Diabetes Self-Management Blog

Hope you have or had a good Thanksgiving. I thought this would be a good time to remember the people on the other side of Thanksgiving. But this blog entry isn’t an angry listing of the wrongs and abuses Native Americans have suffered (though you can read some examples here). It’s about self-esteem, self-love, and diabetes.

You’ve probably heard of the Pima Indians of Arizona. They have among the highest rates of Type 2 diabetes in the world. They are also among the most studied people in the world. In my opinion, most of these studies are wasted effort. Others disagree.

But one Pima study I did find valuable enough to include in my book, Diabetes: Sugar-coated Crisis. In this study, published in the journal Diabetes Medicine, 95 obese adults were split into two groups. “Pima Action” consisted of physical activity and nutrition interventions, typical diabetes stuff. “Pima Pride” met with tribal elders for activities emphasizing Pima history and culture.

The experimenters thought of Pride as a control group to the real intervention, Pima Action. They were shocked when, two years later, the members of the Pride group had better results in weight, waist size, diet, two-hour glucose tolerance, and systolic and diastolic blood pressure.

What does it mean?
How could these results have happened? Probably not by chance— the “p-values” of some results were as low as 0.007, meaning that the odds of that outcome happening randomly were less than 1 in 142. Pride clearly had an effect on people that Action did not.

Like most Native Americans, Pima have been victimized for generations, and years of powerlessness can make it very difficult for people to value themselves. The Pima have sky-high rates of suicide, drug and alcohol use, and domestic violence, but they also have high levels of cancer, heart disease, mental illness, and many other problems.

In the face of these conditions, an activity and nutrition program didn’t have much of a chance. People have to value themselves and believe in themselves to live a healthy life, especially in unhealthy environments. Feeling helpless, hopeless and worthless makes self-management seem too difficult and too much trouble.

It seems that learning about their tribe’s history and accomplishments raised the Pride group members’ self-esteem and self-confidence (or “self-efficacy”). They learned that they did have value, and they learned some of the reasons why things are so hard for them. They may have realized that it’s not their fault. They have to do the best they can with their situation, but they should not blame themselves for it.

These feelings translated into better behaviors and probably mind-body healing as well.

Applies to all of us
I think that this is an important finding for everyone to know. Few of us are living through an ongoing genocide. But all of us struggle with believing in and loving ourselves. Society has many ways of tearing down our self-confidence and self-esteem. And we need those qualities to live good lives.

The great Jewish philosopher Hannah Arendt wrote, “If we do not know our history, we believe it is our fate.” In other words, we blame ourselves for the way we are and the way our lives go, when most of it comes from our history, whether it’s social, genetic, or personal.

If we can learn to forgive ourselves and accept ourselves the way we are, we will have a much better chance of changing behaviors and much better quality of life.

What about you? Can you see ways that you blame yourself for things that were not your doing? Ways that your history has affected you in healthy or unhealthy ways? What have you done to improve your self-concept or love yourself more? Let us know with a comment.


  1. That was a good article, after I was diagnosed with diabetes I had to go through a similar process as the “Pride” group did to properly care for myself.

    Posted by dnewman |
  2. The problems of the Native Peoples are blamed on their failure to improve themselves. Ignoring all the hardships past & current, does not cure the deep wounds that exist in Native American societies. There needs to be a sort of communal healing ceremony that recognizes the pain & maybe then, can the healing begin & maybe there will be an appreciation of self & the good that exist in every individual.

    Posted by Maranon |
  3. That’s insightful, Maranon. I suggested such healing ceremonies to people I interviewed for my book. Most said it would be too painful, that people weren’t ready to face these profound traumas. I don’t see how you can heal them without talking about them, though. Especially when the traumas are still going on — many Natives suffer more trauma every day. And the larger society refuses to acknowledge that it even happens.Historical trauma

    Posted by David Spero RN |
  4. I can appreciate this blog. I am a diabetes educator in NY. And have learned that when people are under stress, and feel undervalued, unloved, the last thing they want to do is take care of themselves. Sometimes I have to direct people to the social worker first, to help them get the resources and help, to get back on their feet. recently I had an hispanic patient who was being beaten and abused when he rode his bike to work. This was done by a group of men who were also yelling racial/ethnic slurs at him. The patient was afraid to call the police because of his illegal status.
    We listenend and tried to get him the help he needs. There are many others like him.

    Posted by donna |
  5. David,

    I love knowing about Pima Pride.

    I have Slovak heritage. If you look at maps showing world rates of diabetes, you will notice that Slovakia has a very high diabetes prevalence rate.

    Some years ago, I researched my Slovak heritage (which was not taught to me by my moter). I learned Slovakia has been conquered and dominated by many other groups throughout its history. However, the Slovak people have kept the language and culture alive — even when these had to be taught in private because it was forbidden to speak Slovak in public. We are proud survivors!

    Around that time, I also learned of the “thrifty gene” hypothesis. Now, when I talk to other Slovak-Americans about our high rate of diabetes, I explain that we needed those genes to survive. Rather than be ashamed of our tendency to diabetes, we can celebrate the fact that we are survivors. And we can learn new ways of surviving — ways that involve eating differently, and being more active.


    Posted by Beth |
  6. Thank you for this article. I’m totally gunna use this for a powerpoint presentation!! THANKS a million snoop dawg!.

    Posted by Aaron James |
  7. excellent article and feedback.

    Thank you.

    Posted by jim snell |

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