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Diabetes Education in Tribal Schools (DETS) Curriculum

Diabetes Education in Tribal Schools logo

In 2001, the congressionally authorized Interagency Diabetes Mellitus Coordinating Committee, chaired by the NIDDK, hosted a meeting to address the seriousness of type 2 diabetes in the American Indian and Alaska Natives (AI/AN) communities.  The meeting was attended by the Indian Health Service Division of Diabetes Treatment and Prevention (IHS/DDTP) and the Tribal Leaders Diabetes Committee (TLDC)

The Diabetes Education in Tribal Schools (DETS) Project was part of a national effort to decrease the incidence and improve the care of type 2 diabetes among AI/AN. The resulting Health is Life in Balance K-12 curriculum consists of units that incorporate National Science Education Standards, Inquiry-Learning (5E model), and AI/AN cultural and community knowledge.


The goals of the DETS K - 12 Curriculum were to:

  • Increase the understanding of health, diabetes, and maintaining life in balance among American Indian/Alaska Native students. (Teach about diabetes)
  • Increase American Indian/Alaska Native students’ understanding and application of scientific and community knowledge. (Value and use scientific and traditional knowledge)
  • Increase interest in science and health professions among American Indian/Alaska Native youth. (Encourage science and health careers)

Curriculum Ordering Information

The NIDDK no longer offers the DETS curriculum. Free supplements maybe requested from the Indian Health Services.

Curriculum Overview

Elementary School, Grades pre-K – 4

Exploring Health and Foods (pre-K & K)

Students participate in active learning exercises to develop a concept of health and being healthy. They explore the varieties of healthy foods and the ideas of food groups and eating appropriate quantities.

What is Healthy Life in Balance? (grades 1 – 2)

Students build their understandings of health through a comparison exercise, and then explore the idea of health is life in balance. The students use a plate-balancing model with representations of areas in life that need to be in balance, and demonstrate how excesses or deficits in one area unbalance the whole. Students identify and illustrate messengers who help them stay healthy and apply the concepts of health and balance to a story of a child’s everyday activities.

  1. What Helps a Person Be Healthy?
  2. Myself in Balance
  3. What is Balance?
  4. Let’s Move – The Round Dance
  5. Milo’s Family – A Message of Good Health

Exploring the Food Groups (grades 1 – 2)

Students will identify and sort foods and explain similarities and differences between foods. Students will explore the food groups on MyPyramid for Kids and compare their food groups to the scientists’ food groups. Exploring each color of MyPyramid for Kids will reinforce the importance of eating foods from all food groups everyday and of choosing more foods from some groups than others. Students will be reminded to be physically active every day and make healthy food choices.

  1. Creating Our Own Food Groups
  2. Introducing Scientists’ Food Groups
  3. Let’s Have a Pizza Party
  4. Physical Activity is Important Too
  5. Linking the Food Groups with Physical Activity, and the Round Dance
  6. What I Know About Eating and Exercise

Diabetes is an Imbalance in the Body (grades 1 – 2)

Students will participate in a number of activities to understand the concept of disease and to learn specifically about diabetes. Specific activities to emphasize include developing a definition for disease, comparing diabetes to a cold as two types of bodily imbalance, and a story in which students learn that eating healthy foods and staying physically active can help people stay healthy.

  1. What Does It Mean to Have an Imbalance
  2. What is Disease
  3. Comparing Diabetes
  4. Lowering the Risk of Getting Diabetes
  5. What I Learned About Diabetes

Balancing the Body’s Needs (grades 1 – 2)

Students will understand that nutritious food, water, and a balance of rest and physical activity are linked with growth. Through physical and sensory activities, they explore how body clues help us recognize when we need food, water, rest, and exercise for balance. They listen to and discuss stories to identify messengers who give them scientific and cultural knowledge to maintain a healthy balance.

  1. When Do We Do Things that Keep Us Healthy and Strong
  2. Balancing the Body’s Needs
  3. The Body’s Need for Play and Physical Activity
  4. The Role the Senses Play in Making Food Choices

Exploring a Healthy Balance (grades 3 – 4)

The unit will help students to understand that their overall health consists of many areas that work together. Students will explore the four areas of their lives (food, water, rest, and exercise) that promote good health when working together in harmony. Participation in the Round Dance and story discussion are used to explore the importance of people in our lives who give us wisdom. Concepts of diabetes and glucose are introduced.

  1. The Gift of Trees
  2. Messengers
  3. What is Diabetes? How to find out more. 
  4. Let’s Move – The Round Dance 
  5. My Health Message for Others

Being Smart about being Healthy (grades 3 – 4)

Students will develop the skills they need to become informed consumers by learning to evaluate products and understand the motivation behind the commercial messages they continually see and hear. Skills for making good choices are learned by identifying food groups, nutrients, and portion sizes and by learning to read food labels. In learning about healthy food choices and the importance of being physically active every day, students will acquire the skills to prevent obesity and diabetes.

  1. Recognizing Tricky Treats
  2. Becoming a Smart Eater; Becoming a Smart Consumer
  3. Practice Thinking Critically and Making Good Food Choices
  4. A Celebration of Community Diversity

Exploring Diabetes (grades 3 – 4)

After reading Knees Lifted High, students will discuss why we eat, and explore the digestive process. They will be asked to think like scientists as they investigate how the body uses food. They will use graphic organizers to construct the sequence by which food becomes glucose, and depict how the cell draws in glucose from the bloodstream. With greater understanding of the concept of diabetes as, “having too much glucose in the bloodstream” and how diabetes occurs in the body, students will explain how they can keep themselves healthy and physically active every day.

  1. Why Do We Eat?
  2. How Does Our Body Use Food?
  3. Millions of Cells – The Body
  4. The Pancreas
  5. How Glucose Works in the Body
  6. Our Bodies Use Food to Stay Healthy

Harvesting Our Mother Earth (grades 3 – 4)

Students will explore the concept of energy balance, in which the amount of energy in (from food and drinks) and the amount of energy out (from growth and activity) supports natural growth without promoting excess weight gain. This lesson promotes healthier food and exercise choices in students by comparing the traditional diet and active lifestyle of early hunter-gatherer ancestors to our present American diet, recognizing science and traditional wisdom, and exploring present day food and activity choices.

  1. Balance The Food You Eat with Activities You Do
  2. Traditional Native American Foods and Activities
  3. What Keeps Us Healthy?
  4. Scientific Knowledge and Traditional Wisdom 
  5. Food Content of Traditional and Refined Foods

Middle School, Grades 5 – 8

A Balancing Act: Preventing Diabetes (Science/Grades 7 – 8)

The unit consists of five life science lessons for seventh and eighth graders.  Students will learn how understanding of the disease process grows slowly over time as the result of scientific investigation and the accumulation of evidence; that diabetes is a disease in which a person’s body is not able to use glucose properly; that balance between calories taken in and calories used in physical activity is particularly important; and that even small changes in a person’s lifestyle can significantly reduce his or her risk of developing chronic, debilitating diseases, such as diabetes.  In addition, students will understand that there are certain factors that increase an individual’s risk of developing diabetes along with ways to prevent or reverse the trend of increasing incidence of diabetes among the U.S. population as a whole, but specifically within the Native American population.

  1. History in the Making
  2. Focus on Diabetes
  3. Health is Life in Balance
  4. The Diabetes Health Care Clinic
  5. Diabetes Prevention Program

All Life is Connected: Lifestyle, Environment and Diabetes (Social Studies/Grades 5 – 6)

The unit consists of four social studies lessons for fifth and sixth graders. Students are challenged to describe the lifestyle and environment of an earlier time by examining archival photographs (Grandmother's Treasures) from their local tribal culture. In the process of inferring the lifestyle shown in the photographs, students also explore their contemporary lifestyle and environment as a point of comparison. Type 2 diabetes is presented as one possible consequence of the changes the students identify. Through a combination of group and individual work, students explore risk factors for type 2 diabetes to determine which factors are matters of individual choice.

  1. Letter from Down Under 
  2. Changes and Choices
  3. Anna’s Questions about Diabetes
  4. Connections

Life in Balance (Social Studies/Grades 7 – 8)

The unit consists of four social studies lessons for seventh and eighth graders. These lessons build upon the concepts of lifestyle and environment and their relationship to prevention of type 2 diabetes. A Circle of Balance model is used to define health. Civic responsibility is woven into the activities. Students are challenged to identify choices they can make that will prevent diabetes. Students simulate participation on a School Wellness Committee and develop a presentation that proposes diabetes prevention ideas for a Community Wellness Plan. Activities are performed in groups, which deepens student understanding of the concepts.

  1. Civic Action and Health
  2. Diabetes and the Circle of Balance
  3. A Community Seeks Balance
  4. Your Community Needs You

High School, Grades 9 – 12

Diabetes and American Indian/Alaska Native Health (Health Education/Grades 9 – 12)

The health education unit consists of six lessons for students in grades 9-12.  Students are challenged to define diabetes, identify risks for type 2 diabetes, and explore five professions involved in the treatment/preventions of type 2 diabetes.  The students also discover how changes in American Indian / Alaska Native environments and lifestyles may contribute to the development of type 2 diabetes.  Through evaluation and comparison of stories and graphs or charts, along with interviews and role playing, students will become aware of ways to reduce the chance of developing type 2 diabetes.  Students will synthesize and communicate information in a newsletter that defines and describes the prevention and management of type 2 diabetes.

  1. Diabetes and the Community
  2. The Facts of Diabetes
  3. Health Risks in Diabetes
  4. History: Changes in Environment and Diet
  5. Diabetes Prevention Program
  6. Evaluation

Life in Balance: Understanding Homeostasis and Diabetes (Science/Grades 9 – 12)

The science unit consists of seven science-related lessons for grades 9-12.  It has three primary scientific topics:  blood glucose; homeostasis; and health is life in balance.  The seven lessons focus on: diabetes and its impact on the Circle of Balance, with personal stories of two American Indian teens with diabetes; blood glucose, with a hands-on experiment; keeping blood glucose in balance and homeostasis; how insulin works and insulin receptors; reducing the chance of developing diabetes and the complications associated with high blood glucose; evaluation, with the story of another young American Indian woman; and health careers related to diabetes for which students may have knowledge or interest.

  1. What is Diabetes? 
  2. What is Blood Glucose?
  3. Keeping Blood Glucose in Balance
  4. How Does Insulin Work?
  5. Diabetes – Why Does It Matter?
  6. Sharing Your Knowledge of Type 2 Diabetes
  7. Using Your Knowledge of Type 2 Diabetes

Content Creators and Collaborators

Federal Agencies

NIDDK, National Institutes of Health

Lawrence Agodoa, M.D., Director, Office of Minority Health Research Coordination (retired)
Sanford Garfield, Ph.D., DETS Program Director
Jennifer Curry, Program Specialist

Native Diabetes Wellness Program, Centers for Disease Control and Prevention

Lemyra DeBruyn, Ph.D.
Dawn Satterfield, Ph.D., RN, CDE

Division of Diabetes Treatment and Prevention, Indian Health Service

Kelly Acton, M.D., MPH, FACP, Director
Lorraine Valdez, RN, MPA, CDE, Deputy Director/Nurse Consultant
Tammy L. Brown, RD, MPH, BC-A M, CDE, Nutrition Consultant

Office of Science Education, National Institutes of Health

Bonnie Kalberer, Consultant

Contributing Partners

Doug Coulson, Ph.D., PS International, External Evaluator
Michelle Chino, Ph.D., University of Nevada Las Vegas, Ethnographic Interviewer
Carolee Dodge-Francis, Ed.D., University of Nevada Las Vegas, DETS Sister Site Coordinator
Marilyn Hetzel, Northwest Indian College, Consultant
Barbara Schulz, Northwest Indian College, Consultant

DETS External Advisory Committee Members

Roger Bybee, Ph.D., Biological Science Curriculum Study
Robin Butterfield, National Education Agency
Jody Chase, Ph.D., National Science Foundation
Gerald Gipp, Ph.D., American Indian Higher Education Consortium
Cindy La Marr, Capitol Area Indian Resources, Inc.
Joseph Taylor, Ph.D., Biological Science Curriculum Study
Roberto Trevino, Ph.D., Bienestar Health Program, Social and Health Research Center
Alvin Windy-Boy, Rocky Boy Indian Reservation

Principal Investigators at Participating Tribal Colleges and Universities

Cynthia Lindquist, Ph.D., Cankdeska Cikana Community College 
Margaret Campbell, Fort Peck Community College
Shelly Bointy, M.S.W., Haskell Indian Nations University
Lynn Aho, Ph.D., Keweenaw Bay Ojibwa Community College
Juanita Wiley, Leech Lake Tribal College
William Freeman, M.D., M.P.H., Northwest Indian College
Corey Sangrey, Stone Child College 
Carol Maller, M.S., RN, C.H.E.S., Southwestern Indian Polytechnic Institute

Last Reviewed April 2024