President Obama announces the nomination of Sonia Sotomayor on May 26, 2009.
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If she makes it through the nomination process, Judge Sonia Sotomayor would not only be the first Hispanic to sit on the U.S. Supreme Court, she would also be the first member with type 1 diabetes.
At age 8, Sotomayor was diagnosed with the chronic condition, which reduces her life expectancy by five to 10 years relative to her peers. And because the disease also puts individuals at risk of cardiovascular problems, kidney failure, nerve damage and even blindness, there has been some concern about ability to fulfill her role as a justice.
But on Thursday, a letter from Sotomayor's longtime physician, Andrew Drexler of the David Geffen School of Medicine at the University of California, Los Angeles, surfaced, allaying many of these concerns. Drexler wrote that Sotomayor "always had excellent control of her diabetes" and that "her hemoglobin A1c levels, the best measure of diabetes control, have consistently been less than 6.5 percent, the optimal level defined by all diabetes organizations." Drexler also noted that he does not expect her to develop any of the more serious complications of diabetes.
To find out more about diabetes and what Sotomayor's A1c levels really mean for the future of the Supreme Court, we spoke with Mark Schutta, an endocrinologist and medical director of the Penn Rodebaugh Diabetes Center.
[An edited transcript of the interview follows.]
What is type 1 Diabetes?
Diabetes is basically a disease where patients have an inability to make insulin. Insulin allows glucose to go from the bloodstream to the cells, where it is used as fuel. Type 1 diabetes is an autoimmune disease where the body destroys the beta cells of the pancreas: the cells that make insulin. There are several theories about its cause, including a virus or a genetic predisposition set off by an environmental trigger. It presents itself very acutely and is treated with insulin at the time of diagnosis.
What is a hemoglobin A1c test?
It represents the percentage of glucose that binds to hemoglobin in red blood cells. Because red blood cells live for about 90 days, the test gives you a good snapshot of a patient's glucose control.
Is Sotomayor's A1c healthy?
6.5 percent represents excellent control of diabetes. The American Diabetes Association recommends an A1c less than 7 percent, although they advocate that patients strive for an A1c as low as possible. The American College of Endocrinology advocates less than 6.5 percent. In reality, it's an age-dependent test, and a healthy 20-year-old person is probably at 5 percent, while there are poorly controlled patients with poor medical care who are as high as 10 to 14 percent.
The facts are that diabetic patients have a shorter life expectancy of about five to 10 years, and diabetes as a disease is the fifth leading cause of death.
How do you control it?
The standard of care is for patients to receive basal insulin injections once or twice a day, and at meal time they receive rapid-acting insulin to help them take care of the spike in blood sugar levels. One issue is the downside of insulin in that it can induce hypoglycemia [low blood sugar]. That's why it's important for patients to monitor blood sugar levels and make sure they're staying within an acceptable range.
Sounds like a lot of work. Do you think Sotomayor's diabetes should disqualify her as a Supreme Court nominee?
Absolutely not. Diabetes is challenging disease to live with, but it is also a completely manageable disease. It doesn't preclude anybody from accomplishing anything or participating in any activity.
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10 Comments
Add CommentVery good! I WILL learn from Sonia Sotomayor and strive to control my diabetes well and keep my A1c level below 6.5.
Reply | Report Abuse | Link to thisI wonder how having type 1 diabetes would impact a person's view of fetal stem cell research. It puts a human face on someone who could be saved by that research.
Reply | Report Abuse | Link to thisMemories are so short. Have we all forgotten the young man with type 1 diabetes who won Olympic Gold swimming medals for 2 olympics in a row? The idea that having type 1 diabetes disqualifies anyone for certain jobs makes less sense than prior heart attacks with a defibrillator in place. And Dick Cheney made it through 8 years one heartbeat froom the presidency just fine.
Reply | Report Abuse | Link to thisA 6.5 A1C is spectacularly good, and it speaks to Judge Sotomayor's discipline that she can maintain it. No more than a fraction of 1 percent of diabetics attain that kind of control. However, she has had diabetes for 46 years, and it is a virtual certainty that her blood sugar control was not good for most of that time. In fact, what we consider good blood sugar control now was unattainable when she was a child and a young adult. (In the 1990's, the standard set by the American Diabetes Association was an A1C of 8, which we know to be much worse for long-term health than a 7, simply because the ADA did not think it was realistic to ask people to do any better than that.) Diabetics today often combine a synthetic insulin that mimics natural, short-acting insulin, and another synthetic insulin that provides a reliable, long-acting base. Neither of those existed 15 years ago; the insulins people used before were much more problematic. There were also no home glucose meters when she was young, and no A1C test. Most diabetics, most of the time, had no real idea what their blood sugar was, and no way to find out. Year after year of that primitive kind of control may very well have taken a toll on her heart, her kidneys, her retinas, her arteries, no matter how good her recent control is. Or maybe not. There is simply no way for us to know. But for a doctor to state baldly that she's fine and suffers no effects is not very credible.
Reply | Report Abuse | Link to thisIt is, however, still 30 percent above normal. We don't really know what kind of long-term effect that has; there's simply too little evidence.
I agree. Please note this recent accomplishment by Type 1 diabetics below in the Race Across America. I've qualified and run the Boston Marathon myself.
Reply | Report Abuse | Link to thishttp://www.nytimes.com/2009/06/30/health/30well.html?em
"Last week, a team of eight cyclists completed the coast-to-coast bike marathon called the Race Across America in record time. It was quite an achievement under any circumstances, but what made it extraordinary was something all eight of them had in common: Type 1 diabetes."
Diabetes Dad, I don't understand this sentence by you: "But for a doctor to state baldly that she's fine and suffers no effects is not very credible."
Reply | Report Abuse | Link to thisI'm sure it would be valuable for her doctor to reveal more details on her health (eyes, heart, kidneys, etc). There is a way to better verify her health by looking at the history of her tests (if that is even allowed, but I don't see where this plays into her's or anyone elses nomination). My endocrinologist of the past 15+ years has all my A1C #'s, annual 24 hr urine collection for protein, creatine clearance rates, lipid profile, and other tests from my eye doctor which indicate that my 23 years with diabetes has not resulted in any detectable adverse impacts to my eyes, kidneys and nerve extremities. Granted I've maintained an avg. 5.7-6.2 A1C level during this period due to discipline of vigorious exercise 6-7 dayts/week, testing my blood glucose 8-10 times/day to correct highs and lows, and watching my diet as best I can. My doctor would be able to confidently state that my physical health is as good, if not much better than the majority of US population, especially for my age, 48.
Remember Tilden, childhood diabetic, who got the advantage of the newly discovered insulin, and went on to become world one Tennis.
Reply | Report Abuse | Link to thisDiabeted Dad concludes "It is, however, still 30 percent above normal."
Reply | Report Abuse | Link to thisThe Q&A above states "a healthy 20-year-old person is probably at 5 percent."
Yes, she's 30% over the perfect number for a perfect 20-year-old...in a more reasonable comparison, her 6.5 is barely over the 5.7-6.2 range maintained by the impressive 48-year-old, quadkk. To my inexperienced eye, it seems like she's at an A1C that any diabetic would love to have and maintain. Is there still a danger of cumulative damage at 6.5?
Nice article. MensaJeff - yes there is still a danger of damage at 6.5. Even though doctors suggest an A1C of less than 7 is acceptable, the risks of cardiovascular disease and amputation are still quite elevated at this level. There is research currently going on to investigate this, and the utility of post-prandial readings to determine overall risk. If anyone has questions about diabetes, you can ask me at my hub:
Reply | Report Abuse | Link to thishttp://hubpages.com/hub/hemoglobin-a1c
Diabetes shouldn't be the problem here. It should be the fact that this judge may need an <a href="http://barringtonfamilyeyecare.com">eye doctor</a> instead. She needs to see what is going on in regards to the Obama administration.
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