It’s Up 2 You!

by Matt Peters

Awareness and prevention of type 2 diabetes, especially among urban Native Americans, was the goal of a comic book published by the Arizona State Museum (ASM) in late 2011. It’s Up 2 You! was created by ASM’s Head of Community Engagement Lisa Falk and artist and educator Ryan Huna Smith, who had previously worked on Jon Proudstar’s original Tribal Force comic (Mystic Comics, 1996).

Type 2 diabetes is the most common form of diabetes, a chronic condition caused by insufficient production of insulin, a hormone that helps regulate blood glucose (sugar) levels. It can result in fatigue, frequent urination, brain fog, blurry vision, and neuropathic discomfort, among other symptoms. It often leads to complications such as kidney damage and cardiovascular disease.

Unlike type 1 diabetes, which results from an autoimmune condition that attacks insulin-producing cells, type 2 diabetes results from a combination of contributing factors—some genetic, some related to age and medical conditions, and some related to lifestyle. Among the latter are unhealthy diet, inadequate physical activity, and alcohol and tobacco use. Because of those lifestyle factors, type 2 diabetes is preventable and takes time to develop. It is usually diagnosed in adults, though childhood diagnoses are becoming more common.

At the time It’s Up 2 You! was published—and still today—type 2 diabetes was a major concern in Native American communities. A year prior to the comic book’s publication, an article in Diabetes Spectrum, a journal of the American Diabetes Association, reported a number of alarming statistics about the prevalence and burden of diabetes in the American Indian and Alaska Native (AIAN) population. The disease had been virtually unheard of among AIAN people prior to World War II, but by 2009, it was the fourth most common cause of death in the AIAN population, according to the Indian Health Service. More than 16% of AIAN people had been diagnosed with diabetes, exceeding the rate among non-Hispanic whites (8.7%) and other racial and ethnic groups. Between 1990 and 2004, diabetes diagnoses among Native Americans under 15 years of age increased 77%, and among those aged 15 to 19, diagnoses increased 128%.

It’s Up 2 You! focuses on three characters, Tomás, Brandon, and Samantha, who live in Tucson, Arizona. Their tribal identities are never explicitly revealed, but at one point the comic makes references to tepary beans and toka—a traditional food and outdoor game, respectively, of the Tohono O’odham Nation, a people indigenous to various parts of Southern Arizona and Northern Mexico. (Tepary beans are traditional to other indigenous peoples as well, including the Akimel O’odham and Pascua Yaqui Tribe, but are not as central to those cultures.)

The story opens with Tomás and Brandon relaxing on Tomás’s front porch, watching neighbors and passersby bike, run, shoot hoops, and walk dogs. The two friends are drinking sodas and snacking on potato chips when Tomás’s neighbor Samantha shows up on a skateboard. She declines their invitation to eat chips with them, and they decline her invitation to go to the skate park with her. After that brief exchange, Samantha skateboards away, and Tomás and Brandon go inside to play video games—and continue snacking.

With their sedentary activities and overconsumption of snack foods, Tomás and Brandon put diabetes risk factors on full display in the opening pages. Warning signs of diabetes are given a somewhat subtler treatment. Tomás mentions problems with this leg falling asleep, as well as frequently feeling tired. Later, he’s seen with a bandage on his right foot. To be sure, none of those are surefire signs of diabetes, but they can potentially indicate, respectively, the peripheral neuropathy, fatigue, and foot sores that are common to the condition.

The turning point in the story comes when Tomás falls asleep and sees a distant ancestor in a dream. That ancestor tells Tomás about a more active past when people in their community “played games such as toka” (page 23, panel 1) and enjoyed “healthy fresh food, songs and dance” (page 24, panel 1). That dream or meeting—however the reader wants to interpret it—helps snap Tomás out of an in-the-moment mindset and take a longer view of his own life. Instead of the immediate satisfaction of drinking a soda or sinking into his living room furniture, he thinks about the long-term impact his actions can have—not just on his own health, but on the health of the community where his actions are part of a larger arc of history. The next day, when he sees Brandon and Samantha again, his choices take a different tack.

After the story concludes, the comic has two supplementary prose pages (sans sequential art), titled “Facts on Diabetes” and “Myths About Diabetes.” Both pages offer additional information that didn’t make it into the main narrative.

The comic offers a simple but effective story, featuring concise, plain-language dialogue that should make it accessible to most readers. Smith’s art is stylized in a way that’s inviting to both younger readers who are drawn to cartoons and older readers who are drawn to indie comics. Rather than going for realism, Smith goes for a look that’s reminiscent of Rob Guillory’s Chew (Image Comics, 2009-2016), using exaggerated proportions and simplified forms to be more expressive than representative.

When It’s Up 2 You! was released in 2011, it came out in both a print and digital edition. The print edition is no longer available, though some collectors might chance upon a copy in the back-issue inventories of some comic book shops—though the likelihood of that might be nominal outside of Arizona. (This reviewer found a copy at The Collector’s Territory in Tucson’s Fourth Avenue District.) The digital edition, however, still lives on, available for viewing or downloading on the Arizona State Museum’s website. Along with the comic book itself, website visitors can access audio recordings of the comic’s dialogue, available in English, Spanish, and Tohono O’odham, as well as a diabetes knowledge quiz. At one time ASM’s physical space hosted a tie-in exhibit, featuring art panels and information from It’s Up 2 You! The exhibit was loaned to various community venues before it was eventually archived.

The Arizona State Museum continues to offer other programming and resources related to the archaeology, ethnography, and modern culture of Arizona’s indigenous peoples. Smith continues to work as a painter, illustrator, and graphic designer based in Tucson.

Reviewer’s Note: Panels are arranged differently in the digital edition compared to the print edition, resulting in more total pages in the former. Page citations above refer to the digital edition.

Matt Peters is a program manager at Health Sciences Design, an interdisciplinary health innovation program at the University of Arizona Mel & Enid Zuckerman College of Public Health. He is also a longtime comic book reader and collector who can be found from time to time at his local comic book shops. Views expressed are his own.