Sotomayor's Diabetes: Will It Be a Handicap?

As President Obama's first nominee to the Supreme Court, Judge Sonia Sotomayor approaches the bench with a number of firsts. If she is confirmed to the lifelong post, as is widely expected, Sotomayor would be the first Hispanic to sit on the high court, and she would also be the first Justice with Type 1 diabetes.

The nominee's chronic condition is worth noting, since it puts her at increased risk of several serious medical conditions, including heart disease, kidney problems, blindness and nerve damage — and an increased risk of early death. Studies show that adults with diabetes are two to four times more likely than non-diabetics to die of heart disease. But when treated correctly, say doctors, Type 1 diabetes patients are able to lead relatively healthy lives. The latest data suggest that patients can successfully manage the disease for four or five decades with no serious health complications. (See pictures of Sotomayor.)

Still, while better medications have helped reduce deaths due to heart disease among Type 1 and Type 2 diabetes patients, that trend has been seen only among men. Between 1971 and 2000, heart-related deaths among men with diabetes dropped by half but doubled among diabetic women in the same time period, according to a 2007 study. Many diabetes patients also suffer from poor circulation, which puts them at higher risk of vision problems and amputation when blood does not adequately nourish tissues.

Once known as juvenile diabetes, Type 1 diabetes typically begins in childhood — Sotomayor was diagnosed at age 8 — eventually causing the body to slow production of insulin, the hormone necessary to break down sugars found in food. (In Type 2, or adult-onset, diabetes the pancreas continues to make insulin, but the body fails to respond properly to the hormone's signals.) While it is not yet clear what causes Type 1 diabetes, some experts believe that a patient's own immune system starts to attack insulin-producing cells in the pancreas, ultimately leading to a drop-off in hormone production. (Watch TIME's video "Uninsured Again.")

Without enough naturally produced insulin, Type 1 diabetes patients must rely on an artificial source; some patients wear insulin pumps, which are permanently inserted under the skin to deliver a dose of the hormone after each meal or snack, while others self-administer regular insulin injections to sustain normal levels throughout the day.

The proper management of blood-sugar levels, say experts, can keep many diabetes-related complications at bay. Today, patients can choose from among 20 highly effective types of insulin, some man-made and some derived from animals. One synthetic product called pramlintide, which was recently approved by the FDA, appears to control blood-sugar levels more naturally, without the huge dips in glucose that can occur when the body receives too much insulin at one time. The more successful a patient is at maintaining consistently normal blood-sugar levels, the more likely she will be able to avoid damage to the heart, kidney or other organs.

"In the days leading up to this nomination, there were several media reports suggesting that Judge Sotomayor should not be considered for this position simply because she has Type 1 diabetes," said Dr. R. Paul Robertson, president of the American Diabetes Association, in a statement following Sotomayor's nomination. "The advancements in the management of Type 1 diabetes have been just amazing over the last two decades, and the ability of people to manage their diabetes successfully has been proven. People with diabetes can function and live a long and healthy life."

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