Hey, All -- Got questions about life with diabetes? Welcome to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico.

Today, Wil is fielding a question about diabetes risk when it comes to minority populations -- specifically, Native Americans. Having worked in a rural New Mexico clinic where a good amount of the patient population had Native American roots, Wil has a particular expertise here. Read on for his insights...

{Have diabetes questions of your own? Email us at AskDMine@diabetesmine.com}

 

Cindy, sugar-normal from New Mexico, writes: Surprise! I just got my Ancestry DNA report back, and it turns out I’m nearly one-third Native American. I had no clue! No one in the family ever mentioned it. Who knows, maybe I was left as a papoose on the door step, but anyways, I’ve read how terrible diabetes can be for NA’s and I’m wondering… how much should I worry? What can I do? No offense, Wil, but I’m not too interested in joining your tribe!

 

Wil@Ask D’Mine answers: As one of the Media Chiefs for the Pasonsweda’ Diahbeetes Nation, I can assure you that we never take offense when people don’t want to join us. But your loss, you should see our casino! 

Just kidding. Actually, I wish we PWDs could get tribal status and open a casino, the profits would help defray the crazy-high cost of insulin for all our members!

Now, down to business. That DNA stuff is full of surprises. I have a French name, but apparently that’s all that’s left of that blood line: Less than 1% of my DNA comes from mainland Europe. Another buddy of mine grew up in a German-speaking family with German parents and she’s mainly British! From a family (and world) history perspective, these consumer DNA kits are fascinating stuff, but I personally hadn’t given much thought to the health consequences until you wrote. (Although of course the 23 and Me folks offer that controversial gene-analyzing service.)

You’re correct that Native Americans are disproportionally impacted by the Big D. How disproportionally? Well, the Health and Human Services’ Office of Minority Health lumps all American Indians and Alaska Natives together in their data, and no, I have no idea why. But they show that while 6.6% of the Lone Ranger’s peeps have been diagnosed with diabetes, Tonto’s peeps are doing much worse: The percentage of American Indians and Alaska Natives diagnosed with diabetes is a whopping 17.5%. If you crunch the math, and I didn’t—Human Services did it for me—that means that folks with Native blood are 2.4 times more likely than white folks to get diabetes. Apparently, their outcomes are worse, too.

So that’s pretty depressing. 

Does this mean that you’ve been given the genetic equivalent of a puppy with rabies as a pet? On the surface it would appear so, but there’s more to the story than meets the eye, because Native Americans haven’t always had a diabetes problem. In fact, prior to World War II, diabetes was rare among Natives. Then it took off. So what’s up with that?

Well, there’s been much research into the change, and in the end most experts believe that it comes down to changes in diet and activity amongst the Native peoples. 

Consider this: Prior to the 1940s, instead of diabetes, malnutrition was the biggest heath threat for Native Americans. This was reversed with various food aid programs that “Americanized” the Native diet, combined with social changes that in many tribes resulted in the collapse of Native culture and ways of life. One (politically incorrect) researcher in the 1970s said that the new Native lifestyle was waiting for “the arrival of welfare checks and the distribution of government commodities” rather the traditional active farming and hunting lifestyles of the past.

Some cultural bias might be showing there, but his quote gets the point across. If your life becomes sitting on your bum waiting for boxed and canned high-fat, high-carb food to show up, your health might not be the best. But how would that trigger such epic diabetes rates? Huge numbers of Americans eat like crap and sit on their bums, so why do the Natives have higher diabetes rates? 

That’s where the whole DNA thing comes in. It seems that you Natives drew a bad hand in the game of DNA, because something lurking in the DNA you’ve inherited carries a greater likelihood for diabetes, given the right triggers.

What are those triggers? 

In addition to the diet and activity issue, the Office of Minority Health singles out the following diabetes triggers: Obesity, hypertension, and cigarette smoking. Actually, come to think of it, those are the same triggers that can light the fires of diabetes in other blood lines as well. But two things are at play for Natives: Not only do Native genes seem to make them more susceptible to diabetes in the presence of triggers, but Natives have high rates of all those triggers in the first place.

Working backwards using Federal data, compared to us white folks, Natives are 20% more likely to be cigarette smokers, are 30% more likely to have high blood pressure, and are 50% more likely to be obese.

Is it any wonder they have the worst diabetes rates in the world? 

But what about you? Now that you are an unofficial part of the 4.5 million American Indians and Alaskan Natives in the U.S. (it sounds like quite a War Party, but it’s actually only one-and-a-half percent of the population), what’s your risk?

I’d hazard a guess that if you got fat and smoked cigarettes, which will raise your blood pressure, you’ll have no trouble participating in an unwanted Native tradition along with 17.5% of your genetic kin. But the fact that diabetes was a non-issue for Natives prior to the 1940s also tells me it can be a non-issue for you, too.

Keep active. Keep your weight down. Eat right. Don’t smoke a peace pipe (don’t flame me -- just trying to be creative with the theme here). Your newly discovered Native blood need not be a risk. Instead, it can be a powerful incentive, an extra motivation to stay healthy.

And you know what? That’s actually a good prescription for a healthy life for anyone: whether their skin is red, white, yellow, black, or brown.

 

“This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.”