Demi King and Taylor Hill are both in Webster University’s dance department. On top of auditions and practice, both dancers have to be mindful of their blood sugar levels.
In the lounge of Webster University’s dance department, junior Demi King peers down at her continuous glucose monitor, checking her blood sugar levels.
90 milligrams per deciliter. Safe.
It’s an audition day for prospective students, and Pam Hill sits on a couch next to King. Her daughter, Taylor, is inside the large dance studio taking a ballet technique class as part of her audition.
Pam Hill notices King. She notices her monitor; it looks like the one her daughter wears. Pam Hill felt relieved. Her daughter wasn’t alone.
“You know how they say safety in numbers?” Pam Hill said. “I wouldn’t wish [diabetes] on anybody. But it was nice to know that there was someone there that [Taylor] could identify with.”
According to the Juvenile Diabetes Research Fund, some 1.6 million Americans are living with Type 1 diabetes (T1D). This autoimmune disorder is characterized by the pancreas’ inability to produce insulin.
When insulin is not produced, the glucose needed to create energy can not enter cells, leaving people with T1D unable to regulate their blood sugar. Symptoms of unstable blood sugar levels are uncomfortable in the present, but long-term instability can have dangerous, or fatal, repercussions.
The consequence of a major rise or fall in blood sugar is a persisting worry. Add the rigorous course load of a Bachelor of Fine Arts in dance – averaging 20 hours of dancing weekly – and the pressure grows. The athleticism and stamina required of these dancers can impact their blood sugar levels, increasing the danger.
“There are sometimes where I’m in class and my pump will alert me and I’ll leave the class real quick,” King said. “There have been a few times where I just had to leave the room and eat something because I’m starting to get really shaky. There’s always that worry in my head that ‘I can go low right now’ while I’m in class.”
King was diagnosed at 3 years old. A visit to the doctor for excess thirst, frequent urination and rapid weight loss set off alarm bells for diabetes. But when the doctors pricked her finger to test, her blood sugar was 1200 mg/dl, nearly ten times the normal range for a child her age.
This was the impetus of a lifelong battle with T1D.
“I don’t know anything different and I’m glad about that,” King said, due to her young age at diagnosis. “If I were to wake up tomorrow and [my] diabetes was just gone, I don’t know what I would do with myself. I only know how to [check] my blood sugar, give myself insulin, change my pump, repeat. Unfortunately [for] Taylor, she doesn’t have the same experience.”
Taylor Hill knows a decade without the round-the-clock routine of blood sugar checks, pump changes and carb counting. The major lifestyle adjustment left 10-year-old Hill angry and questioning.
“It was easier to do things physically than deal with them emotionally,” she said. “I was more frustrated in myself that I now had more things to be concerned about than the average dancer. The ‘why me?’ hit me really hard.”
Sore muscles and torn-up feet are commonplace for Webster University Dance Department students. However, an open cut on the foot could become infected, and for someone with diabetes, an infection can quickly lead to limb amputation.
“We’re barefoot all of the time. If someone cuts their foot, they can say, ‘Yeah, it’s fine, I’ll just clean it up and put a Band-Aid on it.’ I can’t do that,” Hill said. “I pretty much always have to wear socks.”
During periods of exercise, humans become more sensitive to insulin, causing blood sugar to drop.
Nathaniel Hogrebe is a postdoctoral research fellow in the division of endocrinology at Washington University in the laboratory of Jeffrey Millman. He says that in contrast to the body’s response to exercise, the stress of competition – or in a dancer’s case, performance – could make blood sugar levels rise.
“A person participating in sports has to take into [consideration] all these different factors – such as the length and intensity of exercise, how much they have eaten recently, their level of stress – and try to estimate the right amount of insulin to give themselves,” Hogrebe said.
Hogrebe said it is important for people participating in physical activities to have their blood sugar within a normal range but said overestimating the amount of insulin they need can be dangerous.
“Dancing is going to be hard on a body that’s in perfect health,” Pam Hill said. “Adding diabetes on top of that is going to be a lot of wear and tear. My concern is that if she doesn’t take care of her body, it will give out on her. So until there’s a cure, there could be better ways to make it easier for people with diabetes to actually manage it and take care of themselves, so that they can lead more normal lives.”
Pam Hill’s hope for a cure may not be too far off. In October 2021, a potential breakthrough in diabetes treatment was announced. Vertex Pharmaceuticals tested a new therapy, essentially transplanting synthetic insulin-producing cells into the body. For one man, it worked, and his need for insulin injections nearly disappeared.
Hogrebe and Jeffrey Millman are pursuing a therapy that will not require the use of immunosuppressants, unlike the therapy created by Vertex Pharmaceuticals. Hogrebe said he believes that their therapy is good enough to cure a person with T1D.
“For a normal patient who is fairly good at controlling their blood sugar, [being on immunosuppressants is] not worth the risk,” Hogrebe said. “Our lab at WashU is able to take pluripotent stem cells and turn them into beta cells that function similar to normal beta cells. These cells can sense changes in glucose levels and secrete an appropriate amount of insulin. Transplanting these cells into a patient with Type 1 Diabetes would thus provide a functional cure,” Hogrebe said.
According to Hogrebe, this cell replacement therapy would make it so that the patient wouldn’t know that they have diabetes anymore.
For these dancers, a life without diabetes seemed inconceivable before these new therapies. King sees hope for a cure and acknowledges the impact it would make on her and the lives of so many others with T1D.
“I feel a huge weight would be lifted off my shoulders,” King said. “I feel like getting rid of this would be amazing, just because diabetes is so unpredictable. And it’s so hard to keep your blood sugars in range. There are [also] some effects down the road. And it’s just a scary thought that’s always going through my mind. If I were to have a cure and not have to worry about things like that, my life would be golden.”
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