Sotomayor - First Hispanic & Type 1 Diabetic?

I don't know that much about Supreme Court nominee Sonia Sotomayor yet. I just know the press has made a big deal about her being a woman and Hispanic. The more diverse the Supreme Court, the better, in my opinion (obviously taking into account who's qualified and who's not).

Well, today I ran across something else that I'm sure will come up in the confirmation process: she's got Type 1 Diabetes! As much as I don't wish this stupid disease on others, I always secretly wish for more high profile Type 1's. There's so much misinformation out there about this disease and having more intelligent, open, famous folks speaking up about it can only serve to correct some misconceptions. I look forward (at least now I do...hopefully that won't change later) to what's to come.

I'll start off with the process. Here are some notes that need to be added to the Time article (Sotomayor's Diabetes: Will It Be a Handicap?) I just read:

"Once known as juvenile diabetes, Type 1 diabetes typically begins in childhood - Sotomayor was diagnosed at age 8 - eventually causing the body to slow production of insulin, the hormone necessary to break down sugars found in food."

Eventually causing the body to slow production of insulin? Do they mean before you're diagnosed or what? Type 1 is usually diagnosed when 90% or more of the beta cells in the pancreas have already been destroyed by the immune system. Most of us by then have virtually no insulin production whatsoever. It's not a slowing down. It's a complete or near-complete stopping. An absolute, life-threatening deficiency that results in coma and/or death if not caught in time. "Eventually" makes it sound like you get the disease and then some years later your insulin production winds down. Shah, I wish.

Type 1 diabetes patients must rely on an artificial source (of insulin); some patients wear insulin pumps, which are permanently inserted under the skin...

Fail. Popular misconception. Even the anesthesiologist at the knee surgery clinic had no clue about my pump, thinking it was implanted or something. There's nothing permament about today's insulin pumps. The insulin is delivered via an "infusion set", through a tube connected to a tiny canula inserted just under the skin, held in place by an adhesive patch. Nothing near permanent. You must do a whole new infusion set (new insulin reservoir, new canula, new location under the skin) every 2 to 3 days. Now, to continue...

...permanently inserted under the skin to deliver a dose of the hormone after each meal or snack...

We don't just have to take insulin after a meal or snack. Another very common misconception that I'd just like to mention here. It's actually all the time that we need insulin. All people (you, too!) have to have insulin in the body 24/7, whether you eat or not. This is called "basal insulin" and your body needs it constantly. Insulin pumps deliver small doses of insulin every minute of the day, according to personalized patterns (like you usually need more insulin in the morning than in the afternoon, so you might set your pump to give you less after 1pm). Then we give ourselves more insulin (a "bolus") when we eat or otherwise need to due to stress, illness, whatever.

People on insulin shots also have to give themselves basal insulin. Newer analogs like Lantus and Levemir allow them to take 1 shot of basal insulin per day that will then slowly absorb at a fairly constant rate under the skin over about 20 to 24 hours (as opposed to the older basal insulins which were given twice a day). Then they must take an additional shot of a different faster-acting insulin for meals, etc. So they use two different insulins. (Or older mix insulins like 70/30, but I'm just trying to make things simple, lol.)

One synthetic product called pramlintide, which was recently approved by the FDA, appears to control blood-sugar levels more naturally, without the huge dips in glucose that can occur when the body receives too much insulin at one time.

Controls it more naturally than what??? Insulin?? You still have to take insulin like always! Pramlintide (brand name Symlin) is the synthetic version of another hormone (amylin) that is made by the pancreas at the same time insulin is. That's right.. Type 1 Diabetics don't make insulin, amylin or c-peptide. Thrice screwed. Amylin mainly controls the speed at which the stomach empties into the small intestine and it reduces the nutrient-stimulated sugar release that the liver would do in its absence (along with some other less-researched things like affecting bone breakdown rates, brain chemicals, etc). By adding amylin shots in addition to insulin, the body functions a little more normally, yes... meaning the stomach empties at a more normal rate so the blood sugar doesn't rise as quickly, giving the insulin shot/bolus more time to get into the bloodstream before the food's glucose does. But you're actually MORE likely to have "dips in glucose" on amylin because often the insulin will hit before the food does. It takes extra care to figure out how to adjust your insulin (with a pump is easier) for a later time. Hypoglycemia is one of the side effects. Man, oh man. Guess they should have read the brochure on the Symlin website... (Btw: This product isn't available in Europe. And it was approved "recently" in America if that means a few years ago. I was using Symlin back in America in 2005.)

"In the days leading up to this nomination, there were several media reports suggesting that Judge Sotomayor should not be considered for this position simply because she has Type 1 diabetes," said Dr. R. Paul Robertson, president of the American Diabetes Association... "The advancements in the management of Type 1 diabetes have been just amazing over the last two decades, and the ability of people to manage their diabetes successfully has been proven. People with diabetes can function and live a long and healthy life."

That's right, but it takes work and you never get a vacation from it. Although this disease does mean some more dangerous jobs may not be allowed in some countries (pilots, divers, firefighters, military, etc), there's no reason I can see why being a Supreme Court Justice would be a problem. If Sotomayor takes care of herself (she'll have health insurance, so that's a big obstacle for many that she won't have to deal with), there's no reason she couldn't be sharp as a tack and sitting on the bench at 80 years old.