Diabetes Self-Management Blog

I was blessed to be invited to the Alaska Native Diabetes Conference last week. Met so many beautiful people; learned valuable things. Folks come from all over Alaska for the three-day conference at The Hotel Captain Cook, Anchorage’s finest.

Friday, I had lunch with Chief Paul Williams, who lives in Beaver, somewhere in the far north near the Yukon River. He is 75, looks great though living with diabetes, and he is committed to helping the suffering youth of his community. There is drug use and frequent suicides among young people there.

Chief Williams has opened a youth camp to teach kids the old wisdom and skills and help them get on track. He is star of a film called Yukon Johnny, directed by a nurse named Tim Langdon. (You can see some of it on YouTube here. Langdon had been a Southern California surfer but moved to northern Alaska many years ago and is learning subsistence ways.

Even the hotel staff was inspiring. Wednesday night I had a waitress named Shirley who is 70 years old and working for the fun of it. What a positive spirit! She turned out to be interested in diabetes and bought one of my books and gave me a hug.

One evening I went out for dinner with a crew from a clinic in Kenai. A really fun group, but it was hard to get through all the snow on my scooter. (It snowed every day.) They took turns pushing me through the snow.

There’s a lot of good food in Anchorage. The hotel had four good restaurants in it, and I was on expense account, so I really enjoyed the eating part, although there weren’t too many vegetables. (Usually I stay at Motel 6 and eat at Subway, so this was a much nicer trip.)

What I Talked About
Native Alaskans have high rates of diabetes, and the government has many programs to try to help. But like much of American medicine, the diabetes program suffers from Band-Aid syndrome. The wounds the Natives suffer are much too deep to be treated effectively with metformin or insulin. Drugs just take the edge off.

I gave three talks. The fun one was “Sex and Diabetes,” the same talk I gave in Las Vegas for the American Association of Diabetes Educators. I was afraid that with my being from San Francisco and the audience from Alaska, there might be a mismatch in our openness about sex. But apparently not — people seemed to like it.

The heavier talks were called “Social Approaches to Diabetes” and “Empowerment as Medicine.” In them, I got into the trauma the Natives are living with and how it causes illness. Of course, that dynamic doesn’t apply only to Native Americans — a lot of people with diabetes are living with trauma and stress that contribute to illness.

The “Social Approaches” talk was about how bringing people together for mutual support improves diabetes management and outcomes. I talked about group appointments, patient mentor systems, support groups and classes, and also about involving families and communities in diabetes care and prevention.

The “Empowerment” talk was about how social disempowerment puts people in harder situations, leaves them fewer resources for dealing with those situations, and subjects them to enormous stress. All of these contribute to Type 2 and perhaps other types of diabetes.

Since unhealthy environments and lack of power are among the main causes of Type 2, prevention and treatment should focus on empowering people and changing the environment. Of course, doing those things is a lot harder than talking about them. Health-care professionals should work with people to build their self-confidence and self-esteem. Bring people together to support each other and change the environment.

One thing the Alaska program does well is hiring Community Wellness Advocates (CWAs). CWAs are Native people without advanced degrees, who can model healthy behaviors and attitudes and help people cope with their environment. I was honored to meet many of them; they are inspiring.

Presenting With Disabilities
The “Empowerment” talk was emotional. Because of my multiple sclerosis (MS), I have developed a mild case of “emotional lability.” That means I laugh and cry very easily. About ten times during my talk, I had to interrupt myself briefly because of crying. Usually a drink of water gets me back in control, but it’s embarrassing, although audiences don’t seem to mind. I guess it lets them know I really care. But I also got really tense, which I think made the talk too preachy and angry-sounding. I’ll see when the evaluations come out.

The wheelchair was not a problem. The organizers had put in a ramp to the stage, so I didn’t have to climb around. They got me an accessible hotel room, and Yellow Cab had a ramp van to get me to the airport.

One fun thing was the gingerbread city that a local artist creates every year at the hotel. It’s huge, maybe the size of three ping-pong tables, covered with cute stores and streets and local landmarks. The countryside is lovely. From my seventh floor room, I could see the beautiful Chugash Mountains, at least during the few hours of daylight.

I hope to be able to do more such events. I’m passionate about the topics and love meeting new people and learning from them. It’s hard getting around, but it’s totally worth it.


  1. David:

    Thank you for the sensitive introspective depth of your sharing of the issues. Some of them seem absolutely heartbreaking.

    Posted by jim snell |
  2. “Heartbreaking” is the word, Jim. At dinner, one woman casually mentioned that out of nine boys she went to school with in her village, only three are still alive. And she’s less than 40 years old!

    Posted by David Spero RN |
  3. David, I must admit that even the caregivers on the front lines could use a bit of encouragement once in a while. Your talk on Empowerment as Medicine was like coming in to an oasis to rest and get a cool drink of water. We will all head back out into the vast Alaskan wilderness refreshed and focused in our purpose. Cheers-

    Posted by Tim Langdon RN |
  4. I sure understand emotional lability. I have no reason for it, but I cry at the drop of a hat. It can be embarrassing, but my friends keep assuring me that it’s HUMAN to show emotions, and that many people will actually feel closer to you when you cry. Even MEN are allowed to cry — we’ve come a long way since Thomas Eagleton! Don’t be ashamed of being who you ARE! :-) Hugs!

    Posted by Natalie Sera |
  5. David,
    Thank you for the talk back in December. I am recently new to area. I am the walk coordinator for JDRF and it was pleased to hear your talks

    Posted by Mike Wyne |

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