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Sonia Sotomayor's nominated to the U.S. Supreme Court

Judge Sonia Sotomayor's nomination to the U.S. Supreme Court is historic not only because she is the first Latina to be nominated. Drs. Irl and James Hirsch highlight the medical advances that make it possible for a person with diabetes to be a healthy contender for this high-profile job.

Por Irl B. Hirsch y James S. Hirsch

Special to The Times

SIXTY years ago, Dr. Elliott Joslin would give medals to his diabetic patients who had exceeded their life expectancy. The medal featured a boy etched on one side, standing with his dog on a boat before a setting sun. Inscribed around the edge: EXPLORERS OF UNCHARTED SEAS.

The nomination of Judge Sonia Sotomayor to the Supreme Court has made diabetes a factor in the confirmation process. Diagnosed at age 8, she is the first nominee to have the disease, and the position's life tenure has raised valid questions about her health while also giving her critics an opening.

The good news is that no one distributes medals anymore to diabetic patients for exceeding their life expectancy, in part because a well-controlled person with diabetes should have the same life expectancy as one without it. What's more, improvements in care have sharply reduced the risk of complications, such as blindness and kidney failure.

Type 1 diabetes is a disorder in which the immune system destroys the body's insulin-producing beta cells. (The more common form of diabetes, type 2, is associated with weight gain and aging.) No one is declaring victory over diabetes, which is increasing at epidemic rates and imposes huge burdens on patients, their families and the entire health-care system.

But Judge Sotomayor's nomination should be given its historic due. If a Latina would have never been considered for the highest court 40 years ago or even 20 years ago, neither would have a person with diabetes. Workplace discrimination was common; social stigmas flourished; misperceptions were the norm.

Until insulin's discovery in 1922, there was no effective treatment. Your diagnosis was your death sentence. Insulin, however, allowed patients to live by the grace of this miracle drug — making them, as Dr. Joslin said, "the explorers of uncharted seas." But those waters were hardly calm.

Insulin helps regulate blood-glucose levels, but for much of the 20th century, patients simply didn't have the tools — including a way to actually measure blood sugar — to maintain near-normal levels. It was thought that those with diabetes who took their medication, exercised and ate balanced meals would be in better shape, but even for them, genetics — luck — played a huge role in complications and mortality.

The landscape began to change about 25 years ago. First, using crude clinical tools, researchers funded by the National Institutes of Health confirmed that near-normal blood-glucose levels do indeed reduce eye and kidney disease, a finding that has now been extended to other complications. Today, patients have the means to more closely replicate the way a non-diabetic body functions.

Insulins, for example, have evolved from animal-based concoctions to purer, faster-acting synthetic solutions. Today's home blood-glucose meters are sleek, fast instruments whose numbers can be downloaded, manipulated and displayed for easy analysis. Insulin pumps have also become high-tech wonders that allow users to micromanage their disease and, more recently, real-time continuous glucose sensors have become routine for many, paving the road for our next triumph, an artificial pancreas.

Make no mistake, good diabetes care requires financial resources, a qualified health-care team and personal commitment. Too many patients still fall short of their goal and our health-care system is far from perfect. But our improved tools are paying dividends. In a typical half-day clinic at the University of Washington Diabetes Care Center, nine or 10 patients collectively can boast of more than 300 years of diabetes duration. Patients with what was once called "juvenile diabetes" are now Medicare age.

We won't predict what type of Supreme Court Justice Sonia Sotomayor will be, but we do know that her health care will be guided by tools and technology that none of us have yet imagined.

Diabetic patients are still exploring the uncharted seas, but now they're sailing with the wind to their backs.

Irl B. Hirsch, left, is a professor of medicine at the University of Washington in Seattle. James S. Hirsch is the author of "Cheating Destiny: Living with Diabetes."

Copyright © 2009 The Seattle Times Company

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