When Ketchikan dietitian Carey Guthrie visits a middle-school classroom to talk about nutrition, she can spot the students most likely to become diabetic.
"You can kind of tell because people who are at risk tend to have the bigger bellies, the obesity around middle, and then with a lot of the kids we see what's called acanthosis nigricans, the darkening of skin in the back of the neck," said Guthrie, diabetes coordinator for the Ketchikan Indian Community Tribal Health Clinic.
Guthrie is among the Alaska health-care providers watching for an expected rise in young people of type 2 diabetes, an ailment normally found in adults.
Nationwide studies have shown an increase in type 2 diabetes among children in recent years. An American Academy of Pediatrics report released this fall predicted far more cases, especially among Alaska Native and American Indian children.
Dr. Julien Naylor, director of the Anchorage-based Alaska Native Medical Center Diabetes Program, said she knows of about 50 Native children with diabetes. For the first time, a significant number have type 2.
"If we look at all diabetes overall in the juvenile population, it's less than 1 percent. But when you look at that very teeny-tiny number, you note that out of every three cases, one of them appears to be type 2 diabetes now," Naylor said.
The most common form of diabetes among children is type 1, in which the body does not produce insulin, which helps cells turn blood sugar into energy, said Kathy Capacci, a diabetes nurse educator with the SouthEast Alaska Regional Health Consortium in Juneau. In type 2 diabetes, most often found in middle-aged and older people, the body produces insulin but is not able to use it well.
Type 2 diabetes can lead to kidney failure, blindness, toe or foot amputations and other complications.
Obesity, poor diet and a lack of exercise are major contributing factors for type 2 diabetes, said Lani Hill, a nurse practitioner at the Ketchikan tribal clinic.
"Some of the kids are well beyond 150 percent of their ideal body weight. So with the decreased activity, which is a risk factor, and obesity itself, which causes insulin resistance, and poor diet, yes, I'm sure were going to be seeing more," Hill said.
Researchers said the disease's increasing presence in Alaska's Native population has to do with cultural change. The risk increases as people move from a traditional diet to processed food rich in sugar and fat. It increases as physically demanding subsistence hunting and fishing is replaced with a more sedentary life.
Capacci of the regional health consortium said she uses such traditions or their contemporary equivalents as prevention and treatment tools for her patients.
"I point out some of the good habits they're doing, maybe some different foods that they're eating that are very good. I certainly push Native, traditional foods. They're very healthy for people," Capacci said.
The American Academy of Pediatrics clinical report, released in October, strongly recommended a system of screening children, especially Alaska Natives and American Indians, for type 2 diabetes.
The Native medical center and the Ketchikan tribal clinic routinely screen kids. Many other health-care providers do not.
American Diabetes Association: www.diabetes.org/
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