When Sonia Sotomayor was nominated for a seat on the US Supreme Court, news stories stressed that she would be the first Hispanic justice. Less noted was the probability that she would be the first justice with diabetes.
Among her endorsements from labor unions, feminists, and Hispanics was one from the American Diabetes Association. Perhaps, said its chief medical officer, Sotomayor’s nomination would shatter the stigma of diabetics as people incapable of living long, productive lives.
This stigma was especially strong in the 1960s when Sotomayor was diagnosed, at age eight, with a form of the disease then known as juvenile diabetes. That’s when she began injecting herself daily with insulin to regulate the level of sugar, or glucose, in her blood. She was disappointed as a little girl when someone told her that a diabetic was too fragile to be a detective like her literary heroine, Nancy Drew.
Sotomayor applied the same self-discipline to her diabetes that she did to her studies, which took her from a Bronx housing project to the Ivy League. She checked her blood-sugar several times a day—not too high, not too low—and gave herself insulin shots.
That was her routine as she moved through Princeton, Yale Law School, a prosecutor’s office, and private law practice and into a seat on the US Court of Appeals in New York City. She never made an issue of her diabetes and didn’t try to hide it—friends have spoken of watching her pull a glucose meter out of her purse at a restaurant, prick her finger, read the test results, and give herself a shot of insulin at the table.
Sotomayor’s quiet struggle with diabetes did have political implications: Supreme Court justices, eligible to serve for life, are scrutinized with an actuarial table. President George W. Bush had appointed two conservatives to the court with the promise of long careers—Chief Justice John Roberts, nominated at age 52, and Samuel Alito Jr., at 55. Democrats hoped for as much from Barack Obama’s first nominee. Sotomayor was 54 when she was nominated, and some people raised the question of whether someone with diabetes had a shorter life expectancy. There was a time when few people with juvenile diabetes survived past 60.
Concern about Sotomayor’s longevity was largely dispelled by a letter from the physician who had treated her for 25 years. He said she kept control of her blood sugar and showed no signs of the damage—to her eyes, kidneys, nerves, blood pressure, or heart—that the disease can inflict. Her test results suggested she’d probably be sitting on the bench next to Roberts and Alito when they all were in their eighties.
A Surprise to Many
Justice Sotomayor has lots of company. Nearly 24 million Americans have diabetes, according to the Centers for Disease Control and Prevention. More than 47,000 adults have the disease in DC, 461,000 in Maryland, and 596,000 in Virginia. There are differences by age—less than 1 percent of the population under 20 has the disease, compared with 23 percent of those 60 and older. About 224,000 Americans die each year of complications from diabetes, and it’s the leading cause of blindness, kidney failure, and non-traumatic amputations.
A quarter of America’s diabetics—nearly 6 million—don’t realize they have the disease. Some diabetics have no symptoms other than high blood sugar, detectable only by a laboratory test. Others mistake the symptoms—increased fatigue and weakness, excessive thirst, extreme hunger, dry and itchy skin, frequent urination—for signs of aging.
A diabetes diagnosis can come as a complete surprise, uncovered during some other medical event. Actress Mary Tyler Moore’s was discovered when she had a miscarriage at age 30, sports commentator Michael Wilbon’s after a heart attack.
Chris Matthews, host of MSNBC’s Hardball, first learned that his blood sugar was too high in 2002 during treatment for malaria contracted on a trip to Africa. He did nothing about it. Four years later, he was hospitalized with complications from diabetes. He was off the air for two weeks—and jolted out of his complacency. By watching what he ate, Matthews lost 30 pounds. Despite an aversion to needles, he began testing his blood sugar regularly and taking insulin injections every day.
Diabetes is growing more prevalent in the United States—the number of cases is up by 30 percent over the past decade, with nearly 4,400 new cases diagnosed each day. Contributing to that rise, besides improved detection, are a growing population of elderly and a higher incidence of obesity born of unhealthy eating habits and lack of exercise. Obesity—one of the main risk factors for diabetes—seems to explain why North America has a higher rate of diabetes than other parts of the world. The number of diabetics worldwide is estimated at 249 million.
Diabetes is more common among most minority groups. While 9.8 percent of non-Hispanic whites over age 20 have diabetes, the numbers are 14.8 percent among African-Americans, 14.2 among Native Americans, 10.4 among Hispanics—but only 7.5 percent among Asian-Americans.
DC and Prince George’s County, with high percentages of African-American residents, have the highest diabetes rates in metropolitan Washington. The worst rate in the world is among Arizona’s Pima Indians—50 percent of those over age 35 have diabetes and also suffer from obesity.
Diabetes is one of the country’s costlier diseases, with an annual bill of $174 billion. Two-thirds of that is direct medical costs—diabetes accounts for about one in every three dollars spent on Medicare—and the other third is in lost work days and diminished productivity. It’s also costly to individuals and their families, though the burden varies depending on health-insurance coverage. Sugar Ray Leonard, the boxing champion from Palmer Park, told a congressional committee that the financial burden of his father’s diabetes was one reason he abandoned plans to enroll at the University of Maryland and turned pro instead.
Diabetes has spawned many organizations to support those who have it. The American Diabetes Association, founded in 1940, is headquartered in Alexandria. It lobbies Capitol Hill for funding, raises money for private research with a Tour de Cure bike ride and other activities, and provides information to diabetics about diet, fitness, and medications through publications, a Web site, and a network of more than 100 offices nationwide. Similar efforts are made by the New York–based Juvenile Diabetes Research Foundation International, created in 1970 and often identified with its longtime spokesperson, Mary Tyler Moore, who has been joined by a new generation in 17-year-old singer Nick Jonas, who was diagnosed in 2007.
The ADA is active in fighting discrimination that diabetics have faced. The Americans with Disabilities Act was broadened to include them; the ADA pushes legislation and files lawsuits to give diabetics access to all but a few professions and to ensure that their needs are accommodated. A ban on diabetics as truck drivers was lifted in 2003, and a recent court ruling allowed a diabetic to join the FBI.
A focal point of research is in Bethesda at the National Institutes of Health, which will spend about $1 billion this year on diabetes studies, about half of them managed by the National Institute of Diabetes and Digestive and Kidney Disease. Among the goals: to understand the disease’s microbiologic complexity and use that knowledge to develop new techniques for controlling it, perhaps using stem cells.
Diabetics have lots of support on Capitol Hill. The bipartisan Diabetes Caucus is the largest in the House, with more than 250 members, several of whom have the disease or have family members who do. One cochair, Colorado congresswoman Diana DeGette, got involved a decade ago when her four-year-old daughter was diagnosed.
Screenwriters have used diabetes as a dramatic device. Crises loom when an ex-convict with diabetes loses his insulin during a plane crash in Con Air and when a teenager is locked away without hers in Panic Room. Even the murderous Michael Corleone in the Godfather series was a diabetic, as was the original book’s author, Mario Puzo.