Ka Wai Ola - Office of Hawaiian Affairs, Volume 16, Number 8, 1 August 1999 — Diagnosis : Diabetes [ARTICLE+ILLUSTRATION]

Diagnosis : Diabetes

Hawaiians among most at-risk populations

WHEN IT comes to diabetes, Hawaiians are among the most at-risk populations worldwide. Some 20 percent of Hawaiian adults ean expect to be diagnosed in their lifetime with Type 2 diabetes, often before 40, the commonly accepted age of onset. The proportion is reflected on the Office of Hawaiian Affairs board where two of nine trustees are diabetic. It is

exceeded only by the statistics on Arizona's Pima Indians, who suffer at a rate of 50 percent, the highest in the world, and on the people of Nauru, in the South Pacific, where the prevalence rate is 30 percent. In contrast, for the entire United States populahon, that rate is 6 percent. Why are Hawaiians so vulnerable? "That's the $64 million question," answered the University of Hawai'i's Dr.

Marjorie Mau, one of two Native Hawaiian endocrinologists, and a specialist in the disease as it affects Hawaiians. "Certainly genetics has a role. Diet is important, but if you look at the evidence, it's very mixed. There's a raging debate on what is the right diet, but we do know what the wrong one is. High fat and fast foods probably add to the problem. The tighter association is with physical exercise. If you're

sedentary, you're at greater risk." Diabetes is defined by high levels of glucose, a sugar in the blood that is one of the body's primary fuels for energy. Of the checks and balances that maintain glucose in a normal range, insulin, whieh lowers glucose, is the primary hormone. When the insulin process does not work right, diabetes is the result. According to Mau, of the two kinds

of diabetes, Type 1 appears in children due to destruction of their insulin-producing cells by an immune system malSee DIABETES on page 14

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Dr. Marjorie Mau, Hawaiian expert on diabetes, teaches her specialty at the Univerisity of Hawai'i School of Medicine.

PHOTO:PAULA DURBIN

DIABETES From page 12 function. "Hawai'i has one of the lowest rates in the nation of Type 1, whieh is thought of as a Caucasian disease," said Mau. "But when you talk Hawaiian, you are talking a heterogeneous mixture. So although the numbers are low, surprisingly there are quite a few Hawaiian children in there." The far more widespread Type 2 diabetes results from either insulin resistance, often occurring in overweight people, or from insufficient insulin secretion, whieh happens when the pancreas doesn't release enough of the hormone. "Hawaiians are frequently obese.

Superimpose McDonald's and the Dairy Queen on 60 channels of 24-hour television and that's their ticket for their major problem, insulin resistance." said Mau. "Asians have an insulin secretion problem, but what are Hawaiians? Asian mixed. So Hawaiians get a double whammy. " f ymptoms of Type 2 diabetes ean ® be excessive thirst, appetite or urination; weight loss; blurred 1 vision; and fatigue. But most W people are asymptomatic and eonsequently are not diagnosed for, on the average, seven years after the disease has hit, when its cruel complications are irreversible. "Diabetes impairs the immune system and circulation. It is

the leading cause of blindness, kidney failure and nontraumatic amputation," said Mau. "Because it is so silent for so long, many people diagnosed for the first time already have eye damage, life-threatening infections or eoma from severe and prolonged neglect. The sad thing is that we know we could have prevented the loss of sight, kidney function or sensation in the feet if we had just picked these people up earlier." A landmark National Institute of Health study whose findings were published in 1993 convinced physicians that tight control of blood sugars could reduce such damage by 30 to 60 percent. "Diet and exercise are the cornerstone for all therapy," said Mau. While the child victims of Type 1 dia-

betes require daily injections of insulin to live, adults ean take pills that improve glucose levels by attacking the under lying causes without adding more insulin to the system. "Part of the solution is realizing that Westernized medicine has a plaee," Mau concluded. "The real goal is perpetuating the race and if that means asking your doctor, family and friends for help, that is consistent with a traditional way of life. Hawaiians are up against some bad statistical odds, but there are great examples in the Hawaiian culture of overcoming the odds, such as the Hōkūle 'a. That's what Hawaiians must do with regard to their health." ■