Health Topics > Court Nominee Manages Diabetes With Discipline

Court Nominee Manages Diabetes With Discipline

WASHINGTON — Judge Sonia Sotomayor carries a small black travel pouch, not much larger than a wallet. It contains the implements she needs — a blood sugar testing kit, a needle and insulin — to manage diabetes, a disease she has had for 46 years. Friends say she is not shy about using it.

“She’ll be eating Chinese dumplings,” said Xavier Romeu Matta, a former law clerk to the judge, “and she’ll say, ‘Excuse me sweetie,’ and pull out the kit and inject her insulin.”

That no-nonsense attitude, combined with the attention to detail that characterizes her legal opinions, has been a hallmark of Judge Sotomayor’s approach to Type 1 diabetes, according to friends, colleagues and her longtime doctor, Andrew Jay Drexler. An endocrinologist in Los Angeles, Dr. Drexler pronounced her “in very good health” in a letter provided by the White House.

In Type 1 diabetes, typically diagnosed in childhood, the body fails to produce insulin, necessary to regulate blood sugar. Experts say “tight control” of blood sugar, through careful monitoring, is essential to preventing complications, which can include blindness, kidney disease and nerve damage. Today, many patients wear pumps to deliver a steady metered dose of insulin, but Judge Sotomayor does not; her friends say she prefers to inject insulin the old-fashioned way.

In his letter, Dr. Drexler, who practiced in New York until two years ago, wrote that Judge Sotomayor has maintained “excellent control” over her blood sugar in the more than 20 years he has cared for her. She is free from eye, kidney and nerve complications and not expected to develop any, he wrote, adding that her blood sugar levels, as measured by the standard A1C hemoglobin test, have consistently been “better than 98 percent of diabetics.”

Medical experts say that is a significant achievement for a woman who has had diabetes for more than four decades. “Achieving a good A1C for 20, 30, 40 years and having a high-powered job and living your life is really challenging,” said Dr. Robin Goland, a diabetes expert at Columbia University Medical Center. “It’s hard, and not many people can do it.”

Whether the judge achieved that level of control during her first two decades with the disease is difficult to know, in part because the White House has not released records and in part because treatment and care were far less sophisticated when, as an 8-year-old girl growing up in the housing projects of the Bronx in the early 1960s, she learned she had the disease.

The discovery marked a turning point, said her brother, Juan, a doctor. As a young girl, Sonia was listless and uninterested in school, he said, but diagnosis and treatment helped lead to “a seminal change.”

Still, the outlook was grim. The assumption was that diabetes could take decades off a person’s life — a message that friends say stuck with Ms. Sotomayor.

“Sonia told me many years ago that because of her diabetes, she had only a certain amount of time to live,” said Toni Smith, who grew close to Ms. Sotomayor in 1979 when they worked together in the Manhattan district attorney’s office. “She’s lived maybe 20 years longer than she ever thought she would.”

Today, friends say, Ms. Sotomayor no longer thinks that way. “She watches her diet and does all the things somebody with diabetes who is prudent would do,” said Ellen Chapnick, a dean at Columbia Law School and a close friend, “but not in a way that makes her a victim of a disease or a person whose life is ruled by a disease.”Liver and Gallbladder Cleanse