Canku Ota
	(Many Paths)
	An Online Newsletter Celebrating Native America
	November 17, 2001 - Issue 49
	Cherokees Tackle Diabetes with Education
	by Betty Smith, Tahlequah Press Staff Writer November 02, 2001

A stickball game a day keeps the diabetes away-- or at least helps. Like their Native American counterparts across the country, young Cherokees are in jeopardy of becoming diabetic as they grow older. Diabetes is a silent epidemic among the Indian population, frequently developing long before its presence is detected. Working from within, it eventually can result in blindness, kidney failure, and amputations. Cherokee Nation officials hope to cut down on the growth of diabetes among today's young tribal members through encouraging proper nutrition and physical exercise. "We're all about prevention and teaching," said Patricia Hawk, a registered nurse and director of community health nurses at the Cherokee Nation. According to statistics from the National Diabetes Information Clearinghouse, American Indians are nearly three times more likely to become diabetic as non-Hispanic whites. The percentage of diabetics among children is low, but the amount of adult-onset or Type 2 diabetes increases with age. Diabetes was extremely rare in children a decade ago. Today, one-third of all children under 18 diagnosed with diabetes have Type 2 diabetes. And the percentage of young people who are overweight has more than doubled. The most recent survey showed that among Americans 45 through 64, 17.8 percent of Native American men and 21.7 percent of Native American women were diabetic. That compares to 5.4 percent of white men and 5.1 percent of white women. Over age 65, the percentages were 19.8 percent of men and 24.6 percent of women in the native population, compared to 1.8 percent of white men and 11.2 percent of white women. Risk factors include a genetic predisposition to diabetes, and medical and lifestyle issues. Among these are obesity and physical inactivity. Some of these have come about because of lifestyle changes among Cherokees and Americans in general, Hawk said. Numerous things have contributed to this. Families are busier, either because both parents work, or because more children live in single-parent families. People eat out more and turn to high-fat, high-sugar fast food. And children tend to glue themselves to the television, video game or computer screen after school and during the evening. Parents can't entirely be blamed for this, Hawk said. "Many mothers work late, grab something at fast food places," she said. "If the kids are going home and the parents aren't present, they don't want them to be outside because it's so dangerous." Throughout the Cherokee Nation, nurses are partnering with schools to screen students for detection of early diabetes, or possible future diabetes. "We were reading articles that more and more lower grades and age levels were coming up with Type 2 diabetes," said Caroline Holbird, a registered nurse and public health nurse. "We decided that we would go ahead and see if we could start some screening in the schools." They started last year at Sequoyah High School. Students in all grades were screened with a height and weight measurement, blood pressure and blood sugar checks, and visual screening of the student's neck. The latter may reveal acanthosis nigricans, a change in skin. The affected areas - including the neck, underarm, and other skin folds - can look velvety and darkened, and may feel thick and rough. It is common among teens and adults, and often found in Indians. People with these skin changes are at risk for developing diabetes at a young age. Screening of the first 528 students in fifth grade and above at Sequoyah, Briggs and Lowrey revealed 195 who were overweight according to the chart, 88 with acanthosis nigricans, and 13 who tested with high blood sugar. At the grade schools, only the students with parental permission received the finger-stick blood sugar tests. "We tell the students this [agranthosis nigracans] does not mean that you have diabetes at this time. This is just an indication," Holbird said. The screening program recently was held at Keys and Tenkiller schools. "We had a really good response at Keys with parents giving permission [for the finger stick]," Holbird said. The screening also includes education about what diabetes is. "If they're overweight, we talk to them about it," Holbird said. "We tell them you need to start thinking now. It's not just for today, it's for a lifetime." Many of the youngsters participate in sports while they are in school, but after graduation they become more sedentary. Hawk said the Cherokee Nation has received a grant in conjunction with the University of Oklahoma. It will promote physical activity among young people. Registered dietitians also will work with the screening program to educate young people about better food choices. Ann Cherry, home and community education director for the Oklahoma State University Extension Service in Cherokee County, also is working with the program to promote healthy eating habits. Many people who are apparently healthy don't know they are diabetic or at risk for diabetes until they come into contact with medical professionals for another reason - be it an accident, other disease, or screening - Holbird said. If young people change their diet and exercise routines, they can cope with the disease before it progresses. For example, one study showed 49 percent of Indians with the disease had diabetic retinopathy, which can lead to blindness. And diabetic Cherokees have an especially high rate of kidney disease. If people find out about their diabetes younger, "many of the complications are not bad yet but they're getting started," Holbird said.

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