When Foxwoods Resort Casino, one of the world's largest gambling enterprises, opened in 1992 on the Mashantucket Pequot reservation in the backwoods of eastern Connecticut, some expected it would have to close shop during the early morning hours.

More than 10 years later that still has never happened.

In fact, the casino shows no signs of slowing down, having added three hotels and a world-class museum. An average of 40,000 people a day visit the casino, which earned $783 million after jackpot payoffs from its 6,400 slot machines alone in 2001.

Perhaps no other individual better epitomizes the frenetic, non-stop action found at the casino than Kenneth M. Reels, who just completed a four-year term as chairman of the Mashantucket Tribal Council, the tribe's governing body.

When Reels was elected chairman in 1998, his already busy schedule became overloaded as he met more often with tribal members and town and state officials, hosted banquets for conferences held at the casino, and kept a red eye on the 24-hour, seven-day-a-week operation.

"I was all caught up in my job," said Reels. "That's all I could focus on day and night. I always thought, `What task is next and what needs to be completed?' It controlled me. The responsibility of being a chairman is huge."

"Everything Was Foggy"

About one year after his election to this demanding and influential position, Reels began to suspect something was wrong with his health. He had ballooned to the highest weight of his life, he was feeling extremely tired, and he was thirsty much of the time.

Then one night, as he was driving, he got really sick. "Everything was foggy," Reels recalls. He visited a doctor immediately.

Tests showed his blood sugar level was over 300 mg/dl. That's when he discovered he had type 2 diabetes. The doctors told him that fat was making his body resistant to insulin.

Although his mother and some of his aunts had had type 2 diabetes for several years, Reels said he didn't even know what the disease was before he contracted it.

And he didn't realize that some American Indian tribes have the highest rates of diabetes among ethnic groups in the world.

Lifestyles And Diabetes

Reels was put on insulin immediately. But after consulting with his doctor, he decided to see if he could get control through diet and exercise instead.

Reels typically had eaten on the run. All too often he would grab a Big Mac to hold him over between meetings. At more upscale restaurants, he enjoyed large steaks. At the various banquets he hosted at the casino, he enjoyed more fattening food, especially potatoes with sour cream, butter, and cheese, topped with lots of salt.

Reels added, that, like most American Indians, his family was marked by poverty prior to the rise of the now wildly successful casino. "We ate a lot of fatty foods," he said. "If you are poor you don't get to eat lean meat. You get the cheapest you can afford to feed your family."

So one of the first things Reels did after his diagnosis was revert to a diet that his ancestors typically ate: nuts, berries, and corn. He eliminated dairy products. And he adopted a vegetarian diet.

His approach has worked. He reports that his blood sugar levels are in a healthy range, he consults a doctor once a month, and he checks his blood regularly.

To stick to his new diet, Reels must exercise lots of restraint. There are 25 restaurants at the casino, and according to casino officials, 2,000 pounds of sausage, 9,800 pounds of prime rib, and 53,000 five-ounce pieces of chicken are served in them each week. "You are what you eat," Reels said. "If you eat fat you're going to be fat."

Reels now reserves time for daily exercise. He goes to one local gym in particular because it's the only one that is open late. On a recent typical visit he stayed for three hours before leaving at 12:30 a.m. He lifted weights for 1 1/2 hours, did aerobic exercises for an hour, and stretched for 30 minutes.

Concern For Others

When Reels got diabetes he not only began to pay more attention to his health, but also to the health of his 11,500 employees.

He has made this a priority, promoting five annual diabetes conferences and ordering changes in Foxwoods' menu to include healthier choices: a salad bar, green vegetables, and beans, not just the usual burger fare.

"[Our dietitian] has been telling us for years and years but we just haven't been listening," Reels said. "It really does work. Attitudes of employees have changed greatly."

Reels recalled one tribal member's battle with diabetes.

"I've always known him to be in a wheelchair. They kept cutting him and going up and up. That scares me to death.

"I'm trying now to live to be 100 years old. That's my goal."

native americans and diabetes

* The prevalence of type 2 diabetes among Native Americans in the United States is 12.2 percent for those over 19 years of age.

* One tribe in Arizona, the Pima Indians, has the highest rate of diabetes in the world. About 50 percent of the tribe between the ages of 30 and 64 have diabetes.

* Type 2, or adult-onset diabetes, is increasingly being discovered in Native American youth.

* Among people with diabetes, the rate of diabetic end-stage renal (kidney) disease is six times higher among Native Americans.

* Amputation rates among Native Americans are three to four times higher than the general population.

* Diabetic retinopathy (eye disease) occurs in 18 percent of Pima Indians and 24.4 percent of Oklahoma Indians.

health care crisis

Health experts say denial and a lack of information remains a problem among American Indians who suffer from diabetes but don't seek care until they face a serious, sometimes life-threatening complication.

"I think [many Native Americans] are ignoring it until they have a heart attack, stroke, kidney problem, or blindness," said Elaine Sullivan, a national certified diabetes educator at the Joslin Diabetes Center, an affiliate of Lawrence and Memorial Hospital in New London, Conn.

About 17 million Americans have diabetes, six million of whom don't know they have the disease. Ninety to 95 percent of those with diabetes have type 2. But American Indians, on average, are more likely to develop diabetes than any other ethnic group in the United States, according to the Centers for Disease Control and Prevention.

The issue of diabetic care for American Indians in southeastern Connecticut has become more relevant as more move into the region to work at the region's two world-class casinos. The 2000 census showed the number of Connecticut residents claiming sole Indian ancestry had increased 50 percent--to 9,600--since 1990.

Citing statistics from the Indian Health Service, Christopher Sorli, MD, medical director of the Diabetes Management Center at The William W. Backus Hospital in nearby Norwich, said 30 to 40 percent of the Mashantucket Pequots' 650 members have diabetes. And about 10 percent of the Mohegans' 1,450 members have the disease. But only about 180 American Indians have joined local diabetes management programs.

The Mashantuckets operate Foxwoods Resort Casino and the Mohegans operate neighboring Mohegan Sun Casino.

"We aren't seeing as many people as I expected we would be," said Dr. Sorli, who has lectured about diabetes at Foxwoods. "I have no trouble reaching employees, but Native Americans tend not to come to these things."

Even more disconcerting is the fact that doctors have become better able to prevent type 2 diabetes. They no longer have to wait until the disease manifests itself before taking action.

In 2001, the Diabetes Prevention Program, a major national clinical trial, showed that exercise--just 30 minutes of walking five days a week--and a healthy diet significantly reduce the chances of an individual with impaired glucose tolerance (a condition that most often precedes type 2 diabetes) ever developing the disease.

Participants reduced their risk of getting type 2 diabetes by 58 percent. The same study found that treatment with the oral diabetes drug metformin reduced the risk of getting type 2 diabetes by 31 percent. A number of the participants were of Native American descent, so medical professionals know that lifestyle changes could prevent many Native Americans from developing diabetes.

Armed with this information, local health officials are anxious to reach Native Americans.

"I don't know whether it's a fatalistic approach to the disease," Sullivan said. "I think there is a distrust of non-Indian services. Some American Indians are afraid we'll discount traditional medicine. But I will work with them."

--A.B.

awakening the spirit