[health]

		Death by Sugar: Diabetes and Pacific Islanders
		by Jake Fitisemanu Jr.

Gagao suka, tauale huka, mahaki suka, mate huka, ma’i suka – no matter how you say it, it still means the same thing: “sugar sickness.” And no, we’re not talking about that stomach ache you get from slurping panipopo sauce from the pan or eating too much puteni at family reunion. We’re talking about diabetes here – a disease that claims millions of victims every year, including an alarmingly disproportionate number of Pacific Islanders.

This disease has become such a major problem among Polynesian communities and families that we all know of someone close to us who is diabetic. But do we really understand the gravity of the situation? Do we, as islanders, really comprehend how much we are at risk of becoming diabetics? Let’s have a brief look what diabetes is, why islanders are at a greater risk, and what measures can help prevent and manage diabetes.

Diabetes is the result of insufficient production or abnormal processing of a hormone called insulin, which we need to maintain healthy levels of sugar in our blood. The carbohydrates and sugars we eat usually end up in the bloodstream as glucose and there are very serious health effects if insulin is not available to break this sugar down. These harmful effects – such as blindness, cardiovascular disease, kidney failure and nerve damage – drastically alter everyday life for people with serious or unmanaged cases of diabetes.

There are basically three types of diabetes. People with Type 1, or “juvenile onset diabetes,” require regular doses of insulin because their bodies do not produce it themselves. Most PI diabetics are Type 2 (or “adult onset diabetes”) because their bodies don’t produce enough insulin and/or don’t properly process insulin. Pregnant women can have gestational diabetes, often a temporary condition, but women who have had gestational diabetes are predisposed for type 2 diabetes as well.

I work with medical lab specialist Salesi Kupu in a Salt Lake clinic where many islanders don’t realize they are diabetic until the disease reaches very serious, advanced stages. We both observe that many Polys are uncomfortable with modern hospital settings, but early detection by a doctor could end up saving money, time, pain, and even your life. People developing diabetes often feel abnormally hungry and thirsty, feel more tired than usual, and may experience blurry vision, weight loss and wounds that seem to heal slowly. If diabetes is not identified early, this increases the chances of life-long dialysis treatments, expensive medical therapies, amputations, permanent blindness and eventually death.

Statistically, Polynesians lead many ethnic groups in terms of diabetes prevalence rates. Sunia Foliaki and Neil Pearce (2003) published data indicating that Pacific diabetics experience more sickness and complications “than white people with diabetes.” They concluded that genetics play a major role in PI diabetes cases, but so do “risk factors such as obesity, unhealthy diets, and physical inactivity.” Many physicians support this data, such as Dr. Satupaitea Viali who has observed that islanders “don’t exercise as much as we’ve done it before,” and that inactivity and heavy eating greatly contribute to the development of diabetes.

Speaking of eating, it’s a well-known fact that Polynesians have an intimate love affair with sweets, from traditional dishes like faikakai, otai and kulolo to Western-inspired fare like custard pie, puligi and ice cream. But we shouldn’t only be concerned with sweets since sugars also come from carbohydrates, which many Polynesian families consume in unhealthy amounts. Dr. Papali’i Viopapa Annandale affirms that traditional Polynesian hospitality and food customs put PI’s at a higher risk of contracting diabetes than other ethnic groups. “It’s not easy,” she says, “because we have a culture that encourages lots and lots of food, and lots of the wrong types of food.” So if you really “are what you eat,” then that explains why we’re such sweet people, right? Hmm, or maybe that’s why we’re such fat people.

Obesity is a plague that is currently reducing the quality of life and shortening life expectancy for thousands of Polys. PI’s who live in urban American communities are significantly more massive on average than those living in rural, home-island villages. Polynesian-Americans also have higher rates and risks of diabetes, making the obesity-diabetes correlation very clear. Even worse, many experts believe that these statistics are inaccurate because for every islander professionally diagnosed with diabetes there is another who doesn’t know they have the disease.

According to the NZ Ministry of Health, the PI incident diabetes rates are three times higher than pakeha, and islanders are “five times more likely to die” from diabetes, with an average life expectancy reduction of 12 years. So what can be done? Families and communities need to be aware of the seriousness of this disease and how it hurts us and our loved ones financially, emotionally, psychologically and physically. We should understand that our cultural and genetic predispositions put us at greater risks for diabetes and therefore require greater effort to prevent and treat diabetes. I laughed at the following quote (because I love fast food) but I realize it speaks to all PI’s about the unique relationship that genetics, diet and lifestyle have within Pacific ethno-cultural contexts, especially in regards to diabetes:
“The reality is that a Big Mac hurts Maori more than it hurts Caucasians”
Professor Chris Cunningham, Massey’s Research Centre for Maori Health

Jacob Fitisemanu is a certified medical assistant and recently graduated from Westminster College with a Bachelor of Science degree in Social Science and will be attending medical school this fall.