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Diabetes and Native Americans
3
Diabetes - Cross Cultural Care and Native Americans
created by Samantha Aguilar, William Bake and Megan Conklin
General Prevalence
An estimated 30.3 million people of all ages - 9.4% of the U.S. population - had diabetes in 2015.
Prevalence varied significantly by socioeconomic status.
- 12.6% of adults with less than a high school education had diabetes.
- 9.5% of those with a high school education had diabetes.
- 7.2% of those with more than a high school education had diabetes.
What is Diabetes?
Types of Diabetes
Diabetes mellitus in a group of metabolic disorders characterized by abnormally high levels of blood glucose secondary to inefficient insulin action and/or secretion. The disease often leads to significant disability, including renal failure, blindness, limb amputation and up to death.
Types of Diabetes
Type I Diabetes (insulin dependent)
Type 1 Diabetes
Type 1 Diabetes: the body does not produce insulin. The body breaks down the carbohydrates you eat into blood glucose (also called blood sugar), which it uses for energy. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. Commonly associated with children.
Type 2 Diabetes
Type 2 Diabetes
Type 2 Diabetes: the most common form of diabetes. Diabetes is a problem with your body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. If you have type 2 diabetes your body does not use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it isn't able to keep up and can't make enough insulin to keep your blood glucose at normal levels. Commonly associated with adults, later onset in life and effects Native Americans.
Diabetes and Native Americans
Prevalence in Native Americans
American Indians had the highest prevalence of
diagnosed diabetes for both men (14.9%) and women (15.4%)
.
Prevalence was highest among ...
- American Indians/Alaska Native = 15.1%
- Non-Hispanic blacks = 12.7%
- Hispanic ethnicity = 12.1%
- Asians = 8%
- Caucasians = 7.4%
.
Native Americans are 2.2 times more likely to have diabetes compared to caucasian.
Diabetes occurring in Native Americans
is almost exclusively type 2 diabetes
Frequency of Diabetes in Native Americans
Frequency of diabetes in Native Americans
It is not entirely clear why the frequency has increased among Native Americans during this century. Conjectures include ...
- genetic predisposition of non-insulin dependent diabetes mellitus (type 2)
- Modifiable factors such as ...
- Obesity
- Dietary composition
- Physical inactivity / sedentary lifestyle
- Hypertension
- Smoking
- Hyperlipidemia
- Futurelessness
- Stress
How Diabetes has Integrated into a Native Americans Worldview
Culture of Diabetes- Native Americans and Futurelessness
https://www.healthline.com/diabetesmine/ask-dmine-native-americans-diabetes-risk#3
Growing up in a Native American culture, individuals are exposed to a much higher prevalence of type 2 diabetes. Because of this it has become a part of their presumptions in their worldview for their own health future.
The Prevalence of Diabetes in Native American Culture
Inside Statistics
- There was a 65% increase in individuals aged 15-19 diagnosed with type 2 diabetes (Treatment and Care)
- 95% of diabetes diagnosed is type 2 (Treatment and Care)
- 30% of individuals are pre-diabetic (Treatment and Care)
http://www.diabetes.org/
A Worldview of "When I get diabetes"
When Not If
James W. Sire states "A worldview is the fundamental perspective from which one addresses every life issue" (Sire 24) and diabetes is a common issue among Native Americans. It has become an "inevitable issue" (UNNATURAL CAUSES) in the culture. Begging people to ask not if they get diabetes, but when will they get diabetes. Morphing diabetes into an inescapable disease instead of a preventable one from a sociocultural perspective.
Perspective
When addressing diabetes in Native American culture it is important to understand their perspective because of their worldview. As Paul and Elder state, "whenever we reason, we must do so within some point of view or frame of reference" (Paul and Elder 107). In order, to empathize with their situation a healthcare professional must take into account how diabetes has effected their lives and why it might not seem like a preventable disease.
Point of View
Talking Circles and Diabetes
Since the western culture of inactivity and high calorie meals gave rise to the increased prevalence of diabetes among Native Americans it has been speculated that turning back to a traditions may help. Talking circles have grown in popularity to provide an outlet for those diagnosed with diabetes and for those who are pre-diabetic.
Cultural Coping
http://brasdorindianvillagebandassociation.yolasite.com/mikmaq-culture-2.php
Goals of a Diabetic Talking Circle
Goals
- Sharing thoughts, frustrations, and feelings when dealing with the disease (Roberts)
- Leaders with diabetes can attend and represent strength (Roberts)
- Bringing the focus back to one's self care and how that relates to family care (Roberts)
- Learning that diabetes is not a death sentence and can be manged (Roberts)
- Can be used as an educational source (Roberts)
Stress
When living in poverty the stress that people are under this is not just a public health measure this is a way of life.
People are worried about the essentials of living ... food, clothing, shelter, surviving another winter.
Native American - Stress and Diabetes
Other Health Concerns
General Health
American Indian populations have higher rates of ...
- infant mortality
- cardiovascular disease
- alcoholism
- depression
- suicide
- obesity
Other Variables
When looking at measures of stress, different types of hormones like cortisol or epinephrine are considered. Those chemicals increase blood sugar too, so not only are people faced with diabetes and high blood sugar they are faced with stressful living environments in in the communities. In the families it’s those stressors that make the challenge of controlling diabetes that much more difficult.
Diabetes
Medical Care
Diabetic Care
There is a direct biochemical connection between the trauma that people face living within the culture of poverty and blood sugar control, and we must be cognizant to that when we are looking at trying to manage these types of diseases in impoverished communities.
Providing an welcoming, understanding, non-biased medical clinic with culturally sensitive and knowledgeable providers will assist with medical compliance.
Diabetes and Native Americans- Genes or Environment?
Diabetes Among Native Americans- Genes or Environment
Over the past 40 years the United States government has been researching the biological explanation for why the incidence of diabetes in Native Americans has skyrocketed in the past 100 years. More specifically, the Pima Indians of southern Arizona, having one of the highest rates of diabetes in the world.
Incidence
http://www.capradio.org/documentaries/Dealingwithdiabetes.html
Evidence that Points to Environmental Causes
Environmental Causes
- Incidences were significantly lower even rare before the damns were built in Arizona
- Dams were built in the 1920's and 1930's and by the 1970's some of the local tribes had the highest rates in the world.
- A significant genetic shift was not seen from the 1900's to the 1970's pointing to environmental factors
- Diet and processed foods also becoming more popular make a significant impact on the rise of diabetes.
Allocation of Resources
Resources
- Haven't prioritized the allocation of resources to suit the needs of the community
- We've allocated resources to reflect the needs of policy makers and the medical research community
- Millions of dollars are spent in genetic in Native Americans
- Yet at the same time $40,000.00 a year wont be spent on a P.E. teacher
Worldview
Summary / worldview
Growing up in a Native American culture, individuals are exposed to a much higher prevalence of type 2 diabetes. Because of this it has become a part of their presumptions in their worldview for their own health future. It is a worldview of when I get diabetes, not if I get diabetes.
Just because Native Americans are born into impoverished communities does not mean that they should have to choose a life of poor health.
That is essentially the circumstances that the communities face. What is seen in Native American communities is that early death in communities seems to facilitate more early death in the community. A worldview that can be prevented and changed with culturally appropriate available medical care.
Citations
Changing Numbers, Changing Needs. (1996). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK233089/
Diabetes among Native Americans, February 20, 2011. Retrieved from https://unnaturalcauses.org/video_clips_detail.php?res_id=72
National Diabetes Statistics Report, 2017. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Roberts, Shauna S. "Talking circles ease burden of diabetes for Native Americans." Diabetes Forecast, Oct. 2004, p. 23+. Gale Academic Onefile, https://link-gale-com.mchs.idm.oclc.org/apps/doc/A122257500/AONE?u=mercychs&sid=AONE&xid=5722295f. Accessed 8 Aug. 2019.
Sire, J. W. (2015). Naming the elephant: Worldview as a concept. Downers Grove, IL: IVP
Academic.
Treatment and Care for American Indians/Alaska Natives. April 1, 2014. American Diabetes Association. Retrieved from http://diabetes.org/living-with-diabetes/treatment-and-care/high-risk-populations/treatment-american-indians.html
“UNNATURAL CAUSES: About the Series . Video Clips: CALIFORNIA NEWSREEL.” UNNATURAL CAUSES About the Series . Video Clips CALIFORNIA NEWSREEL, NACCHO, unnaturalcauses.org/video_clips_detail.php?res_id=76.
Warne, D. 2008, July 8. Impact of Poverty and Stress on Diabetes among Native Americans. Retrieve from https://www.youtube.com/watch?v=_3CJKtC8aCc
Contributors
Creators
William Bake
Samantha Aguilar
Megan Conklin