Why patients train every day

Tuesday, August 5, 2008

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 let glucose enter cells from the blood stream and allow that power generation to happen. In healthy people, the pancreas can help regulate blood sugar levels and make certain cells get the energy source they need. In patients 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 and 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 became 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 diabetic always needs to be working to maintain normal blood sugar levels. This was a relatively new concept. Not so long ago, the hope was that one insulin injection a day would be enough to return diabetics to their normal state. Blood sugars were allowed to fluctuate in a wide band and patients and their doctors were comfortable with the trade off. Once or twice a day shots didn’t affect lifestyle. But “OK” control wasn’t “OK”.

Research showed that blood sugars should be kept in a tight band of normal and technology should adapt to make that happen. Smaller glucose meters were developed. Insulin pumps became more routine. 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 happens year round 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 and 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 diabetic gets to cheer thirty years later playing with grandkids.

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