There is an epidemic of diabetes among American Indians. Health officials say more than 16 percent of American Indians have the disease, compared to just 9 percent in the general population.
The Rincon Reservation lies in the shadow of Palomar Mountain in San Diego's North County.
In a large meeting room at Rincon's Indian Health Council, a group of people sit at circular tables. They listen to four members of the Intertribal Bird Singers recite ancient songs. That's followed by a woman who teaches people how to carve gourds.
These activities may be unusual for a diabetes control program, but among American Indians, culture is extremely important.
Next, nurse Regin Baysa gets down to brass tacks. He tells the crowd that diabetes is the leading cause of blindness in the U.S. Baysa says whether a diabetic loses their eyesight is up to them.
"Prevention is the key," said Baysa. "You have to make a commitment, it's a big word, commitment, to manage your diabetes. Because, you know, it's your eyes, it's not anybody's eyes, it's only you."
This monthly meeting is part of a program called Journey of the Heart. It's open to diabetics of nine Indian tribes in North County.
There are 125 people enrolled in the program. They agree to take a number of steps to manage their diabetes.
Physical exercise is one of them.
"All right, exhale at the top. One, two…" said Angelina Renteria.
Inside the gym at the Indian Health Council, physical activity specialist Renteria puts Jackie Withers through the paces.
Withers was diagnosed with diabetes four years ago.
"It's very annoying," said Withers. "You have to watch very carefully what you eat. You have to check your blood sugar often, you need to exercise. And there's so many things that can happen to you, things you don't expect. You could have trouble with your kidneys, with your eyes, toes go numb, fingers could go numb."
Renteria says frequent physical activity is one way diabetics can prevent these complications.
"You know, they're really kind of able to see the benefit immediately after exercise," Renteria points out. "They see their glucose drops from 200 to 120, and it's a real encouraging thing for them."
People enrolled in the Journey of the Heart program commit to exercising and monitoring their blood sugar. They must eat a healthy diet and watch their weight. They need to stay on their medication, and have a physical every year. That includes an eye and foot exam.
Martina Portillo directs the program. Like with many other American Indians, diabetes runs in her family. In fact, one of her sisters died from complications of the disease.
Portillo says the high rate of diabetes among American Indians is due to a number of reasons.
"The inactivity, and just a change in our diets, the accessibility of high fats, high starch food," Portilla said.
Combine that with a genetic predisposition to diabetes, and you have a recipe for an epidemic.
Portillo says the whole point of the Journey of the Heart program is that diabetes is a manageable condition.
"It's not a death sentence," Portillo said. "You don't have to go onto complications, you don't have to have an amputation, you don't have to go on dialysis, you don't have to lose your eyesight. People can live long and wonderful lives with diabetes, and then in control."
But Portillo concedes it's not easy. One of the complicating factors in diabetes is obesity. And the vast majority of people in her program are obese.
The Centers for Disease Control warns unless all Americans adopt healthier lifestyles, the prevalence of diabetes will increase dramatically. The agency predicts if current trends continue, one in three Americans will have diabetes by 2050.
