Heather Mars-Martins and her family would dive off the coast of Westerly, Rhode Island, to catch quahogs and clams, native to the eastern shores that her Narragansett tribe had long foraged for. Mars-Martins and her family would swim back up to their canoes before returning home to prepare traditional chowders or shellfish pies.

But her diabetes complications frequently disrupted those trips, and she’d have to rush to the emergency room when her blood sugar dropped to dangerously low levels.

The tribal elder has had diabetes for the past 17 years. It runs in her family; her grandmother lost both legs as a result of the disease’s complications. Diabetes disproportionately affects Native Americans, who are nearly three times more likely than non-Hispanic whites to be diagnosed with the disease and are less likely to receive treatment.

According to data from the Centers for Disease Control and Prevention, American Indians and Alaska Natives were 2.3 times more likely to die from the disease in 2018. According to the CDC, only 1% of Indigenous people with diabetes had foot or eye examinations the previous year, compared to 70% and 61% of white people, respectively. According to data, the population is also twice as likely to develop end-stage renal disease as a result of diabetes.

Tribes, researchers, and medical communities have long worked to address such health issues that are rooted in systemic inequities. The pandemic’s impact on Native Americans has only increased the urgency. Karen Harrison, a lead registered nurse at California’s Alameda County’s Urban Indian Health Center, was recently diagnosed with diabetes. Harrison’s ancestors are Pomo, Wintu, and Paiute, and the disease runs in her family.

Luohua Jiang, an associate professor of epidemiology at the University of California, Irvine School of Medicine, works with tribal clinics across the country to implement evidence-based diabetes prevention and management programs.

“(Diabetes) definitely increases the risk of getting serious complications when they contract the virus. Given the high prevalence of diabetes in American Indian communities, that makes things a lot worse,” said Jiang.

In response to the pandemic, the Sogorea Te Land Trust, an indigenous, women-led cooperative in the San Francisco Bay Area, launched a healthy food distribution program. According to the Bay Area Equity Atlas, the Bay Area has one of the state’s largest populations of intertribal American Indians.

The land trust distributes vegetables from the community gardens such as kale, chard, and onions, as well as plants important to indigenous cultures such as sage and angelica root. The organization focuses on indigenous elders and has community gardens in West and East Oakland, which have long been identified as food deserts.

According to research, some people can reverse type 2 diabetes by losing weight, changing their diet, and exercising. According to Jiang and other experts, programs that resonate with Indigenous cultures are more likely to succeed than standardized ones.

Dr. Sharon Stanphill, chief health officer of Oregon’s Cow Creek Band of Umpqua Tribe, served on the steering committee for the Indian Health Service Special Diabetes Program for Indians. She adapted the federal prevention model to the tribe’s culture, environment, and resources, developed intensive classes and support groups, and wrote a toolkit for other tribes to use.

Tribes across the country would send each other encouragement gifts ranging from boxes of beef jerky to bags of rice. However, the pandemic slowed the program, which had been successful in preventing diabetes for many years. “People who wanted to get into the program couldn’t,” she explained.

There is now a backlog. People’s health has been put in jeopardy in the last year, which has heightened interest. Mars-Martins, an administrative assistant at the Mashantucket Pequot tribe’s Pequot Tribe Health Care center in Connecticut, started a telehealth lifestyle and diet program through Virta Health. She lost 31 pounds on the plan, which included nutritional coaching and physician guidance, and reduced her insulin doses from six to one for the first time in 17 years.

The Pequot Nation has made the program available to tribe members as well as employees like Mars-Martins. According to Virta Health, the Pequot Nation has cut its total medication spending in half over the last two years, or about $3,800 per patient. The program has also been made available to tribes such as the Chickasaw Nation, and participants can communicate with one another to share healthy recipe ideas that incorporate indigenous cuisine.