Diagnosing the Legacy

The Discovery, Research, and Treatment of Type 2 Diabetes in Indigenous Youth

Larry Krotz (Author), Frances Desjarlais (Foreword), Heather Dean (Afterword), Jonathan McGavock (Afterword), Michael Moffatt (Afterword), Elizabeth Sellers (Afterword)


In the late 1980s, pediatric endocrinologists at the Children’s Hospital in Winnipeg began to notice a new cohort appearing in their clinics for young people with diabetes.

Indigenous youngsters from two First Nations in northern Manitoba and northwestern Ontario were showing up not with type 1 (or insulin-dependent diabetes), but with what looked like type 2 diabetes, until then a condition that was restricted to people much older. Investigation led the doctors to learn that something similar had become a medical issue among young people of the Pima Indian Nation in Arizona though, to their knowledge, nobody else.

But these youth were just the tip of the iceberg. Over the next few decades more children would confront what was turning into not only a medical but also a social and community challenge.

Diagnosing the Legacy is the story of communities, researchers, and doctors who faced—and continue to face—something never seen before: type 2 diabetes in younger and younger people. Through dozens of interviews, Krotz shows the impact of the disease on the lives of individuals and families as well as the challenges caregivers faced diagnosing and then responding to the complex and perplexing disease, especially in communities far removed from the medical personnel a facilities available in the city.


"Diagnosing the Legacy vividly describes the impact of this ‘new disease’ on the lives of individuals and communities and outlines clinicians’ attempts to diagnose, treat, and control it. It illustrates the limits of biomedicine in dealing with the totality of the personal and communal costs of this public health crisis and highlights the need to recognize and to integrate traditional ways and knowledge in an effort to counter it.”

J.T.H Connor, Memorial University

“As a whole, academically trained researchers and practitioners are making very little difference to the lives of Indigenous children with type 2 diabetes. We need to advocate, not for longer-acting or more concentrated insulins, or a better pill, but for better relationships, such as those between the Manitoba team and these remote communities, as described in the compelling stories of Larry Krotz’ book.”

Ellen L Toth, The Lancet Diabetes & Endocrinology

“An engaging narrative and insights into the limits of biomedicine and public health when dealing with the type 2 diabetes, as our understanding of the disease and the public health crisis evolved.”

Raglan Maddox, American Review of Canadian Studies

Diagnosing the Legacy is at once detective story, indictment, and scientific investigation. [...] Krotz, a writer and filmmaker, does an outstanding service in using the lens of type 2 diabetes mellitus—which is increasingly diagnosed in young people, a population not previously thought to be at risk for this condition—to critically examine the political, social, economic, and biological features of this chronic disease among the people of the First Nations. Importantly, the book emphasizes the biological aspects of genetic risk together with the origins of health and disease, arguing that genetic risk—in conjunction with a fetus’s intrauterine environment—both impact that individual’s metabolism. This biopsychosocial perspective moves beyond genetic determinism to consider inequities in diabetes prevalence and treatment from an individual and community standpoint. Krotz stresses the importance of strengthening resilience among First Nations, shifting the locus from individual risk and responsibility to structural factors and solutions. Moreover, the book was written in cooperation with, and supported by, First Nations communities, who are partnering with academics to develop their own solutions to the growing spread of type 2 diabetes among their youth.”


About the Authors

Larry Krotz is an award-winning writer, filmmaker, and author of five previous books, including Midlifeman and Tourists, which looks at how mass tourism is changing the world. Over the past 25 years he has travelled to a number of African countries, where he produced the documentary film, Searching for Hawa’s Secret, and wrote extensively for magazines and newspapers on scientific research and foreign aid projects. Originally from Winnipeg, he currently lives in Toronto.

Frances Desjarlais is a registered nurse from the Swan Lake First Nation who has worked on diabetes initiatives in First Nations communities for most of her career.

Table of Contents


Early Alarm

A New Disease Recognized

Gaining Traction

Island Lake

Early Research, Innovations, and Strategies for Care

Investigation and Hypotheses

After the Deluge

Revisiting Roots


Poverty and Disease

Partnerships and Participation

Hopes and Dreams

Island Lake Encore

By Heather Dean, Jonathan McGavock, Michael Moffatt, and Elizabeth Sellers


University of Manitoba Press is grateful for the support it receives for its publishing program from the Government of Canada through the Canada Book Fund; the Canada Council for the Arts; the Manitoba Department of Culture, Heritage, and Tourism; the Manitoba Arts Council; and the Aid to Scholarly Publishing Programme.