Dean Azule

Type II Diabetes

Lesson 4 – The Warrior – Still Fighting Disease

Goal: Prevalence of Diabetes

Fighting the enemy

Activity: Watch Dean Azule’s interview on Video 2

Answer questions
Group discussion


Diabetes among the Pima Tribe

It is estimated that one half of adult Pimas have diabetes and that 95% of those with diabetes are considered overweight.  Dean is a member of the Gila River Pima and he shares his battle with diabetes in hopes to help others to understand how important it is to exercise and watch their diet intake.

Historical events that contributed to the disruption of traditional ways of life among many Native people, have impacted the traditional way of life of the Pima people who practiced this lifestyle until the 19th century when farmers diverted the Pima’s water supplies upstream from their villages.  The Pima had been using a 2,000 year old traditional way of irrigating their foods and when the farmers stole their water supply it caused poverty, malnutrition, and starvation.  The Pima people had to use the government issued lard, sugar, and white flour in order to survive and this high fat and carbohydrate diet increased their weight gain.  This disruption to their cultural practices has impacted the Pima for last thirty years and the prevalence of diabetes continues today.

The percentage of American Indian/Alaska Native people diagnosed with diabetes is about 16% of those ages 20 years and older and are served by the Indian Health Services.
Diabetes is a common disease among the Native communities and many share the same experience as Dean.  Dean shares his story of his diagnosis.

Ok.  Well, first of all, I had been exposed to diabetes on the reservation. I think that if you look at the Pima population, we lead the country in diabetes affliction. I think I read somewhere that like 70 percent of our population is diabetic. The kids practically are born with it so they have to constantly fight it.

Dean Azule-Gila River Pima

Dean recalls his childhood and seeing his grand-mother’s battle with diabetes on the reservation and the difficulty of keeping her lesions clean because they didn’t have running water and without electricity it made it difficult to keep her insulin cold without refrigeration.  His grand-mother eventually had some of her toes amputated.  From this experience Dean never thought he would be afflicted with diabetes.

Dean notices symptoms after he had gotten married, he noticed he was tired a lot more and he was always extremely thirsty, so he thought drinking cold beers would cure his thirst, but in reality he was contributing to the diabetes.  He also noticed it would take a long time for a simple paper cut to heal; he would have to use a lot of Neosporin and keep his cut covered.  Another symptom he notices was his need to urinate all the time.  Dean realized he had gained a lot of weight, wasn’t doing any exercising, and was drinking alcohol regularly at a local bar where he was eating fatty foods high in cholesterol.

Diagnosis of Diabetes

Dean attends an education conference at health screening booth to voluntarily test his blood, he is told his blood sugar levels are around 480 and the doctor is concerned so he asks Dean to return the next day without eating anything but he never does return to the health booth.

Eventually Dean ends up seeing a doctor and is told he has diabetes he is about 35 years old at the time, and his weight is about 365 pounds, even with the doctor telling Dean he has diabetes, Dean pushes it to the back of his mind, a denial response many Native people have, Dean continued practicing unhealthy habits like using alcohol and not eating a proper diet, and skipping meals so he could go drink.

Dean eventually ends up having vision problems and is told he has a cataract and has his lens replaced, his doctor continued to warn Dean, he told Dean, “This is going to impact your liver. You’re already impacting it with your drinking. It’s going to mess with your kidneys. You’re getting spotting and there is going to come a point where you may have to have kidney - hemodialysis.”

Dean makes some changes to his lifestyle after getting worse and finally taking the advice of his doctor; he starts walking, playing tennis, and lose weight

I started walking and got myself up so that I could control easily two miles per day. I was just walking slowly. I’m not a fast walker, I never have been, but I found that I was doing that and I also found that I wanted to get out and I was to playing tennis more and I was getting myself into games where I actually could play. I was having to play – guys and ladies who were much older than I was at least I was keeping up, packing what I was packing.

For many of us being diagnosed with diabetes is a hard thing to hear even if we know someone in our family has been dealing with it or has died due to complications associated with diabetes, we believe it will not happen to us but like Dean if we don’t listen to our bodies eventually we have to hear a doctor tell us we need to change our ways.

Dean is battling with diabetes and shared his experience with his diagnosis as a way to help us to fight diabetes among our own families and to prevent ourselves from dealing with diabetes.  A warrior is prepared and fights for the safety and welfare of his family, community, and tribe, as Native leaders the role of a warrior has changed from fighting people to fighting disease, the weapons are different and so has the battle field as we fight to prevent diabetes among our Native people today and for the prevention of the future generations.


We can help others by learning about things like sugar and how much sugar is contained in the beverages we drink at home, at a Powwow, on special occasions, and during athletic events.  Food is a part of our cultural lifestyles, we celebrate our children’s accomplishments, within our tribe we have a dinner which often includes many carbohydrates and fatty foods along with high sugared beverages, so being aware of sugar content is a step towards fighting diabetes.

Activity: After reading the following information of Sugar and Alcohol (information found at

Take a paper and estimate how many cups of coffee, tea, soda, or alcohol you drink a day/a week and figure out how much sugar you consume per day, per week, and per year.


**A teaspoon of sugar, which has 15 calories, 2 teaspoons of sugar = 30 calories

**13 tsp is equal to 4 tablespoons + 1 tsp, or just over 1/4 cup of sugar.


Monster Energy drink=A can has about 52 grams of sugar in it. A teaspoon of sugar weighs about 4 grams equaling about 13 teaspoons of sugar in that can.

Coke (12 oz) = 40.5 grams of sugar. Drinking one Coke a day for a year results in 32 pounds of sugar. 


Alcohol consumption causes damage when we abuse it and many times AI/AN people who use alcohol for long periods of time finally decide to quit and find out they have diabetes and continue to drink alcohol, if you are drinking alcohol this information can help you see how it contributes to weight gain and diabetes.

Alcohol and the Body

“Alcohol is often considered "empty calories," meaning people often drink a lot of it with little regard for the amount of calories they are consuming. While many may find beer filling, alcohol is not typically considered as filling as its calorie counterpart in food.

Once digested, the body converts a portion of the alcohol into fat; however, the remainder is converted by the liver to acetate. Acetate directly affects how much fat your body is able to metabolize. Simply put, when there are high levels of acetate in the body, your body spends less time burning fat and more time burning acetate. This means that the body stores more fat calories, causing weight gain.”  (

When considering why alcohol may cause weight gain, consider some of the average calorie counts in alcoholic beverages as provided by the University of Rochester:
• light beer (12-oz. can): 100 or more calories
• beer (12-oz. can): 140 to 200 calories
• shot of liquor (1.5-oz.): 115 to 200 calories
• wine (4-oz. glass): 62 to 160 calories


Discussion: Discuss Alcohol’s affect to your body and family.  How does alcohol contribute to the risk of diabetes?   Do you see alcohol as an intergenerational cycle of behavior being passed on to the next generation?  What can we do to change this cycle of behavior?

Reflection: Write down your feelings or thoughts about how alcohol has impacted American Indian culture, health, and your life today.