Portland-area Native Americans take on a diabetes epidemic

In a North Portland health clinic on a dreary Saturday, Michael Teeple  does his part in the war against the diabetes epidemic rocking Indian Country. 

Teeple, 60, a member of the Ojibwe tribe and diabetic for five years, sees a series of experts at the daylong clinic. Already he's learned his blood sugar and pressure are high. Now he takes his turn with the podiatrist. Dr. Chris Seuferling clips Teeple's toe nails, thick and distorted from a fungus nurtured by diabetes. 

Teeple knows the disease can constrict blood flow, which can damage the veins and nerves in his legs and feet -- and lead to ulcers, gangrene, amputation. Blood vessels in the back of his eye could balloon, close off, scar the retina and cause blindness. Thickened and blocked vessels also could destroy his kidneys, and trigger a heart attack or stroke. 

"Michael, I expect, will keep his feet for the rest of his life," says Seuferling. "The patients coming in here are not the ones I'm worried about." 

The doctor is part of a diabetes care team assembled one a month by the Native American Rehabilitation Association of the Northwest, Inc., or NARA, to help the Indian Health Service take its attack on diabetes to the city. 

Native Americans have the highest diabetes rate among all racial and ethnic groups in America and offer a preview of where the rest of the country is headed. They also have found ways to keep the disease at bay. 

"The one with the biggest problem has to solve the problem," says Sharon Stanphill, director for the Cow Creek tribal health center in Roseburg. "Indian Country knows diabetes. We know what to do." 

Nationally, one in six Natives have diabetes, more than double that of white Americans. Nearly a third have pre-diabetes. Natives die at three times the rate of the general population from the disease, which can cut a life short by 15 years. Diabetes also steers tribes into a larger share of other health problems. 

It is also expensive. Diabetics must daily monitor their blood sugar and most inject insulin. Managing the disease averages $13,240 a year, compared to $2,560 in medical care for a person without it. 

Signs of improvement are scarce. The most prevalent form of the disease, Type 2 diabetes, usually strikes adults, though it is emerging earlier, especially among minority youth. Type 2 diabetes and pre-diabetes has spread to nearly one in four U.S. teenagers. Equally troubling, the disease progresses faster in youth and is harder to treat. 

In the metro area, the epidemic is less apparent, in part because urban Indians like Teeple are less visible, geographically scattered as a small, diverse minority. 

And diabetes sneaks up. So Teeple eats a healthy, low-sugar diet, walks regularly, keeps his weight under control and checks in with Ruth Anne McGovern, a family nurse practitioner and diabetes educator at the NARA clinic. 

Today, McGovern says a special camera to examine Teeple's retina did not get useful photos because his pupils are too small. He will need to go to another clinic and have his eyes dilated for an exam by a specialist. He has no health insurance. 

McGovern tells him he qualifies for a free exam at the Chemawa Indian School in Salem or at the Grande Ronde Health and Wellness Center east of Salem. His third option is an eye clinic in Portland, which could work out a payment plan. 

With no car, Teeple chooses the local clinic. 

Diabetic dining 

One morning two months later, Teeple finishes an hour of tai chi and then joins 21 elders upstairs for lunch at NAYA, the Native American Youth & Family Center in Northeast Portland. They often choose foods from the old days -- fish, game, berries, nuts. Teeple loads his plate with rice, salad and buffalo. 

In addition to him, three in the group have diabetes, and three are on the cusp. 

One is Randy Avart  of Vancouver, a Nez Perce retired from the U.S Forest Service. He learned of his diabetes18 years ago. His mother also had it, as did her mother. At 63, he takes insulin injections twice daily along with drugs to lower his blood pressure, cholesterol and blood sugar. 

Also at the table, Mary Renville, a Sisseton Wahpeton Oyate, has been diabetic since her late 40s.

"It was a total shock," says the Portland woman, 65. "You feel as healthy as a horse." 

The disease runs in her family: two sisters, her mother and brother. One sister died at 43 of kidney failure from diabetes. Her mom died at 58 of heart problems related to it. 

Down the hall works Candida King Bird, 38, pregnant and diabetic, whose 85-year-old grandmother in Salem will soon have her second leg amputated because of the disease. 

A century ago it would have been hard to find a Native American with diabetes. Today, mostly because of poor diets, alcohol and obesity, they are everywhere. The epidemic is most visible on certain reservations, such as Gila River Pima-Maricopa in Arizona, where half the adults have diabetes, among the highest rates in the world.