diabetes culminating task1

							Part I:                           Andrea: The Death of a Diabetic
                                      by Clyde Freeman Herreid
                                  Department of Biological Sciences
                        University of Buffalo, State University of New York
          Edited by D. Danter (Sir Frederick Banting S.S.) and M. McLean (A.B. Lucas S.S.)

My sister, Andrea, was born in 1948 and she suffered from diabetes. She died in 1987, when she
was only 39. If she had lived a century earlier, she would have been dead by the age of 14,
shortly after her condition was discovered. If she had been born today, she probably would have
lived a full life. My parents told me Andrea had diabetes right after she was diagnosed, during
my first year at Harbord Collegiate in Toronto. I didn’t know what to make of the news, except
that I figured it was serious. My parents’ faces confirmed that for me. Later on, I learned that
Andrea would have the disease as long as she lived. I found out that she would be taking insulin
shots (made from pig insulin) every day of her life in order to survive.
Somewhere along the way I learned that my grandmother, Cora, had diabetic symptoms when she
was a young woman. She was able to control her mild diabetes by diet; lucky for her because
insulin had not yet been discovered.
During my second year at school, I had a teacher named Miss Simmons. She found out who in
her history class planned to go to college and those of us that dared to raise our hands were given
special a special assignment. We were to write a term paper, to help prepare us for next level. My
mother, upon hearing of this anxiety-provoking assignment, immediately suggested I write my
term paper on the topic of diabetes so I would better understand my sister’s disease. I could not
think of a better topic and so I agreed.
A couple of times a week, the future collegians were excused from the regular classroom grind
and allowed to go to the library to do research. Days and weeks passed as we looked through
encyclopedias, biographies, and thousands of pages of the Reader’s Guide to Periodical
Literature (no Internet in those days.) I read Banting and Best’s story of their discovery of
insulin. I learned that they removed the pancreas from dogs, causing them to develop diabetes.
They then “cured it” by injecting a solution of juices they had isolated from the pancreas. The
hormone insulin was on its way to being discovered.
My file cards rapidly filled with the reports of old books and journal articles. I filled them out
with an intensity born of the fear of meeting with Miss Simmons each Monday to review my
progress. More cards meant more progress. I learned about the Islets of Langerhans, named for a
scientist who discovered microscopic islands of tissue embedded among the other cells of the
pancreas. These cells were dedicated to producing digestive enzymes to squirt into the small
intestine. Langerhans didn’t seem to have a clue as to why the islets were there, but Banting and
Best thought they knew: the beta cells of the Islets were responsible for secreting insulin. This
insulin was necessary so that the body cells could absorb the blood sugar that was part of every
meal. Without insulin, Andrea’s cells would starve to death, even though she had plenty of sugar
in her blood. In fact, like other diabetics, she had so much that it spilled over into the urine and it
could be measured there. Each day she would measure her sugar level and then inject insulin into
her thigh, or else she would waste away.

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My cards multiplied and I finally got to the point where I wrote my term paper. I don’t remember
the grade I got, but my father deserves some of the credit for whatever success I had. He typed
my hand written notes into the wee hours of the night before the paper was to be handed in. And
if we are to believe recent genetic studies, he deserves some of the blame as well because
juvenile diabetes is inherited.
Time passed and I eventually graduated and moved on to university in Kingston. Andrea even
followed me to Queen’s University. After I had been there a couple of years, I was surprised to
be joined by my sister, along with instructions from my father to look after her. I did so with
little enthusiasm. I would say hello to her, on the rare occasions when we crossed paths on
campus, and we would talk on the phone infrequently. We never talked about her health. I didn’t
want to, and she didn’t either. What was there to say? Injections were not part of my life.
After Andrea’s freshman year, she decided that Kingston wasn’t the place for her. She returned
home and went to the University of Toronto. I don’t know how all of this came about except that
she was gone. I had the distinct feeling that I had not been there for her.
I think that the University of Toronto was a good choice for her. She went to classes, parties, and
maintained her good looks. After Andrea graduated, she married a lawyer-to-be, and helped him
struggle through school. Andrea and her husband adopted a child because she had repeated
miscarriages due to her diabetes. Unfortunately, Andrea and her husband would eventually
divorce, in part I think, because of the stresses caused by trying to manage her diabetes.
I heard from Andrea over the years, mostly by the obligatory Christmas cards or secondhand
news via my mother. Andrea, along with the rest of my family, remained in southern Ontario
while I was moving about the country getting an education. I eventually got married, had a
couple of children, only to settle on the opposite side of the country in Edmonton. I would hear of
Andrea’s occasional misfortune when she misjudged her insulin doses and went into a coma and
was hospitalized. This news was always days after the event, in time for me to feel glad that she
had recovered.
One day I was startled to hear that Andrea was coming to Edmonton. We soon learned she was
going blind. As she walked through our house, she was constantly touching the furniture and
curtains, not only for security I think, but to reassure herself of their reality and the texture of life.
She told us that only an operation would save her eyes; something about detached retinas. Her
physicians didn’t hold out much hope because of her lifelong treatment with insulin. Although
insulin had saved her life, it had also wreaked havoc with her circulatory system. Her declining
vision was only part of the problem; her entire cardiovascular system was compromised. It turns
out that any operation carried with it a high degree of risk because of her diabetes.
Even so, my sister was adamant that she was going to have the surgery. She had tried going to
classes designed to help patients who were going blind and my mother was being supportive by
volunteering at an institute for the blind. This was all to no avail, and Andrea despaired at the
thought of her inevitable blindness. She said she would rather be dead than blind.



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Andrea died on the operating table at the age of 39. It was cardiac arrest, not an uncommon fate
for diabetics whose cardiovascular systems were compromised. She left an adopted three-year old
daughter, who eventually went to live with her ex-husband who had since remarried. Andrea had
anticipated every eventuality and had signed a waver saying that she was aware of all of the
potential dangers. She had also visited me to say goodbye—except I didn’t know it at the time.

Questions:
1. Give an overview on blood sugar regulation discussing, glands, hormones & negative feedback.
2. List the causes, symptoms and treatment of Type I diabetes?
3. What is the role of GLUT 4 receptors and how are they affected by Type I diabetes? How are
    GLUT 4 receptors affected by training?
4. Compare Type I and Type II diabetes.
5. What are risk susceptibility genes, and what effect do they have on the development of diabetes?
6. Investigate the cardiovascular and neural pathologies contributing to the following conditions:
           a) Chronic foot problems
           b) Vision problems leading to blindness
7. What are the causes, symptoms and treatments for ketoacidosis?
8. Why do Type I diabetics have a high urine output?
9. Why did Andrea die from a heart attack on the operating table?




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Part II:                         Sally: The Death of a Hurdler
                                        by Mark McLean
                                  A.B. Lucas Secondary School

At 27 years old, Sally Youngblood is the current national 400m hurdles champion and is
currently ranked as the number one hurdler in the world. The next Olympics are still a few years
away, but she had one clear goal; an Olympic Gold Medal. She missed the previous Olympics
due to an injury, and she knows her window of success in competition is closing.
Sally Youngbood’s last day alive began as any other day, a full breakfast, a brief 10km jog and
then a massage before starting her daily training regiment. She lived and trained all year long at
the National Academy for Track and Field with 40 of the top athletes in the country. Her training
partners said that she had been her happy and jovial self and that she consumed 2 Coca-Cola’s
and a Snicker’s Bar right at the start of training. Training began normally that day, but her
training partners quickly noticed that she was sitting beside the track and had stopped training
within 20 minutes of the start. When asked if there was a problem, she was quite irritable and
said she was not feeling well. Unbeknownst to her, she would be dead within 40 minutes.
The academy’s doctor said that she had come in complaining of intense hunger, lack of energy
and was trembling. After a brief check, the doctor assumed she was suffering from hypoglycemia
and offered her some Orange Juice. When asked, Sally stated that she had no medical issues with
her blood sugar what so ever. Within minutes, Sally went unconscious and died in the ambulance
on the way to the hospital.
Authorities later found vials of Humalog Insulin and several syringes in her duffel bag.
Subsequently it was determined that she had been seen injecting something just prior to the
training session. This was confirmed by fresh needle marks on her thighs.

Questions
1. The International Olympic Committee placed Insulin on the banned substances list in
   1998. Describe the athletic advantage that would be obtained by injecting insulin (consider
   energetics and biochemistry)?
2. Describe the differences between fast-acting insulin and slow-acting insulin (include
   biochemical and structural differences).
3. Compare hyperglycemia and hypoglycemia.
4. Why did Sally die?




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