Rare in Indian country just sixty years ago, type 2 diabetes mellitus is now woven into the fabric of losses in tribal communities across North America. Westernized lifestyles, with coincident obesity and physical inactivity, are powerful risk factors for this relatively new "disease of civilization." The web of causation is thicker and wider than obesity and physical activity alone, intertwined by historical, economic, environmental, and sociological roots. As diabetes-related morbidity, disability, and mortality continue to increase in communities around the globe, many tribal elders recall when diabetes was almost unknown. They remember being taught how to stay healthy, lessons that were part of their "traditional ecological knowledge," a symbolic and informational knowledge that is grounded in cultural values and practices, and refined through generations of observation, experimentation, and adaptation. In these conversations, the elders' traditional ecological knowledge richly illustrates the cultural capital that supported their survival and helped maintain the health of their communities even when they had to face challenging times. The purpose of this article is to describe a number of dynamic, tribally driven efforts that draw on traditional ecological knowledge to address the problem of diabetes in American Indian and Alaska Native communities