Native Americans and Diabetes, Research Paper Example

Introduction

Diabetes is a very serious disease caused by the inability by the body to respond to or to produce insulin. Insulin is a hormone that facilitates the entry of blood sugar (glucose) to get into body cells in order to be used up for generation of energy. Diabetes is categorized into two types: type 1 and type 2. Type 2 occurs during childhood or early adolescence while type 2 occurs in people who are above age 45. It has no cure. Among Native Americans, prevalence of type 2 diabetes is 12.2 for people who are above 19 years of age. In Arizona, this is where the tribe with the highest diabetes prevalence rates in the world is found; around 50% of people aged between 30 and 45 suffer from diabetes.

Today, diabetes is an epidemic among Native Americans. In most Native American populations, diabetes and complications related to it are a major cause of deaths. It is also a matter of concern that type 2 diabetes, which is an adult-onset diabetes, is being increasingly discovered among Native American youth.

Pathology of Diabetes 2 among Native Americans

In a report released in 2000 by the Federal Centers for Disease Control and Prevention, a 1990-1997 study indicated that diabetes diagnoses among Alaskan Natives and Native Americans had increased by nearly 30%. During this time, there were more women suffering from the disease than men. Alaska recorded the highest increase in the prevalence rate (76%) in the early 1990’s. The lowest prevalence rate was recorded in the Northern regions of the U.S, n which case it rose by 16%.

The National Institute for Diabetes and Digestive Kidney Diseases reports that according to “thrifty gene” theory, Hispanic-Americans, African-Americans, Native Americans and Asian-Americans benefited from a gene that they inherited from their ancestors, which enabled them to make use of food more efficiently in times of “feast and famine “cycles. Knowler notes that today, few cycles exist and for this reason, certain populations become susceptible to obesity, thereby increasing the risk of developing type 2 diabetes (151).

Ramakrishna & Jailkhani notes the main complications that Native Americans are at high risk of encountering as a result of high diabetes prevalence rate include amputations, blindness and kidney failure (5). Between 10 and 21% of all people who suffer from diabetes also develop kidney disease. Among Native Americans, the prevalence rate of end stage diabetic renal disease is 6 times higher compared to that of other Americans.

When it comes to the matter of non-traumatic amputations of the lower limb, diabetes is the most frequent causative factor. Among diabetes sufferers, the risk of encountering a leg amputation is up to 40 times higher than for people without diabetes. Every year, 54,000 people in the U.S lose a leg or foot to diabetes. Among Native Americans, amputation rates are up 4 times higher compared to that of the general population.

Diabetic retinopathy refers to all abnormalities that are caused by diabetes, whereby small blood vessels in the retina are weakened among diabetic people. Acton indicates that among Pima Indians, diabetic retinopathy prevalence rate is 18% (1451). Among Oklahoma Indians, the prevalence rate of this problem is 24.4%.

Diagnosis

Screening is important for people who are suspected to be suffering from type 2 diabetes. It facilitates the identification of asymptomatic individuals whose risk of having diabetes or pre-diabetes is very high. Screening for purposes of detecting pre-diabetes and diabetes should be done in individuals who are over 45 years, particularly those with a BMI that is greater than 25 kg/m2.

Testing ought to be considered in younger people if one is overweight, meaning he has (BMI > 25 kg/m2); if one is habitually physically inactive, has a first-degree relative who suffers from diabetes, belongs to a high-risk ethnic population such as Native American or has delivered a baby weighing more than 9 lbs. Native Americans who have in the past been diagnosed with GDM (Gestational Diabetes Mellitus) should also go for a type 2 diabetes diagnosis test since they are a high risk group.

Others factors that should propel one into seeking diagnosis tests for type e 2 diabetes include hypersensitivity level that is higher than140/90 mmHg, cholesterol level that is above 35 mg/dl (0.90 mmol/l, Polycystic Ovary Syndrome, previous clinical conditions that relate to insulin resistance, history of vascular disease as well as medications that cause hyperglycemia such as steroids.

Healthcare providers who are responsible for assessing type 2 diagnosis among Native Americans should follow the provisions indicated in Indian Health Service Standards of Care for Adults with Type 2 Diabetes (2006). For purposes of cost-effectiveness and simplicity, non-pregnant adults and children should be taken through the diagnosis process using the Fasting Plasma Glucose Test (FPG).

According to the American Diabetes Association, values between 100 and 125 mg/dl are considered pre-diabetes or impaired fasting glucose (102). FPG values about 100mg/dl are considered to be normal. Individuals whose glucose level is between 144 and 199mg/dl after a glucose tolerance test that lasts for two hours are considered to be suffering from pre-diabetes or Impaired Glucose Tolerance even though these people fail to meet the criteria required for diagnosed diabetes.

Native Americans suffering from impaired glucose tolerance can reduce the risk of suffering from type 2 diabetes mainly through Metformin, diet and exercise-related interventions. Native Americans with psychiatric illness face a greater risk of suffering from obesity and type 2 diabetes compared to the rest of the Native population. In ideal circumstances, Native Americans who suffer from diabetes need to have the disease put under control through monitoring by health care professionals who are knowledgeable in diabetes diagnosis, treatment, care and prevention.

Nutrition for type 2 diabetics

According to Young, one of the core aspects of patient education among diabetes sufferers is nutrition (401). Sufferers need to be educated on the right nutrition in order to put their glucose level under check. Every Native American, by virtue of belonging to a high-risk ethnic group, needs to know about proper nutritional behaviors that greatly reduce the likelihood of the occurrence of type 2 diabetes.

There is a complex relationship between type 2 diabetes and carbohydrates. While taking foods rich in carbohydrates drastically increases the need for more insulin in order for blood sugar to be maintained at normal levels, Bennett observes that diets that are high in carbohydrates cannot necessarily be said to be a risk factor for this disease (126). Researchers have discovered that diets that are very high in sugar are likely to worsen tolerance of glucose in non-diabetic humans. However, the amount of sugar that was used by these researchers was much larger in proportion to those that are often found in human diets in typical cases.

The main factor to consider when choosing carbohydratesis the time it takes for them to be absorbed into the body’s system. This time is assessed through the use of the glycaemic index. Many starchy foods such as processed cereals, rice, potatoes and bread have a glycaemic index similar to that of sucrose (table sugar). Prolonged use of foods with a high glycaemic index is a risk factor for type diabetes. Conversely, foods with low glycaemic indexes such as oats, fruits, peas, beans are ideal for reducing the risk factors for the disease. Although such foods have high carbohydrate content, they have high levels of soluble fibre, whose health-promoting effects overpower the risk factors.

Until very recently, health professionals have been recommending sugar restriction among people with diabetes. Currently, the guidelines provided by the American Diabetic Association do not prohibit the continued use of sugar in moderate proportions as long as triglycerides, glucose and cholesterol levels are maintained within normal standards.

Rx and treatment

According to Ritenbaugh, the first goal in type 2 diabetes intervention is to eliminate all symptoms and then stabilize levels of blood glucose (311). The main ongoing goal is prevention of long-term complications as well as to try as much as possible to prolong life. The primary treatment method for type 2 diabetes is diet and exercise. Patients need to learn diet management skills. Therefore, they require education on how to go about this arduous task. This education is very important in order to avoid occurrence of complications.

Diet management according to Benyshek entails knowledge of what to eat and when. It also entails knowing to monitor glucose levels (27). Other treatment issues that one needs education on include how to take medications as indicated, how to identify and treat instances of high and low blood sugar, how to go about the task of handling sick days, where to seek diabetes medications as well as store them. These skills may take a few months to learn.

Once the patient’s condition has become stable, he should continue educating himself about how to live with the disease as well as how to manage the long-term complications that the disease creates. Self testing entails checking the glucose content that is in a drop of blood. Regular testing is a good indicator of how successful your diet, medication and exercise efforts are in the task of controlling type 2 diabetes.

Among Native Americans, self testing is an important reference point for regulation of medications, diets and physical activity. Health care providers also rely on this information for purposes of intervening before serious, long-term complications occur.

For purposes of diet and weight control, a diet patient may need the professional assistance of a nutritionist. The help given by the professional goes a long way in merging your personal tastes and preferences with the dietary needs that are ideal for your type 2 diabetes condition. Weight management is so important that some people who suffer from the disease may stop medications after managing to lose weight, even though the diabetic condition is still present.

Conclusion

In conclusion, Native Americans have a high risk of getting diabetes, especially the type 2 variety, which conventionally affects people who are above the age of 45. Every Native American needs to ensure that he undergoes regular diabetes screening. Diabetes sufferer need to consult medical professionals who specialize in diabetes for consultation. The primary interventions and medications for type 2 diabetes involve diet, exercise and weight management. Patient education is critical for Native Americans who suffer from this disease as it helps them live with it.

Works cited

Acton, Kelly. “Trends in Diabetes Prevalence among American Indian and Alaska Native Children, Adolescents, and Young Adults” American Journal of Public Health, 92.9 (2002): 1485-1490.

American Diabetes Association. (2007). “Standards of medical care in diabetes-2007.” Diabetes Care, 30(Supplement 1), 4-103.

Bennett, Peter. “Diabetes Mellitus in American (Pima) Indians” The Lancet, 298.7716 (2003): 125-128.

Benyshek, David . “A Reconsideration of the Origins of the Type 2 Diabetes Epidemic among Native Americans and the Implications for Intervention Policy” Med Anthropol. 20.1 (2001): 25-64.

Knowler, William. “Diabetes Incidence in Pima Indians: Contributions of Obesity and Parental Diabetes” American Journal of Epidemiology 113.2 (1981): 144-156.

Ramakrishna, Vadde. & Jailkhani, Rama. “Evaluation of oxidative stress in Insulin Dependent Diabetes Mellitus (IDDM) patients”. Diagnostic Pathology, 2.22 (2007): 1-6.

Ritenbaugh, Cheryl. “A Lifestyle Intervention Improves Plasma Insulin Levels among Native American High School Youth.” Preventive Medicine, 36.3 (2003): 309-319.

Young, Kue. “Diabetes Mellitus among Native Americans in Canada and the United States: An Epidemiological Review” American Journal of Human Biology, 5.4, (2005) 399 – 413.