Diabetes plagues First Nations communities

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The statistics are shocking, the reality grim, and with the rate of incidence at least four times higher than the national average, diabetes poses a very serious and challenging health problem for all First Nations people in this country

At Onion Lake First Nation, with 25 years of clinical observation, research and practical experience under the belt, and a brand new pilot program in place, the health care team headed by Dr. Malcolm A. Warburton and Director Albert Jimmy is tackling the real problems of diabetes, head-on.

Under the guidance of the policy advisory group, the technical advisory group, Chief Wallace Fox and band council members, Onion Lake has developed a well-integrated, community-based traditionally-sound program for the control of Indigenous diabetes.

"There is a high incidence of diabetes in First Nations people in general and a very significant proportion on this reserve who either have diabetes or are at risk," said Dr. Warburton. "The high risk essentially being a genetic and environmental predisposition that originally surfaced with the [life style] changes Aboriginal people have lived with since first contact."

"Before contact, First Nations people existed in times of feast and famine, and over many thousands of years, nature selected certain characteristics within these people to cope with that environment, what is called today the thrifty gene theory.

Pre-contact Aboriginal people were biologically tuned to their environment, hunting and fishing for natural game, walking and searching for roots, berries and grains, with work and exercise in tune with the balance of nature.

This produced a person in harmony, with balance and "copability" that made strong bodies to deal with the peaks and troughs [of available nutrition,] said Warburton.

Post-contact, on the other hand, has led to a more sedentary lifestyle, with less exercise and less balanced and natural nutrition.

"Nowadays, there is no cycle of feast and famine, as such, and an inappropriate supply of unnatural foods readily available, and this has caused people who are genetically prone to develop diabetes," said Albert Jimmy.

"What we are seeing today is a lack of meaningful cultural exercise and natural nutrition," Jimmy said.

"We can't go back to pre-contact times; we can go back in our minds, but we have to deal with the reality we have today. And today a lot of the barriers to overcome are economic, a lack of understanding and good working knowledge."

The health care team at Onion Lake First Nation is addressing the problems on-reserve with a program of three strategies, each structured in a culturally appropriate manner, because past experience has shown that contemporary medicine on it's own just doesn't seem to be enough.

Primary prevention involves grassroots education at the school level, teaching children from an early age the benefits of healthy living and targeting high risk groups whose members may develop diabetes later in life.

Secondary prevention in the program is the attempt to detect diabetes as it exists in the community today, partly by detecting impaired glucose intolerance which can be diagnosed with appropriate testing.

Treating and diagnosing the condition of diabetes in First Nations people calls for two approaches, traditional and contemporary, and each patient has a choice which route to travel.

The health care team has an association with a number of local Elders who help with all matters traditional and are respected for their advise.

The team also has a relationship with the Alberta Diabetes Wellness Clinic, run by Capital Health in Edmonton, which offers support and guidance for and by First Nations people with instruction offered in Cree.

The inpatient clinic offers total immersion in addressing the problems of diabetes, and the desire is to have the whole program on reserve at Onion Lake, in addition to having Elders coming in from Edmonton to give talks.

Tertiary care is part three of he program and deals with the serge of diabetes expressing itself in people who are younger and younger, called MODY or Mature Diabetes Onset in Youth, and deals with the realities of care and complications associated with diabetes.

"And we are especially keen on diagnosing gestational diabetes in (as yet unborn) infants whose mothers may have the conditions," said Warburton.

"It's very important to develop these initiatives and develop them quickly because with a fairly large population, 3,000 on-reserve and roughly half under the age of 25, we have to face the future and urgently address these problems."

Any First Nation people who want to start a program can look to the Onion Lake First Nation health care team for help in how to overcome the obstacles.

The doctor advises any person who thinks they have diabetes to talk to someone and take the first step on the road to healing.