Michael Silver: The Gameface

Cutler adjusting to life with diabetes

Cutler adjusting to life with diabetes
By Michael Silver, Yahoo Sports
May 16, 2008

Michael Silver
Yahoo Sports
ENGLEWOOD, Colo. – Jay Cutler entered the cafeteria at the Denver Broncos' training facility Thursday afternoon, a notebook full of offensive alignments in one hand and a small, black zip-up pouch in the other. I was far more interested in the pouch: a kit containing a lancet device, blood-glucose meter and test strips – the tools for drawing blood from a fingertip and checking his blood sugars.

After sitting down at a table, the strong-armed quarterback placed the pouch in front of him and began talking about the balancing act that has become the predominant force in his young life.

"This goes everywhere with me," Cutler said, spinning the pouch as though it were a football after he'd just snuck across the goal line. "The first thing I do in the morning is test myself to see where I am, and it's the last thing I do before I go to bed. This whole thing is a little scary sometimes, but it's not like you have a choice. It's part of your life, you know?"

I nodded yes. Unfortunately, I know all too well what it means to manage Type I diabetes on a constant and vigilant basis. It sometimes feels like riding a rollercoaster through a dark tunnel that never ends.

Cutler, who learned of his fate a month ago Thursday, is among the approximately one million Americans suffering from the chronic condition. He found out a couple of weeks shy of his 25th birthday – and almost three years to the day that my son, now nine, was diagnosed. Yes, I know the exact date that everything changed, as do most people I've encountered in the Type I community. Other than the birth of our children, my wife and I regard it as the most significant event in our nearly 17 years of marriage.

Before I try to provide some insight into this often misunderstood and perpetually frustrating illness, and how it might impact Cutler's promising football career, let me make one thing clear: Managing Type I diabetes isn't fun, and I wish my family and the other similarly afflicted friends we've made didn't have to bear the burden. But I'm also well aware that there are many adults and children forced to confront far more tragic circumstances, and I feel extremely fortunate that my son is a happy kid who is thriving in many ways and should have a great, long life ahead of him.

He's also, I strongly suspect, about to become a Jay Cutler fan, if only because he understands and sympathizes with what the insulin-dependent passer will have to go through for the foreseeable future – and, unless there is a cure, forever. From what I can tell, the majority of people not in that boat (and I certainly was one of them until getting slapped in the face three years ago) don't really get it.

"Everyone's got a special drink or something for me to try that's supposedly either gonna 'cure' it or 'help' it," Cutler said, shaking his head. "Or people say, 'Hey, you've been eating bad' or, 'You've been drinking alcohol, and that's what brought it on.' They mean well, but they don't understand."

One thing I understand after Thursday's long conversation with Cutler: A month after getting diagnosed and going on insulin, he feels much, much better than he did during most of the 2007 season, when he dropped 33 pounds, lost the zip on his passes and felt increasingly weak and fatigued. But before I get into the details of his specific case, here's a basic template for those unfamiliar with diabetes:

It's confusing, but there are two very different conditions that are referred to as "diabetes" – Type I, formerly known as juvenile diabetes, and Type II. Of the people who call themselves "diabetic," an estimated 90 to 95 percent are Type II. Both conditions involve the body's inability to regulate blood sugars through insulin, a chemical secreted by the pancreas, but there are some important distinctions.

Type II diabetes, often brought on by obesity or poor nutrition, involves a breakdown in the body's ability to process the insulin it makes. For that reason, improved diet and exercise can often improve the condition and lead to the reduction or elimination of the need for insulin injections. Type I is an autoimmune disease in which the body attacks itself and destroys its insulin-making cells. There is no behavior that "causes" it; doctors believe it is a genetic condition often triggered by an environmental stress, such as a virus. It is more typically diagnosed in childhood but in recent years it has become increasingly common for people Cutler's age or older to become symptomatic. Those who suffer from Type I are completely insulin dependent, and there is nothing that can be done to change that fact.

Many awful side effects are associated with diabetes, including stroke, kidney failure, amputation and blindness. However, through proper and prolonged control of one's blood sugars, those dangers can be largely mitigated. Yet control not only requires hyper-vigilance, but it also correlates to a rise in the regular occurrence of hypoglycemic episodes, or "lows" – the scariest day-to-day element of diabetes management.

To control blood sugars, most people use one of those finger-stick kits like the one Cutler carries to check their blood-glucose reading on a frequent basis, certainly before meals and often as much as 15 times a day. When that number is higher than the intended target range, additional insulin can be given through shots or via a battery-powered pump that is threaded into the body (the plastic insertion devices typically must be removed, reloaded and relocated every two or three days). When the number is low, fast-acting carbohydrates – usually juice or glucose tablets – must be ingested. It is also important that a person accurately computes the amount of carbohydrates he/she consumes, ideally by reading labels and measuring or weighing portions. Insulin is then dispensed according to a preset ratio (which also needs to be tweaked based on frequent testing). Exercise, stress, illness, alcohol consumption and altitude are some of the other factors which can impact blood sugars, and even under the best of conditions managing them is far from a perfect science.

The most immediate stress most people with Type I diabetes face is the fear that they will overshoot their insulin dose and go "low" – meaning the oxygen gradually stops flowing to their brain. If carbohydrates aren't ingested quickly, someone suffering from such a hypoglycemic episode can become disoriented and runs the risk of seizure, long-term brain damage, coma or death. For this reason my wife and I give our son far less freedom to roam than many of his peers and sometimes wake up several times in the middle of the night to ensure that his sugars are within a safe range. (It's also the reason why Cutler's mother, Sandy, who lives in the Denver area, insisted on spending the night at her son's house after he was first diagnosed – until, Jay says, "I had to pretty much force her out of the house.") Conversely, running "high" makes you feel lousy and, when it occurs on a frequent and prolonged basis, drastically increases the chance that a person will suffer long-term side effects. As Cutler says, "That alone will scare you into getting your levels right."

It's still very early, but I get the feeling Cutler will try to rise to this challenge the same way he has aggressively attempted to master coach Mike Shanahan's intricate playbook. The skills that have helped make the third-year veteran a successful quarterback with a legitimate shot at stardom – being focused and organized and goal-oriented – will serve him well when it comes to managing his blood sugars. He has the advantage of a strong support system ranging from his parents to the Broncos' training and nutrition staffs; the latter have been sending him home from the facility on Mondays and Wednesdays with easy-to-prepare meals that include pre-measured carbohydrate counts.

For what it's worth, Cutler's attitude thus far has been appreciably positive. "Since he got diagnosed, his (mood) is like night-and-day from what it was before," says Marty Garafalo, Cutler's business manager. "He even smiles now."

There are obvious explanations for the change in demeanor, some of them purely physical. The 6-foot-3 Cutler, who reported for training camp last summer at 242 pounds and struggled to get down to 235 by the season opener, suddenly began losing weight in October and dropped all the way to 202 by the final game. By then he was exhibiting many of the symptoms associated with untreated high blood sugars, including severe thirst, dry mouth, fatigue, frequent urination and ravenous hunger.

"I was just crushing food," he recalls. "I was eating six meals a day – I'd eat a meal and like 30 minutes later I'd be ready to eat again. Yet I kept losing weight, and they were telling me it was the stress. I was like, 'I'm not that stressed.' I mean, my jeans were falling off my body and I was all pale. I looked like hell."

By all rights Cutler, who completed 63.6 percent of his passes while throwing for 20 touchdowns against 14 interceptions in '07, should have played like hell down the stretch. Yet remarkably, though the Broncos lost four of their last six games to finish 7-9, Cutler put up relatively decent numbers during that span. Looking back, he admits, "Those last six or seven games, I was finished. I'd go into games tired and didn't really understand why. I lost a lot of zip on my passes. I was missing deep balls and couldn't figure out why they were falling short."

He felt even worse after the season, especially during the month he spent in Atlanta working out with teammates Tony Scheffler and Brandon Marshall. "I'd always prided myself on working out and being strong in the weight room, but I had nothing," Cutler says. "I'd get through about half the workout and just be done. I'd go home and sleep all day long, and it's not like I'd been out partying the night before. I was taking every nutritional pill and drink known to man, and they weren't working."

Last month, when he returned to Denver, Cutler took a blood test and discovered why he'd been feeling so lousy. His first emotion was relief. Then everything turned surreal: He was sitting in a doctor's office getting an intensified course in introductory diabetes management and, before going home, injecting a dose of long-acting insulin into his thigh.

Now back up to 230 pounds, Cutler says he feels "10 times better" than he did a month ago. Yet he's still feeling his way through the abrupt lifestyle transition, enduring inconveniences like the time he went to dinner with friends, broke the needle off of the only syringe in his possession and drove home to get replacements, a process that took about an hour.

He has grown increasingly less self-conscious about injecting himself in front of others, laughing as he recalls the scene he caused while attending a wedding shortly after being diagnosed.

"I went into the bathroom to test and give myself a shot, and I had all my stuff laid out on a table," he says. "Some guy walked in and saw me and all those needles and high-tailed it out of there. He probably thought I was doing heroin!"

When Cutler shares anecdotes such as that one, he reveals an edge that until recently many outside observers didn't know existed. After being drafted 11th overall in 2006 after a reasonably anonymous career at Vanderbilt, the Santa Claus, Ind., native often seemed devoid of personality during interviews, remaining guarded to everyone but those who knew him best.

That started to change even before his diagnosis. After Marshall, the Broncos' talented third-year receiver, sustained a severe injury to his right arm after putting it through a television set during a wrestling match with his brother, Cutler called out his friend and primary target, telling reporters, "He's not my favorite person right now" and that "it's always something with him."

Cutler, who stated Thursday he would repeat those sentiments, says he has discussed becoming more vocal with Broncos passing-game coordinator Jeremy Bates, explaining, "Coming into my third year here, I think it's definitely time."

He also realizes that, as a public figure with Type I diabetes, he'll likely receive more attention than he did before. To his credit, he's embracing the opportunity. "This is something I'm going to have to live with forever," he says. "I'm going to try to use it as a positive and help as many people as I can."

Cutler, who already has his own charitable foundation, wants to become more actively involved in the push for a cure once he gets a better handle on his routine. In a bizarre coincidence, Garafalo had met with the director of Dedicated to Diabetes, a Denver-based group committed to education about the condition, to discuss Cutler's potential involvement. Cutler, who literally learned of his diagnosis hours later, joined up within days.

For now Cutler – like Charlotte Bobcats forward Adam Morrison, Seattle Mariners pitcher Brandon Morrow, golfers Scott Verplank, Michelle McGann and Kelli Kuehne, swimmer Gary Hall Jr. and other pro athletes with Type I – can help the cause simply by conspicuously continuing to perform at a high level, despite the daily challenges he faces. And if seeing him suck down a juice on the sideline or prick his finger during a timeout helps some observers gain a better understanding of the rigors of Type I management, that's not a bad thing.

Balancing blood sugars is a confounding and relentless job, one in which, as a friend who also has a child with Type I has wryly pointed out, "there is no time off for good behavior."

I thought about this Thursday night when, after flying back from Denver, I took my sons to watch their older sister play the snare drum in an elementary-school band performance. The temperatures had reached triple-digits in our Northern California town, and my son with Type I had suffered from unexplained lows and highs since the early morning – the rollercoaster ride at its most daunting.

Midway through the hour-long performance he began to melt down. Though he had just eaten dinner, he complained of extreme hunger. My wife took out the meter from a pouch similar to the one Cutler carries, drew blood and checked his number, which was within the target range. Yet something was clearly off – perhaps he was dropping, or perhaps he merely has a metabolism to which someone unfamiliar with Type I couldn't relate – and I took him out of the auditorium in mid-song, ignoring the looks of other parents who probably wondered why a 9-year-old was falling apart like a toddler.

Minutes later, my son had eaten and regained his composure – and then the guilt set in. He apologized for having made us leave early and worried that his sister would be upset. I told him to shrug it off, just as I shrugged it off after finishing this column at 2:48 a.m., a few minutes after having checked my sleeping son's sugars for the sixth time since dinner, and having given yet another dose of insulin through his pump.

And I'm smiling as I recall one of the last things Cutler told me as we sat in the cafeteria: "I've read books about parents waking up three to five times every night to check their kids' sugars, and it blows my mind. I've gotten emails from kids that have touched me so much. Once I get all of my stuff a little bit more under control, I'll definitely get involved. I know I can affect a lot of kids in a positive way."

Take it to the ATM

If Sen. Arlen Specter is healthy enough to run for reelection in 2010, Pats owner Robert Kraft will be contributing to his opponent's campaign. … Either Annika Sorenstam or Justine Henin – or both – will come out of retirement at some point, because they're just too damned good. … Brian Urlacher and the Bears will kiss and make up by training camp, and all the Chicago fans who sent me emails questioning his toughness and character will cheer their hearts out as he produces another All-Pro effort in '08.

Lies, lies, lies

1. USC has institutional control over its athletic program.

2. Why, yes, everybody, I would love to join LinkedIn (or whatever business-networking site you're pushing in the emails you've sent).

3. As part of its penance for publishing that article stating the Patriots videotaped the Rams' walk-through prior to Super Bowl XXXVI, the Boston Herald will no longer report on Tom Brady's interceptions, instead referring to them as "complete passes tragically diverted from our heroes' clutches."

Oxygen-deprived thought from above

Have you ever booked a flight, shown up at the airport to board it and learn that it departed the previous day? If so, you and I have something in common. And no, I am not 85 years old, though sometimes I feel like I could be.

Let's do some Don Julio Silver shots for …

Newly hired UC Santa Barbara women's basketball coach Lindsay Gottlieb, who leaves Cal after three seasons as Joanne Boyle's lead assistant. Losing the brainy Brown grad is a blow to the Golden Bears, but those of us who support the program are happy she's staying in the UC system and wish her nothing but success (unless, of course, she happens to be playing us). It'll also be cool to watch my favorite UCSB alum, SportsCenter anchor Josh Elliott, glowingly report Gottlieb's accomplishments as she guides the Gauchos to sustained excellence. And on an unrelated and very cool note, I'll be drinking straight from the bottle while toasting the California Supreme Court.

Yahoo search words of the week

JetBlue toilet

Rollin' with the Royals

Well, that sucked. Perhaps this section should be renamed "Relegated With the Royals," for Reading's 4-0 victory at last-place Derby County last Sunday was not enough to spare it an unceremonious boot out of the English Premier League. With Fulham scoring a dramatic 1-0 victory at Portsmouth on Danny Murphy's 76th-minute header off a Jimmy Bullard free kick, the Royals needed to win by seven to avoid being one of three teams (along with Derby and Birmingham City) to drop to the League Championship division next season. They got a shutout from American keeper Marcus Hahnemann and goals from James Harper, Dave Kitson, Kevin Doyle and Leroy Lita but came up three short. I don't know a whole lot about England's second-most-prestigious footie league, but apparently I'm about to start learning. Here's my dilemma: As I root for the Royals to fight their way back to the Premier League next season, should I adopt a temporary favorite among the big dogs to pass the time? If and when the Royals return, they'll retain my primary allegiance, but is there a worthy surrogate in the meantime? I'm open to your suggestions, though spare me the jump-on-the-frontrunner's-bandwagon emails. Remember, I'm a Cal man; that's not in my blood.

Lyric-altered song dedication of the week

Seahawks linebacker Lofa Tatupu is a favorite of mine, and I believe him when he said, after his DWI arrest early last Saturday morning in Kirkland, Wash., that "this will never happen again." As surprised as I was to hear of Tatupu's alleged transgression, I was even more stunned that it reportedly took place in a 2006 Hyundai. I'm assuming this choice of vehicles is a point of pride, so here's Lofa (with his four passengers providing backup harmonies) riffing on his ride, to the tune of the Beach Boys' "Little Deuce Coupe":

"Well I'm not bragging babe so don't put me down
But I've got the highest gas mileage in town
I need to jam that pedal down to hit 65
But when I have a couple drinks man it feels like she could fly
She's my little deuce coupe
You don't know what I got
(My little deuce coupe you don't know what I got)

Just a little deuce coupe with a boxy frame
But she'll run like Devin Hester in that carpool lane
Well my posse and I were craving late-night cheese
So we buckled up and blasted off for Mickey D's
She's my little deuce coupe
You don't know what I got
(My little deuce coupe you don't know what I got)

I signed for $42 million and felt warm inside
But I didn't run and buy a German ride
And if this doesn't make Mike Holmgren flip his lid
There's one more thing, I'm callin' Goodell "Daddy"

And comin' off the line with that auto-trans
I glanced into my rear view and I saw The Man
I asked the copper, "Can I tell you who I am?"
He said, "A big construction worker with beat up hands?"
She's my little deuce coupe
You don't know what I got
(My little deuce coupe you don't know what I got)
She's my little deuce coupe
You don't know what I got
(My little deuce coupe you don't know what I got)

Michael Silver covers the NFL for Yahoo! Sports. Follow him on Mogotxt, Twitter and Facebook. Also check out ridewithsilver.com. Send Michael a question or comment for potential use in a future column or webcast.

Updated on Friday, May 16, 2008 12:22 pm, EDT

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