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Diabetes: Don't Let It Kill You

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Melissa Conrad Stöppler, MD

For the past thirty years, millions of people invited him into their homes as he broadcast Atlanta Braves baseball to the world. Skip Caray called the plays, told stories, and was like an uncle who showed up day after day to make us smile. Skip Caray died this week from the complications of diabetes.

Diabetes is pretty easy to understand. The body needs glucose (or sugar) as a power source for metabolism. Insulin, a molecule made in the pancreas, acts as a key to open cell doors and allow glucose to enter cells from the bloodstream and allow the necessary power generation to happen. In healthy people, the pancreas can help regulate blood sugar levels and make certain that cells get the energy source they need. In people with diabetes, the system doesn't work; either the pancreas doesn't make any insulin, doesn't make enough insulin, or makes insulin that isn't effective. This causes blood sugar levels to rise, cells to malfunction, and the body to break down.

The treatment of diabetes is theoretically easy. Balance the glucose intake in the diet with the amount of energy the body needs to do its chores, and then add medications by mouth or insulin injections to make it all happen. Reality isn't that easy, and for many people, poorly controlled diabetes leads to problems years later. Small blood vessels start to become narrow and fragile. Organs lose blood supply and begin to fail, slowly at first, but then life-threatening events can occur. Heart attacks, kidney failure, poor circulation in the feet (sometimes requiring amputation), and blindness are just some of the effects of blood sugar levels that remain chronically too high.

As medical science has advanced, there has become a big push to get tighter and tighter control of blood sugar levels. The highs and lows needed to be smoothed out to get as close to normal physiology as possible. This has become the mantra for diabetic care. Just like an elite athlete who is always training, the person with diabetes always needs to be working to maintain normal blood sugar levels. This is a relatively new concept. Not so long ago, the hope was that one insulin injection a day would be enough to return those with diabetes to their normal state. Blood sugars were allowed to fluctuate over a wide range, and patients and their doctors were comfortable with the trade-off. Once or twice a day shots didn't affect lifestyle. But just having "OK" control of blood sugar levels wasn't "OK".

Research showed that blood sugars should be kept within a tight range of normal, and technology should adapt to make that happen. Smaller glucose meters were developed. Insulin pumps became more routinely used. Children with diabetes weren't ostracized; they too could do what they wanted and their friends took the needles and blood tests in stride.

Skip Caray watched athletes his whole life. Early in his career, he watched them train hard during the season and then relax in the off-season, only to work even harder in spring training to regain their skills. Times change. For most pro-athletes, there is no off season. Training is a year round event to maintain performance standards, extend careers, and delay retirement.

Diabetes is no different. There are no days off. Diet, exercise, and medication need to be optimized every day to maintain body performance, avoid the complications of diabetes, and prolong a long and healthy life. The difference is that the reward for all this work comes later. An athlete will be cheered every day on the field. The individual with diabetes gets to cheer thirty years later playing with grandchildren.


Last Editorial Review: 8/7/2008




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