My Life With Diabetes

It is always interesting trying to observe something that we don’t ourselves live with. Though I do not have diabetes, I am surrounded by it through family, friends and work on a daily basis.

This is a blessing in disguise, both for the education I receive on living a healthy lifestyle to ensure that I don’t develop the disease (which is prevalent on both sides of my family) and for helping me assist the one person closest to me in this world – my dad.

When I returned home to Australia in November – kind of an annual pilgrimage for me – I found myself once again at my dad’s house keenly observing his type 2 diabetes management (he was diagnosed in 1997), which, as I understand, is downright poor. My dad is my role model, mentor, father and best friend. So I decided to bring him a new Bayer Contour meter after learning he had not checked his blood sugar in more than six months! It was a gift that he assured me he would use if I brought it with strips – which I did.

One day my dad had just come home from work and we were preparing a big Aussie BBQ. It had been a long, hot day – my toddler brothers were bouncing off the wall and everyone was getting hungry. The stress level was high. Dad had begun to become more and more uptight, and after he commented that his blood sugar was low I asked him how he knew it was low if he never tested?

Have you ever tried challenging a person with diabetes at a high-stress time? Now I’m sure we all know someone who feels the need to justify his lack of pro-activity in managing his diabetes. But it was the next thing Dad said that motivated me to write this: “I don’t care about my health right now.”

A feeling of defeat shot through me, although I knew this was ultimately not my fight or responsibility. All I could do was continue to encourage change. Pictures of his beloved mother, who passed away at 65 from a stroke due to poor diabetes control, suddenly flashed through my mind. I asked myself, “Is this when he will begin to care, after it’s too late?”

Feeling Frustrated

Having someone so close to me visibly affected by diabetes made it frustrating for me to be around him. I felt like a nagging son. I was really hoping that he would receive a message coming from me better than coming from his doctor. As my visit stretched on, we got into constant discussions about testing blood sugar, eating better, not smoking, and of course, exercise! In the end, though, I believe my whole trip went by without him taking even one BG test – something I continue to work on from abroad encouraging him to do.

Although my visit went by without much visible progress, both of us did experience a definite feeling of achievement. My dad agreed that he needed to make some lifestyle changes and even went in numerous times for lab work to check on his cholesterol, glucose and other indicators. In the end, I did begin to see a small shift in his attitude, from that of a man who says, “I just take my pill everyday,” to that of somebody who saw that he could control his diabetes rather than have it control him.

I could go on about the ups and downs of diabetes management I witnessed, but my goal was to support someone I love dearly so that he could live a healthy and prosperous life. As I told my dad that day, “You may not care about your health, but I do.” He is a brilliant man of whom I am so proud, and I just want him to know that he has my unconditional support, always.

Story from: Diabetes Health

Denver Broncos quarterback Jay Cutler plays in the “Mile-High City.” But he was higher than usual last season.

How high? A normally functioning body’s glucose level is generally between 70 and 150 mg. But Cutler says that as he lay gasping in his apartment, trying to recapture some modicum of energy after his morning workouts in January and February, his glucose levels were probably “in the 500s and 600s.” He would sleep from 2 to 6 p.m., eat dinner, and then go back to sleep for the night.

Cutler had all the classic signs of diabetes. In addition to the weight loss and lack of energy, he experienced frequent urination and constant thirst.

When he was diagnosed with type 1 diabetes in mid-April, it was a relief. “I was just glad for a diagnosis,” Cutler says. “Not knowing what was wrong was much scarier.”

The 6-foot-3 Cutler, who will soon be outfitted with an insulin pump, began dropping weight in October. He ultimately lost 32 pounds, down to 202 by the time he was diagnosed. Routine blood tests required of players in the National Football League revealed that his glucose levels were about five times higher than normal.

Cutler is far from the first football player to get diabetes. Former Broncos defensive end Mike Sinclair, former Vikings and Cowboys quarterback Wade Wilson, and former Titans defensive backs Tony George and Mike Echols all continued to play in the NFL after being diagnosed with diabetes. The list of professional athletes with diabetes includes tennis great Billy Jean King, former heavyweight champion Joe Frazier, Olympic swimmer Gary Hall Jr., golfers Kelli Kuehne and Michelle McGann, and basketball player Adam Morrison of the Charlotte Bobcats.

Cutler, 25, told Diabetes Health he feels a crisis was narrowly averted. “I’ve talked to a lot of people and read stories, and the way many of them find out is they go into a coma for two, three days,” said Cutler, who has regained 18 pounds since his diagnosis. “I’m fortunate nothing critical happened.”

Cutler says he’s radically altered his diet from the days when he ate “anything and everything.”

“It’s a big adjustment,” he said. “You’re 25 years old, you’re used to eating whatever you want, doing whatever you want. If you want to go out to lunch, go ahead and go. Now, you’re counting carbs and eating healthier and injecting insulin at the table. You’ve got to have your insulin, your needles, your glucose meter…yeah, it’s a big change. But it’s something you have to deal with.”

Now he’s working with doctors to make sure he can play to his potential on game days without putting himself at risk. He’ll wear an insulin pump in practices and warm-ups to keep his glucose levels normal. Then he’ll take the device off for the games, closely monitoring his glucose levels and drinking Gatorade if his BGs start dropping.

“The more knowledge I get, the more I will be able to manage [my diabetes],” Cutler told ABC News.

Cutler does admit to being a little overwhelmed with all of the information he’s had to take in about diabetes and its ramifications if left uncontrolled.

“It’s a lot to get that news and realize I’m going to have to completely change my life,” Cutler says. “It’s not something that’s going to go away. It’s something I’m going to have to deal with my entire life, and I’ve got to come to grips with that.”

He says he initially feared his career would be over, but doctors put that fear to rest quickly.

“The first thing they said to me [was], ‘It’s going to affect your lifestyle a little bit, but you’ll be able to continue to play football,’” Cutler says.

Cutler, the eleventh pick in the 2006 draft, threw for nearly 3,500 yards and 20 touchdowns last season, but the Broncos missed the playoffs for a second straight year. It was obvious as the season wore on that his arm strength was not what it used to be.

“I’m not going to blame it on diabetes, but thinking back, there were some throws that didn’t have a lot on them,” Cutler says. “I was able to go out and perform, but I just wasn’t that energetic. I was tired. After the games, I was completely wiped out. Some games I didn’t do a whole lot. There was something wrong.”

Today, the third-year quarterback says he feels terrific, and he’s eager to get into practices to see how his body reacts. He wants fans to know he’s going to be fine.

“I’m feeling a hundred times better,” Cutler says. “It’s hard to explain what it feels like when your levels are at 400, 500. You don’t have energy, you don’t really want to do anything, you sleep a lot. It’s tough to deal with.”

Now Cutler is taking up the diabetes cause. He’s appeared on the Today Show, chatting with Al Roker before the weather forecast, and he let cameras trail him for a segment about diabetes on the NFL Network. He’s also planning a golf tournament in Parker, Colorado, to raise money for juvenile diabetes, among several causes.

“I’m blessed to have a [public] profile where I can actually do something to promote awareness about the disease that I have,” Cutler says. “Not many people are in that position.”

Story from: Diabetes Health

Every pilot’s nightmare is the thought of losing his medical certification and being stopped from flying. That happened to me in May of 1986, when I was diagnosed with type 1. In accordance with the International Civil Aviation Organization (ICAO) Standards and Recommended Practices, Canada, along with every other country in the world, would not allow insulin-dependent pilots to hold any type of pilot’s license. My short eight-year career with Air Canada came to an abrupt end, and I was told in no uncertain terms that I would never be allowed to fly an aircraft again.

The ICAO worried that a type 1 pilot might not always be able to maintain the delicate balance of food intake, timing of meals, insulin, exercise and fatigue that all type 1’s struggle with. If a pilot suffered a low blood glucose during flight, he could lose consciousness, with obvious disastrous consequences. For these safety reasons, the ICAO prohibited all persons with type 1 from acting as a crewmember. In 1986, no consideration was given to how well an individual could control his diabetes.

Because I was only 30 years old at the time, I decided to start a new career. What followed was a five-year commitment to obtain my law degree and three years of private practice as a general practice lawyer. Although I did not specifically pick my new job as a lawyer with the intent of attempting to regain my pilot’s license, it turned out that this became a fortuitous benefit of my newly chosen career. Special thanks must go to Air Canada because they were very supportive during this transition period. I was hired as a simulator instructor and spent eight years as both a full-time and, during law school, a part-time simulator instructor on the DC-9, teaching other pilots how to fly this aircraft.

In 1982, Transport Canada’s Civil Aviation Medicine Branch decided to reexamine its policies on diabetes mellitus. However, this proved to be a very drawn out affair. In 1986, Transport Canada started to look at re-licensing pilots who had non-insulin dependent diabetes and who were taking oral agents to control their diabetes. Unfortunately for me, Transport Canada was still shying away from looking at insulin-treated diabetes. Things turned the corner in April 1992, when a panel of expert doctors met to review diabetes in the context of the modern aviation environment. Thanks to the work of the late Dr. Gerald S. Wong, Dr. James Wallace, Dr. Robert Depuis, and Dr. G.Y. Takahashi, a new process for pilots with type 1 was born.
During this ten-year process, the Canadian Diabetes Association decided to take the issue to court in an attempt to speed things up. The Canadian Charter of Rights and Freedoms was used to attempt to force Transport Canada to develop guidelines to reinstate pilots with type 1. In Her Majesty the Queen as represented by the Minister of Transport (Appellant) (Defendant) v. Eileen Grace Bahlsen (Respondent) (Plaintiff) (1996), the Federal Court of Appeal ruled that refusing a medical certificate to an applicant for a pilot’s license because of a blanket prohibition against diabetes was justified under Canadian law. Even though the practice discriminated against the applicant, the court held that as there was no other state licensing type 1 pilots for solo (single pilot) flight, and as there was no consensus of medical opinion on the safety of solo flight by insulin-dependent pilots, Transport Canada was justified in prohibiting pilots with type 1 from flying. The case did, however, help spur Transport Canada into looking at re-licensing pilots with diabetes for multi-crewed aircraft.

The very first pilot in the world with type 1 to get his medical certification and, therefore, his pilot’s license reinstated was a Canadian military pilot, Capt. Chuck Grenkow. Chuck became a diabetic in 1987. After two years of monitoring and individual assessments of his ability to control his diabetes, a very forward thinking Dr. Gary Gray, with the help of Chuck’s endocrinologist, Dr. John Dupre, authorized Chuck to return to flying duties. In August of 1989, Chuck moved to Summerside PEI and returned to active flying status at 413 Sqn. Chuck is presently working as a Major in Esquimalt, BC, where he is still licensed to fly. He will be retiring from the Canadian Forces in July of 2010.

On the civilian side of things, it took much longer.

John McDermott was the first civilian pilot to receive his medical certification with type 1. John had been a Boeing 727 Captain with Air Canada before developing diabetes in 1981. John’s medical certificate was returned to him in September of 1999, and he returned to Air Canada on a Boeing 767 course. Unfortunately, John ran into a number of circumstances totally outside of flying that precluded him from completing his return to work. John was the pioneer in the return-to-work protocol, and it is quite likely that without his efforts, none of the rest of us would have been able to return to flying. He is owed a great debt for paving the way for others.

Brett Walker was next. Brett was diagnosed with diabetes in December of 1998, but he was able to stay off insulin for awhile and continue flying the Boeing 737 and later the Airbus A320. He had to start taking insulin in December 2000 and had his medical certification revoked at that time, but it was returned to him in June of 2001. Brett returned to flying as a First Officer (Co-Pilot) on the Airbus A320 based in Toronto. Brett was the very first civilian pilot with type 1 to return to operational line flying anywhere in the world.

Next came myself and another Air Canada First Officer whom we will call “Tom.” We both received our medical recertification in December of 2001. Tom returned to flying on the Airbus A320 in January of 2002. He is now an Embraer Captain based in Toronto.

I took a little longer because I was living in Hong Kong at the time. I gave up the practice of law in 1994 and moved to Hong Kong to work as a simulator instructor on the Airbus A340 with Cathay Pacific Airways. Following our family’s return from Hong Kong, I returned to Air Canada in November of 2002 as a Captain on the Airbus A320. The return-to-work protocol required me to fly as a First Officer for the first six months to make sure everything went well, but I was able to transition into the left seat (Captain) in October 2003. This made me the first person in the world to fly as the Captain of a commercial airliner while taking insulin. In June 2006, I transitioned to the Boeing 767, which I am still happily flying on international routes around the globe.

Ron Swaisland was the latest of the current crop of airline pilots with diabetes. Ron was first diagnosed with type 2 diabetes in August of 1996. He maintained his active flight status by controlling his blood glucose levels with diet and exercise until July of 2004, when he had to transition to oral medications. Unfortunately for Ron, the oral medications proved unsuccessful and he was placed on insulin therapy in October 2004. Ron returned to active flying status in June 2006 as an Airbus A340 Captain. He retired from Air Canada on June 1, 2007.

Canada is the only country in the world allowing commercial pilots with type 1 to fly, and we are subject to a very strict in-flight protocol to ensure the safety of our flights. We must complete a fingertip blood test within 30 minutes prior to flight departure and at least every 60 minutes thereafter for the duration of the flight. In cases when the blood glucose readings are in the lower range of acceptable readings, that time period is reduced to 30 minutes between blood tests. All of these readings must be forwarded to Transport Canada with each medical renewal, and these readings are the deciding factor in whether our medical certificates are re-issued each medical cycle. We are by far the most medically scrutinized pilots in the world. Our licenses are never renewed: they are revoked at the end of each medical period and then re-issued if we continue to comply with the requirements set forth by Transport Canada.

Today in Canada there are 15 Airline Transport or Commercial pilots with type 1. Three of us continue fly for Air Canada. There are also two air traffic controllers working with type 1.

Canadian pilots are still the only pilots in the world flying with type 1 in a commercial environment. We hope that through our experiences in Canada, type 1 pilots in other countries will eventually gain the medical re-certification that Transport Canada has provided to us.

For each one of the pilots named in this article, a very special thank you must go to the doctors who saw fit to give us the opportunity to return to work. To Drs. Gary Gray at the DRDC, Jim Wallace and Edward Brook at Transport Canada, Ed Bekeris, Craig Winsor and Peter Hopkins at Air Canada, along with some very special endocrinologists, Dr. John Dupre and Dr. Irv Gottesman, we give our personal thanks. A very special thank you is also owed to Capt. Dave Noble of the Air Canada Pilots Association and to Air Canada Flight Operations Management for their help in the return-to-work process. Without the help of these individuals, none of this would have been possible.

Story from: Diabetes Health