First Nations in battling diabetes. At a time when First Nations people are five times more at risk than the general population to get the disease, awareness is important. The National Aboriginal Diabetes Association and the different Aboriginal Diabetes Wellness programs in each province believe prevention is the key.

"The comment we frequently hear is, 'I'm too old to be jumping around,'" said Linda Brazeau, manager of the National Aboriginal Diabetes Association. Brazeau has worked with the group Strategies for Undermining Glucose in Aboriginal Races that started in Manitoba in the early 1980s. The group saw a need in the Aboriginal communities for more awareness about diabetes.
The exercise factor in prevention does not need to be difficult. In terms of exercise it can be as simple as walking 30 minutes a day to prevent or improve a diabetic condition. Brazeau believes that a long time ago, Aboriginal people used to walk everywhere. They were healthier, stronger. People don't realize that even when you go shopping or take children out for a walk that it's exercise.

To Aboriginal people, family is a big thing and if a person with diabetes doesn't want to do it for themselves, then consider the family.

"The main risk factors for getting diabetes is obesity, the type of diet, and activity level of each individual," said Kathleen Cardinal, diabetes outreach worker at the Aboriginal Wellness Program in Edmonton.

Food plays a very important part in life. Being able to eat the food that could help in preventing diabetes seems simple. Yet diet is an outwhelming concern among health caregivers who deal with diabetes and prevention. The factors that affect eating habits with First Nations stem from their history. First Nations people were very active people. Their survival depended on it.

However, today, most Aboriginal people do not need to fish, hunt or trap to survive. The metabolism and make up of Aboriginal people has not changed, but their lifestyle has.

The changes that have happened to the traditional lifestyle of Aboriginal people can help them understand why they are more prone to diabetes.

We also need to understand that it is a disease that can be managed and prevented, said Cardinal. When people are under stress with life situations, food can become a source of comfort. Eating improperly and lack of exercise can lead to health complications such as diabetes.

Cardinal also noted that the different stress levels of each individual is a contributing factor in health. If a person is worrisome and fearful, it greatly their ability to cope with a disease like diabetes.

Scientists find diabetes link in Oji-Cree

By Joan Black
Windspeaker Contributor
SANDY LAKE, Man.

Scientists at the John P. Robarts Research Institute and spokesmen for the Sandy Lake First Nation announced a genetic discovery last month that may lead to better prediction and control of diabetes in Aboriginal people.

The doctors have discovered a genetic mutation in the Oji-Cree of Sandy Lake, Man. that may hold the answer to that population's diabetes epidemic. The new gene has so far only been seen in Sandy Lake people, although other Native groups have been tested. The Cree in the Sandy Lake area do not seem to have the genetic abnormality.

Dr. Robert Hegele, director of the Blackburn Cardiovascular Genetics Laboratory at Robarts, discovered the mutation. Other principal researchers were Dr. Stewart Harris from the Centre for Studies in Family Medicine at the University of Western Ontario, and Dr. Bernard Zinman from the Samuel Lunenfield Research Institute, Mount Sinai Hospital and University of Toronto. Also delivering presentations were former chief of Sandy Lake, Jonas Fiddler, who holds the band's health portfolio; Deputy Chief Harry Meekis; Dr. Mark Pozansky, president and scientific director of Robarts; and Robarts scientist Dr. Tom McDonald, past chairman of the Canadian Diabetes Association National Research Council.

Dr. Hegele hailed the discovery as "the strongest genetic effect on diabetes that I have seen in 15 years of research. I am unaware of any other diabetic population in the world that is so strongly affected by a single gene variant," he said.

The Oji-Cree of Sandy Lake have the third highest rate of Type 2 diabetes in the world. A 1992 survey showed that 25 to 30 per cent of the population has diabetes; at least another 10 per cent have impaired glucose tolerance, which means they are at greater risk of developing the disease. Complications of diabetes include blindness, heart disease and stroke, kidney failure and gangrene, which results in amputations.

"Until 80 years ago," Dr. Hegele said, "few Aboriginal people in the Sioux Lookout zone had diabetes. In the last 10 to 20 years, diabetes started to be expressed at an epidemic rate. A gene or tendency was always thought to be there, but we think that the change in food and lowering of physical activity - plus the gene - results in diabetes."

In 1990, the people of Sandy Lake were so alarmed at the high incidence of the disease among their population that they asked their chief and council to approach Dr. Harris in Sioux Lookout to investigate the problem. Dr. Harris contacted Dr. Zinman and they undertook the survey, which confirmed the Sandy Lake people have five times more diabetes cases than the national average. Setting up protocols and methodology for their study took them three to four years.

At that point, they asked Dr. Hegele to get involved in testing for a genetic link. Dr. Hegele thought the problem was in the people's DNA, so he tested one blood sample from each of the 728 band members who agreed to participate in the study.

The results were startling. Dr. Hegele's group found that a person who inherited one copy of the mutated gene from their parents was more than twice as likely to have diabetes as a person who did not inherit the mutation. If a person inherited two copies of the mutation, however, he was up to 15 times more likely to have diabetes.

They also found that people with one copy of the mutated gene tended to develop diabetes in their thirties. On average, people with two copies of the mutation developed diabetes in their twenties. The findings were published in the March issue of the Journal of Clinical Endocrinology and Metabolism.

The researchers don't claim to have all the answers. They want to know why some people who do not have diabetes have the variant gene, which could indicate they are predisposed to developing diabetes, Dr. Hegele said.

They also found that 50 per cent of the people in Sandy Lake who have diabetes don't have the genetic mutation. Doctors suspect there could be yet another gene connected to the puzzle.

Finally, they say that two additional studies showed more than 100 people had a variant form of the gene, raising still more questions. And no one can say why eight Inuit communities or the Ojibway of Manitoulin Island they tested do not have the gene, although a high rate of diabetes exists in these places too.

"This discovery is a major contribution to further our ongoing research," Dr. Harris said. "Diabetes is emerging as a major epidemic among First Nations . . . and there is an urgent need to develop (prevention) strategies."
Drs. Harris and Zinman and the people of Sandy Lake decided they needed to do more than conduct laboratory research to get this urgent problem under control. They consulted with anthropologists and nutritionists and, starting in 1995, they set up a prevention program, which is ongoing.

One thing they did was to start diabetes education for Grades 3 through 5. They also aired a "Dr. Diabetes" show on the radio. Even the community's Northern Store assisted the project by agreeing to identify healthy food choices through the use of icons, colors and syllabics on their products. Health workers also undertook home visits to treat and educate those with diabetes.

Dr. Zinman said of the gene mutation discovery that it is important "but not earth-shattering." While he sees it as "an important advance" in doctors' understanding of diabetes, he believes the emphasis will have to remain on prevention through education for a considerable time yet.

All the doctors agree that it could be years before an effective new treatment for diabetes is found. Right now, even the test for the aberrant gene is not available outside the research lab and it is not covered by any health care plan.

"This announcement today confirms the importance of committing research dollars to finding new solutions," Harry Meekis said.

 


Attention to culture extremely important
By Debora Lockyer
Staff Writer

The Canadian Diabetes Association's 2nd Professional Conference and Annual Meetings were held on Oct. 14 to 17 and about an hour-and-a-half of the three-day agenda was devoted specifically to Aboriginal people and the disease.

Diabetes, as you know, is a growing concern in many Aboriginal communities. Some communities report that a large percentage to the membership have been diagnosed with the illness. One such community is Sandy Lake First Nation in Ontario, where the diabetes rate is 26 per cent, the third highest rate in the world.

Diabetes care and prevention programs have had little success in Aboriginal communities in the past, because physicians and educators did not understand the cultural aspects that go hand in hand with the treatment of the disease.

But that is beginning to change, and evidence of that change was seen in a number of the presentations in the Native focus sessions at the conference.

Judi Whiting was with the Saskatoon Health District and is now working for the Canadian Diabetes Association. Her presentation, titled Diabetes Self-care Practices and Cultural Beliefs of Urban Dwelling Aboriginal People with Diabetes, revealed some interesting things about what people believe diabetes to be and how it is best treated.

Whiting explained that the prevalence rate of Aboriginal people with diabetes living in Saskatchewan is about 11.5 per cent of the Aboriginal population. That compares to 3.5 per cent of people with diabetes in the non-Aboriginal population. Aboriginal people make up about 7.5 per cent of the total population of Saskatoon, so, according to 1996 population numbers, as many as 1,800 Aboriginal people in Saskatoon may have diabetes.

The study began with 50 people, more women than men, with the average age of the study group being 51 years and the average length of time the participants had diabetes being 8.9 years. In Saskatchewan the average age of diagnoses for Type 2 diabetes is 49 years old in the Aboriginal community as compared to 62 years old in the non-Aboriginal community.

For the most part, the people in the study did not explain the cause of diabetes in cultural terms. One-third of those studied believed that Indian medicine could cure the disease. One-third had taken Indian medicine before, and 10 per cent of the people were taking Indian medicine at the time of the interview. Only eight per cent of those studied believed doctors could cure the disease.

The length of time living in an urban setting seemed to impact the participants' beliefs in the effectiveness of traditional medicines.

But that didn't mean the people were buying into a more conventional approach to treating their illness. In fact, in many cases, the people did not have the self-care skills to help them cope and survive with diabetes. While 75 per cent of the study participants knew the symptoms of low blood sugar, only 30 per cent knew how to treat those symptoms. Only 54 per cent were testing their blood sugar levels and only 33 per cent knew about nutrition.

This is a population at risk.

The next presentation, title A Grounded Theory Study of Type 2 Diabetes in First Nations Adults, was conducted with the participation of 10 people on a reserve in southwestern Ontario. Diabetes was uncommon in Aboriginal communities as late as the 1940s, said Cheri Ann Hernandez, but the disease has now reached epidemic proportions. Hernandez first step was to review existing literature to get an idea of what others had observed in Aboriginal people with diabetes. She found that while some people blamed European settlers for causing the disease because of changes to the food and the environment upon their arrival, others blamed lifestyle or spiritual weakness for the disease in Aboriginal people.

Hernandez's 10 subjects, however, did not blame early Europeans for bringing the illness. They blamed themselves and their own behavior, including alcohol consumption, inappropriate food choices and other lifestyle choices.

The participants went through three stages. Having diabetes was the first stage where they denied that anything was wrong with them, longed for their normal life to return and minimized the effects that diabetes was having on their lives. People were too busy to take care of themselves or learn about diabetes, or just refused to recognize the significance of the disease in their lives.

The second stage, the turning point, demonstrated that a number of factors led participants to finally focus on life with diabetes. One woman suffered a variety of complications before she fully realized the seriousness of the disease. It was when her sight was endangered that she came to terms with the condition. Diabetes can lead to blindness, amputations, kidney failure, heart disease and a myriad other afflictions. Individuals in the turning point stage were focused on their diabetes, learning about it and how to live with it. They were preoccupied with their illness.

The third stage was what Hernandez described as the 'science of one.' In this stage there was integration of the personal self (the self that existed prior to diabetes) and the diabetic self (the new entity that emerged after the diagnosis of diabetes). These individuals became experts in their own diabetes, tuned into (listening to) their bodies and made regimen adjustments based on these body cues. The focus was on living, but on living with their diabetes.

Another interesting aspect to the study was that participants were insistent it was important that diabetics receive advice about the illness from people who had the disease themselves. It was not even important that the educator be Aboriginal, the study noted, just that the educator have this experiential knowledge about the disease. A subsequent debate on what is causing the increases in diabetes seen in Aboriginal people over the years led to a variety of opinions and theories. The feast and famine theory, describing a differing genetic make-up for Aboriginal people, one more suited to the traditional lifestyle of hunting and gathering, including the physical effort it took to get the food, was but one of those opinions put forward. Loss of traditional food and replacement of that food with the "five white gifts" brought to Indian nations from European settlers - sugar, salt, flour, milk and lard - are slowly destroying Aboriginal people, said one woman. The group was reminded, however, that diabetes may not be rooted in the same cause for all Aboriginal people across the country.