We think famous people are different from us because they are celebrities and we are not. On the web you can easily find long lists of celebrities, living and dead, who suffered from type 1 diabetes. Nick Jonas (Jonas Brothers) who is a type 1 diabetic recently lobbied in congress for research funding and interviews with diabetics are becoming a staple of Olympic coverage. When I was diagnosed, my mind went to Mary Tyler Moore, the rare celebrity (at the time) who was open about diabetes and taking insulin as part of her life.
Diabetes poses particular challenges for athletes because it’s a disease of energy management and athletes burn a lot of energy. I recent talked to two artist-athletes, friends, about how they manage. I had imagined that they use special management.
James Samson has danced with the Paul Taylor Dance company for nine years. Seven years ago he was diagnosed with diabetes and began insulin therapy. Modern dancers work harder than ballet dancers as you can see from the video of some current Paul Taylor dances (he is on the right in the first shot and later a solo):
On a day with rehearsals and performances he gets little rest and hours of aerobic exercise. Just like all of us trying to manage our diabetes he takes his Lantus and fast insulin, and measures glucose often. Management consists of eating a lot to counteract the exercise and insulin. (With that much exercise you don’t gain weight!) He told me he cannot eat before a performance (think about dancing on a full stomach); has a snack, checks before each dance, and finally eats after the performance, perhaps as late as 11PM. That’s a challenge.
Jake Slichter is a writer living in New York that I have known a long time. He developed diabetes some years ago (he has joked he got diabetes because he was inspired by my example) and toured as a rock musician with the band “Semisonic” while managing the disease. If you have heard “Closing Time” you have heard Jake drum.
Jake worked out a routine for a performance which he is kind enough to share.
Naturally, the metabolic profile of the day before the show would affect things.
Assuming an otherwise normal day, my goal would be to start the show (90 minutes in length) at 180, test a few times during the show (I look over the set list in advance to plan my tests) and sip cranberry juice as needed, maybe as much as 12 ounces. Usually, 90 minutes of drumming plus 8 ounces of cranberry would land me at a post-show blood sugar reading of 160 or thereabouts, which is good, since it continues to fall over the next few hours.
Our road crew is always on alert if I need more juice. They usually go way overboard and have several glasses of juice at the ready. (Room temperature is optimal, in case I need to gulp.) Back in the day, one of them always had my emergency kit and was trained in its use.
With the pump, I’d remain plugged in, just as when I exercise. The pump allows you to set an alternate basal rate (“give me 50% of my usual basal rate for the next 120 minutes,” etc.), but I’ve found that my normal rate works fine. If I were an athlete, maxing out my system, I would definitely set an alternate basal rate, or even suspend delivery if I got too low. I’d also make sure to test every fifteen minutes if I could.
Hope that helps!
So there is no secret celebrity diabetes management. They do the same things we all must do to manage our sugar fuel.
The problem with being an athlete while having a serious chronic illness is that extreme exertion of the body can produce harmful stress on normal physiology, and who needs additional stresses when he is already suffering from the constant oxidative stress of type 1 diabetes? For example, even for perfectly healthy individuals, extreme running can produce severe hyponatremia, excess muscle breakdown causing renal failure, and damaging fluctuations in renal hemodynamics. (P. Clarkson, “Exertional Rhabdomyelosis and Acute Renal Failure in Marathon Runners,” Sports Medicine, vol. 37, nos. 4-5, p. 361 (2007); G. Lippi, et al, “Accute Variation of Estimated Glomerular Filtration Rate Following Half-Marathon Run,” International Journal of Sports Medicine, vol. 29, no. 12, p. 948 (2008)) Since type 1 diabetics already face a 30% chance of renal failure, the most devastating and lethal of all diabetic complications, why play games with over-stressing the kidneys? Another consideration is that many diabetics will have at least some degree of cardiac disease, which will make heart attacks much more likely as a result of exercise. Add to that the fact that exercise can stimulate the adrenal glands and cause a hyperglycemic spike not anticipated from the exertion of exercise, and you have yet another reason not to become a diabetic athlete.
There always seems to be something slightly pathetic about the person trying to overcompensate for some disability by indulging in various exhibitions of strength to convince himself and others that he is not as sick as he ultimately knows he is. Kaiser Wilhelm II was always regarded more with pity than with admiration for his remarkable skill at tennis, which he had developed to overcompensate for his vestigial left arm which had resulted from obstetric errors at his birth. My own approach on being diagnosed as diabetic was to regard athleticism as no longer a serious option, and instead to concentrate on what I could do as well as anyone else, which was study.