Diabetes is third-leading killer of Cherokee Nation citizens
In this 2013 photo, podiatrist Dr. Melissa Adams wraps the right foot of Cherokee Nation citizen Patricia Dry at W.W. Hastings Hospital in Tahlequah as licensed practitioner nurse Linda Kerr observes. Dry was suffering from a foot ulcer due caused by diabetes. ARCHIVE
According to data gathered over nearly two decades, American Indians are still at highest risk to develop diabetes, but access to health care has reduced incidence of diabetes related kidney failure. COURTESY
TAHLEQUAH – When it comes to health risks in the Cherokee Nation, among the most serious is diabetes, particularly the type 2 variety that typically develops later in life.
It is a condition seen frequently at W.W. Hastings Hospital and the CN health system, and it can be insidious – showing few or no symptoms for many years.
“The Native American population seems to be more at risk,” Dr. Douglas Nolan, director of the CN diabetes program, said. “The Cherokee Nation has put a lot of effort into prevention and treatment of diabetes for the Cherokee people. It is a priority. Diabetes can result in increased incidence of heart and kidney disease, and peripheral artery disease which can result in amputations.”
Diabetes is the third-leading cause of death in the CN behind cardiovascular disease and cancer, and ahead of lower respiratory disease. Deaths of CN citizens due to diabetes numbered 559 during the years of 2005-14.
Risk factors for type 2 diabetes include ethnicity – which applies to American Indians – family history, excess weight or obesity, high cholesterol, high blood pressure and being over age 45.
Early symptoms sometimes aren’t noticed, but those with risk factors need to be aware of increased thirst and hunger, frequent urination, lethargy, blurry vision, slow healing of wounds or cuts, and tingling, numbness or pain in the hands and feet.
“Those are the classic symptoms,” Nolan said. “If a patient has signs, we check the blood sugar or A1C. We are looking for a number 6.5 or greater. If that happens twice, then you have diabetes. If you have the symptoms, you want to see a doctor and get tested. A lot of people have diabetes and don’t know it.”
Type 2 diabetes is a resistance to insulin, unlike type 1 diabetes which is the pancreas failing to produce insulin, or producing insufficient amounts. There is also the condition known as “prediabetes.” Blood sugar is not normal, but not so high as to qualify as diabetes.
“That is a point where we have programs with highly trained people who work with patients on diet and exercise,” Nolan said. “We can delay or prevent the onset.”
Also unlike type 1 diabetes, type 2 is often curable. Weight loss can reduce the effects, or eliminate the condition.
“Some people take say ‘I need to lose 100 pounds,’” Nolan said. “It doesn’t have to be all or nothing. A target of seven percent weight loss will make a difference. That means losing 14 pounds if you weigh 200, or 21 pounds if you weigh 300. A seven percent loss can make a large impact on health.”
Dr. David Gahn, medical director for CN Public Health, said gathering data on Native Americans with diabetes can be problematic.
“We do care for people who don’t self-identify as Native American,” Gahn said. “They have a CDIB but don’t identify. Then we have younger people who identify as Cherokee or Choctaw but not as Native American. So when we look at the (diabetes) rates in northeast Oklahoma, which is most of the Cherokee Nation, it’s about 19 percent, plus or minus four percent.”
Gahn said the CN partners with the Indian Health Service to offer the Special Diabetes Program for Indians, which focuses on prevention of complications, and even curing people of the condition.
There is some debate about whether a “cured” patient is actually a person with “well controlled” diabetes. But whatever the case, lifestyle changes can greatly impact the effects of type 2, and blood sugar levels can return to normal.
Gahn repeated the three biggest causes of morbidity and mortality, and they apply to diabetes as well: obesity, poor nutrition and smoking.
“When we’re in communities trying to promote healthy activities, these also prevent cancer and heart disease,” he said. “That’s why we always talk about that. I sometimes meet people who are happy because they’re 50 years old and don’t have diabetes. They’re accustomed to diabetes being prevalent in their families, and it’s like they are waiting for it to happen to them – that it’s inevitable. But it’s not.”
Nolan said patients with diabetes should keep some measures in mind:
1. Visit the doctor every 3 to 6 months.
2. Get regular A1C tests.
3. Get an annual eye exam, which can help detect any onset or progression of diabetic retinopathy, and provide information for possible interventions.
4. Get an annual foot exam. It can detect symptoms of peripheral artery disease, and help determine whether diabetic shoes are appropriate to reduce callouses or diabetic ulcers. Nerve damage, or peripheral neuropathy, can also be detected.
5. An annual microalbumin test of the urine can detect a protein that is often present with in the early stages of kidney damage.
6. Take prescribed medications. Metformin is usually the first drug prescribed to those with diabetes. Others may be added for additional treatment or to address attendant symptoms or conditions. Nolan said blood pressure medications are frequently prescribed because they also protect kidney function.
Nolan said recent administrative efforts have helped bring an expansion to Hastings and a medical school to Tahlequah, all helping to enhance the health care for Cherokee citizens.
“Diabetes is an example of a heavy disease burden for us,” Nolan said. “We have the room now to provide quality care to many more patients. The Cherokee Nation has some excellent dietitians and educators for those with diabetes. The more you know, the better you can take care of yourself, and realistically, this becomes teamwork between you and your physicians. You can better understand your condition, and better understand the treatment.”