Mashkikiwinini: Diabetes: The thirst for sugary drinks

by Dr. Arne Vainio
News From Indian Country

I recently went to a 2-day diabetes conference in Minneapolis. In our clinic we see many patients with diabetes and do lots of diabetes care. We have a diabetes team that really cares about our patients and keeps us up-to-date on new medicines and therapies.

Still, this was a valuable experience. In the day to day care of diabetes I see foot ulcers, infections, hypertension (high blood pressure), kidney and heart disease, diabetic retinopathy (eye damage due to diabetes) and high cholesterol. These are independent disease states, but diabetes is a common link to all of them.

Managing heart disease, kidney disease, or foot ulcers is a major undertaking and entire (or even multiple) visits get devoted to these complications of diabetes. Sometimes in the middle of the battle it’s easy to miss the big picture.

The big picture is diabetes itself.

Diabetes is a disease that has hit our people especially hard. The type of diabetes we see most is diabetes type 2. In this type, the pancreas is still able to produce insulin, but eventually can’t keep up with the level needed to keep blood sugars in the normal range. Native Americans seem to have a higher level of insulin resistance than other people for some reason. Obesity in itself also causes insulin resistance. Insulin resistance means that a higher level of insulin is needed to allow sugar to move into our cells.

Sugar is one of our body’s primary fuels and our digestive system can convert many foods into sugar, even if they don’t have actual sugar on or in them. If not enough insulin is present, or it isn’t working as well due to insulin resistance, sugar can’t get into our cells (muscle, brain, heart…).

Even if the blood sugar is high, the cells send a signal that more sugar is needed. As the blood sugar climbs, the kidneys try to get rid of sugar. Water follows the sugar and you have to urinate frequently. This makes you thirsty and you start to drink more liquids. Unfortunately, at this point the thirst is for sugary liquids and this worsens the spiral. Sound complicated? It is.

Pay attention, there will be a quiz at the end of this article.

When the blood sugar is too high over a long period, it starts to damage structures, and the blood vessels themselves take much of this abuse. This is when the heart, kidney, eye and other organ damage takes place.

Unfortunately, much of this doesn’t show up until lots of damage is already done. There isn’t any good way to undo this damage, only to try and stop it from getting worse. This is the reason we do screening for diabetes and try to get everyone to lose weight.

There are school programs to keep kids active and to eat better foods. The foods we grew up with (frybread, bacon grease, white rice, fried eggs, fried hamburger, macaroni and other high fat or sugary foods) are not helping. I grew up eating those foods and eating that way reminds me of my childhood. Lots of these foods come from generations of poverty and eating whatever we could get the cheapest.

My mom raised 7 kids by herself and we ate that way out of necessity. So did she when she was young. So did her parents when they were young. With all those brothers and sisters, whoever ate the fastest got the best food and the most of it.

That’s still a hard habit for me to break at age 49. One of my brothers had a hard time breaking this habit, also. He had a stroke when he was 46. He still can’t use his left arm and has a hard time walking. He was a welder and a mechanic, but can’t really do those things any more.

His diabetes was totally out of control when he had his stroke. More on this one in the future as it’s important to me.

Back to the conference. I already have a good understanding of diabetes, but new research is being done constantly, new studies are revealing things about how our bodies work all the time. We can put out huge amounts of insulin for a long time (years) before our blood sugars start to climb.

By the time diabetes is diagnosed, it may have been present for 5 years or more. This is a long time to overwork a pancreas. When it eventually gives out, lots of function has been lost. This is the reason we screen for diabetes whenever we get a chance.

The first screening test is a casual (random) blood sugar. This can be done at anytime. Blood sugars of less than 100 should have a repeat casual blood sugar in one year.

Any blood sugar of 100 or over warrants a 2 hour fasting glucose tolerance test. This means you come in fasting, nothing to eat or drink for 12 hours. The first of 3 blood draws is the fasting sugar. Then you drink a bottle of sticky sweet pop with exactly 75 grams of glucose (table sugar). Then the blood sugar is drawn at 1 hour and 2 hours afterward. There are 3 possible outcomes to this:

1) Diabetes: With a new diagnosis, diet and exercise may be enough to keep blood sugars normal. This is not always the case, sometimes medicines are started.

2) No diabetes: Remember, this test was done for an elevated blood sugar, so yearly screening is still recommended. Diet and exercise are very important here.

3) Pre-diabetes: This is increasingly common. This means without intervention, you can go on to develop diabetes. However, it can be prevented, but it requires lots of work and lifestyle changes.

On to the quiz I promised:

Question: How would I know the glucose tolerance test solution is sticky sweet?

Answer: My random glucose test was elevated at 107. I had to drink the solution and do the 2 hour glucose tolerance test. The test was normal, but I was still diagnosed with pre-diabetes. Now I’m in the Fond du Lac Diabetes Prevention Program as a participant, not an instructor. I have 16 weeks of classes and need to lose 7 percent of my total body weight, exercise regularly and change my eating habits. I’ll keep you posted on my progress.

Arne Vainio, M.D. is a Family Practice Physician at the Min-No-Aya-Win Human Services Clinic on the Fond du Lac Ojibwe Reservation in Northern Minnesota. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..