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This is DAY TO DAY from NPR News. I'm Alex Chadwick.

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I'm Alex Cohen.

We've all heard about skyrocketing rates of diabetes in the U.S. But here is a truly troubling statistic: Nearly a quarter of all Native American adults suffers from diabetes. That's nearly three times the average of the rest of the country. Two sisters are trying to put an end to that. They're waging a battle against diabetes on the Navajo Nation; that's the largest reservation in the U.S.

Arizona Public Radio's Daniel Kraker has this report.

Ms. LITA SCOTT (Nurse): We lost a lot of family. We lost uncles, grandpas, aunts.

DANIEL KRAKER: Few people have felt the scourge of diabetes on the reservation more than Lita Scott.

Ms. SCOTT: Those are reminders for me and my family about where we have to go to prevent diabetes. And whenever I work, I always think about that.

KRAKER: Scott is the diabetes community health nurse in Winslow, Arizona, a small dusty town on the edge of the Navajo Reservation. She's a tiny woman, intense and passionate when she talks about diabetes' impact on her people. Shortly after she finished nursing school, her diabetic father suffered a heart attack. From that moment on, she has devoted her career to fighting the disease. So has her younger sister Laura.

Ms. LAURA CLELAND: Does that feel good?

Mr. HERMAN SCOTT: Yeah. Yeah.

KRAKER: Laura Cleland is kneeling in a cramped office, massaging her father's feet. Herman Scott, now 70, is sitting barefoot, his blue jeans rolled up and a black cowboy hat perched on his head.

Ms. CLELAND: When was it, Dad, '95, when you had your heart attack?

Mr. SCOTT: Oh, yeah. Yeah. Mm-hmm. Yeah.

Ms. CLELAND: And he - (foreign language spoken)

Mr. SCOTT: This side.

Ms. CLELAND: This side had an ulcer. There was a blood clot, and an ulcer was formed there. And they were talking amputation.

KRAKER: Every year there are about 86,000 diabetes-related amputations in the U.S. Native Americans have one of the highest rates in the world. Herman Scott was lucky. His ulcer healed. But his heart attack moved Laura Cleland to quit her job in Tulsa, Oklahoma and start a business distributing therapeutic shoes to 2,000 diabetics on the reservation.

Mr. SCOTT: Is that too big?

Ms. CLELAND: I think it's too big, Dad.

Mr. SCOTT: Okay.

Ms. CLELAND: We need to get a smaller size.

KRAKER: Today she's sizing her dad for a new pair of what look like fancy black leather hiking boots. She pulls out a thick insert in the sole of the shoe.

Ms. CLELAND: What this does is that it really protects the feet from developing the calluses, which leads to ulcerations and then amputation if people aren't careful.

KRAKER: Since Cleland started, she has seen amputation rates among her patients slowly decline. But diabetes rates continue to escalate. They've gone up 70 percent in the past decade among Native American teenagers.

Dr. FRANK ARMAO (Winslow Indian Health Care Center): It's no mystery why diabetes should have reared its ugly head when it did and become such a huge issue for the Navajo people.

KRAKER: Frank Armao was the clinical director at Winslow Indian Health Care Center. He says it wasn't that long ago that under-nutrition was killing Navajo people.

Dr. ARMAO: And suddenly you go from that situation to interstate highway comes through and there's fast food available, and I think that's a major - it's a divide in this epidemic.

KRAKER: More than half of Navajo adults are now overweight and nearly half of children; add to that chronic poverty in the Reservation and inactive lifestyles and Armao says you have a perfect recipe for an epidemic.

Dr. ARMEO: I think sometimes the people get the feeling like there's something wrong with them. It's a genetic thing, or it's, you know, some stereotype of being too lazy or too this or this, and really isn't. It's just a confluence of a lot of unfortunate circumstances.

KRAKER: That's not to say there's nothing Navajo people can do to change those circumstances. But for decades many people say they felt powerless in the face of the disease. And that makes sisters Laura Cleland and Lita Scott's work even more unusual and more important.

Lita Scott recently helped start a wellness and exercise center near her hometown on the reservation. And she's even started a tae kwon do program in Winslow for kids at risk for the disease. Type 2 diabetes, the variety most prevalent among Native Americans, historically has targeted mainly older adults. Now it's increasingly attacking Navajo kids.

(Soundbite of tae kwon do class)

KRAKER: About 30 kids are lined up in starched white uniforms practicing kicks. Verna Bahi's(ph) nine-year-old daughter Lucy is one of the students. Bahi herself is a diabetic, so is her mother. But she hopes the tae kwon do classes will help give her daughter a different future.

Ms. VERNA BAHI: Her way and her attitude have changed a lot. This is teaching my daughter how to stay healthy.

KRAKER: Lucy Bahi is a tiny ray of hope in what can seem like an overwhelming plight. For Lita Scott, it's those stories that keep her going through 12-hour work days that keep her up until midnight studying for her master's degree.

Ms. SCOTT: I believe in our culture. I believe that what we were taught traditionally still does apply to everyday life today. And in those teachings, there's always tomorrow. This is progress - what we're doing with the kids. It may not show today; it will show in 20 years what we have done. That's progress, and that's hope. Saving one life is hope.

KRAKER: For NPR News, I'm Daniel Kraker.

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