Multiple news agencies are reporting this morning that President Barack Obama will nominate Second Circuit Court of Appeals Judge Sonia Sotomayer to fill the vacancy on the United States Supreme Court created by the resignation of Justice David Souter.
While none of the editors of InsideSurgery.com have participated in her care, we have noted the reports that Judge Sotomayor has suffered for the last forty-six years with diabetes mellitus.
Diabetes type 1 is a serious physiological condition caused by the body’s inability to produce sufficient insulin to control glucose regulation in the body. It is marked by a shortened life expectancy and severe morbidity, including cardiovascular disease, nephropathy, retinopathy, neuropathy, and immune dysfunction.
In short, patients with long-term type 1 diabetes as a population are considered by physicians to be seriously and chronically ill and to have little physiological reserve. Life expectancy for the type 1 diabestes population is estimated to be reduced by ten years as compared to the general population.
However, it is difficult to predict the course that diabetes type 1 will take over forty-five years for any one patient. Many diabetics with careful and constant glucose control and other diet and lifestyle modifications can live into their sixties and seventies with relatively few major health problems.
Prognosis for the diabetic patient must be considered in terms of both short-term and long-term complications.
Acute adverse events related to diabetes are related to derangements in the serum level of glucose and other substances. High serum glucose levels (hyperglycemia) result when the administered insulin dose or schedule is not sufficient to promote adequate uptake of glucose into the cells or a patient consumes more food than the administered amount of insulin can process.
Lack of sufficient fuel for the cell can result in diabetic ketoacidosis (aka DKA), a condition where the body switches to an alternate fuel source to provide nourishment to the cellls. Diabetic ketoacidosis is a life-threatening emergency that requires admission to an intensive care unit and immediate medical care.
Hypoglycemia (low blood sugar) occurs when an excess of insulin in the body causes too much glucose uptake and deprives the brain of its’ need fuel. In its’ most severe form, it results in seizures, confusion, and coma. In its most severe form it is a medical emergency of the highest order and requires intervention within seconds to prevent injury and death.
On a short-term basis, diabetes is monitored by subjective reports of the patient (i.e., how they are feeling) and laboratory surveillance.
The most important laboratory value to monitor when dealing with diabetes on a day-to-day basis is the serum glucose level. The most important laboratory value to monitor when evaluating diabetes control on a week-to-week basis is the serum hemoglobin A1c value, which is a measure of the glycosylation of the hemoglobin molecule (i.e., how much glucose is attached to the hemoglobing molecule.)