Meeting the Challenge of Diabetes

Sonia Sotomayor
Sonia Sotomayor (AP)
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Tuesday, June 2, 2009

When President Obama announced his nominee for the Supreme Court last week, he trumpeted her childhood diagnosis of diabetes as one of the challenges she'd overcome. Sonia Sotomayor's success is a testament to how extraordinary life with diabetes can be. Yes, this is a serious disease, without a cure, but it is also very treatable.

Most cases -- 90 to 95 percent -- are the kind I have, Type 2, which usually develops in adulthood. Sotomayor has the less common Type 1, in which the pancreas is no longer able to make insulin, the hormone that the body needs to process glucose, its main source of energy. (In Type 2, the pancreas can still make at least some insulin, but the body is not very good at using it.). If the disease is untreated, glucose will build up in the bloodstream and can damage cells throughout the body, sometimes leading to blindness, requiring amputation and even causing death.

Sotomayor needs to replace the insulin her body no longer makes, and she needs to keep an eye on the amount of glucose in her blood to make sure that it isn't going too high or too low. These are her main diabetes jobs, and while they aren't fun, they are made easier by modern medicine.

Insulin is either injected into the skin with syringes or fed through an insulin pump, a small device that is attached to the body, usually via a tube, just under the skin. People with Type 1 who inject usually do so at night and before each meal. The needles are so small that the injections are mostly painless.

People with diabetes monitor their blood glucose levels with glucose meters or continuous glucose monitors, which give them real-time readings. They should also get a blood test of "estimated average glucose," also known as a hemoglobin A1C test, every three to six months. It's important that blood glucose numbers don't run too high -- this can lead to serious complications over time, as well as acute problems if there is a very large spike. It can also be a problem when blood glucose goes too low (a condition known as hypoglycemia), which can cause disorientation, seizures and coma.

This, then, is the balancing act of diabetes: keeping the glucose as low as possible but not too low. Highly motivated people like Sotomayor do particularly well with the self-management tasks of diabetes. She is also lucky enough to have health insurance, given that diabetes can be expensive to treat and requires access to good medical care.

-- Sara Sklaroff

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