Among the settlers, diabetes was known long before the Gold Rush. My own family has known diabetes for many generations that include my great-grandfather, my grandmothers, several uncles and aunts, and my father. Most recently, my sister was diagnosed with metabolic syndrome and insulin resistance -- strong precursors of diabetes. One of my earliest childhood memories is of Grandma Nellie standing at the dining room table as she tested her urine over a flame. I watched as she pulled up her floral print skirt to a few inches above her knee and drew down beige woolen stockings to slide a needle into her thin thigh. Her chin was set, mouth firmly shut. "Your grandma has 'The Sugar,' " my mother told me. But I could not possibly link the word "sugar" to what I had just witnessed. That day, my grandmother's life seemed as forbidding as the mineshaft with fallen timbers next to her land.

Insulin injections kept Nellie alive in her tarpaper-shingled home in the mountains, far from medical offices, long enough to briefly know her grandchildren. These days, I cannot recall my grandmother's voice, but I remember her death. I sat on the linoleum hallway floor drawing people, trees, the sun, birds, and dogs. Nellie DeWolf died of kidney failure and a diabetic coma in 1956. She was 65.

I believe that we -- the settlers and their descendants -- effectively introduced the spike in Native American diabetes rates in the watershed through our culture. By far the most common form of diabetes for Native Americans is Type 2, which progresses from insulin resistance to full-blown disease. This is the form that is most strongly related to too much fat and sugar, processed foods and sedentary living. Diabetes is like the Japanese knotweed, fish infections and algal blooms that proliferate unchecked in our disrupted watershed and its blocked waterways. Our bodies, designed to handle alternating periods of natural abundance and scarcity, cannot cope with unrelenting, invasive plenty. The pathways between insulin and the mitochondria, the energy organelles of the body, become overwhelmed and damaged. Endocrine-disrupting chemicals and reactive nitrogen compounds from agricultural runoff, industrial waste and consumer products add to the internal chaos. There is no doubt that Type 2 diabetes is fostered by our way of life -- poor eating habits and a sedentary car-centered culture, surrounded by electronic media. Even the less common autoimmune Type 1 diabetes is increasing -- not due to genetic shifts but to environmental triggers and cofactors. For the descendants of white settlers, the loss of food natural to our bodies is tangled up in centuries of migration and dislocation. We barely know what we have lost. But we know that as we gain weight, fish species go extinct.

It is through the tribes on the Klamath that the deep roots of the diabetes epidemic are most clearly seen. Karuk Tribe medical records reveal a 21 percent occurrence in 2005, compared to 7 percent in the general population that year. Among those aged 65-74, 50 percent of the First People had diabetes compared with 20 percent of the country's population in the same age group. And all groups, Native and non-Native, are still showing increases in Type 2 diabetes, especially among the most impoverished. Also, among similar Native tribes, 55 percent of those aged 45 and older show pre-diabetes or metabolic syndrome -- double that of the U.S. population. Metabolic syndrome is a combination of medical disorders that increases the risk of diabetes along with kidney, stroke and heart disease. While all the tribes on the river now have diabetes risk reduction and medical care embedded in their health services, the issues extend far beyond these sorely needed clinics. We also need sustainable local foods -- thriving fish and farms in a healthy, restored watershed.

A member of the Hupa Tribe on the Trinity tributary of the Klamath told me of a time when white soldiers had killed a great number of Natives in retaliation for a small number of soldier deaths. One tribal elder walked out to meet the soldiers, carrying a notched staff - one side marked with the soldier deaths and the other with the much higher number of Indian deaths. He displayed it silently. The soldiers asked him to sign a piece of paper, so he made his mark, believing justice would be done. Instead, he was told he had signed away the people's land. It was an incomprehensible idea for him but it was later violently enforced.

Violence is at the root of every broken place in the land, in the wanton extraction of metals, timber and wildlife for short-run gain. It is at the root of the breakdown of communities and of dynamic natural cycles. In the Klamath River watershed, it left a land in which diabetes could flourish as Native food ecology was destroyed.