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Nick Boynton of the Florida Panthers is a burly defenseman with 10 years' experience in professional hockey. Boynton also happens to be a type 1, insulin-dependent diabetic.

Blood warrior

by Tom Walsh / Photography courtesy of The Florida Panthers

Nick Boynton and the Florida Panthers were having a terrible night.

The Boston Bruins, Boynton's former team, had scored 48 seconds into the game and never looked back. A burly defenseman with 10 years' experience in professional hockey, Boynton also happens to be a type 1, insulin-dependent diabetic. The bad feeling on this night had nothing to do with his blood sugar, though. With the final minutes ticking down, the Panthers were behind 6-1, a blowout by National Hockey League standards. Boynton was not amused.

With just over four minutes left, Boston right-winger Blake Wheeler picked off yet another errant Panthers' pass and sped across the blue line, one-on-none, toward Panthers goalie Craig Anderson. A breakaway goal here would make the score 7-1.

Boynton had seen enough. In a burst of speed, he found himself only a stride behind Wheeler as the Bruins winger was winding up to shoot. Boynton wrapped the blade of his stick around Wheeler's midsection and yanked him to the ice. Two minutes, hooking.

It was a minor penalty that brought Boynton's penalty minutes for the season to 83, 30 minutes more than any of his teammates. Boynton skated slowly to the penalty box. His blatant hooking penalty had made sure there would be no seventh goal. Enough was enough.

As Panthers Coach Peter DeBoer met with reporters after the game in the press room—"It was just ugly," he tells them—Boynton was back in the visitor's locker room, checking his blood sugar and fiddling with his insulin pump.

"I switched to an insulin pump three or four years ago," Boynton says. "It's been a big help…. I take the pump off during the game while I'm playing, and I test my blood sugar and put it back on at intermission and correct myself if need be. Usually, I'm working so hard, and it's pretty physical activity, so my sugar stays pretty level."

Boynton's diabetes wasn't diagnosed until he was 20, long after he began playing hockey. The news, he says, "came as a bit of a shock."

"I was really, really sick for two or three months," he says. "My doctor misdiagnosed me as type 2 and put me on pills. The pills didn't work, and I kept losing weight. I probably lost 35 pounds and actually saw doctors here in Boston, and they finally diagnosed me correctly as type 1. I was worried it was something else."

After his diagnosis, Boynton's doctors suggested that he take some time off from hockey.

"I just got to Boston and was trying out, trying to make the team, so I didn't take any time off," he says. "That was probably a bit of a mistake; I should have gotten a better handle on it before I did physical activity. But it didn't discourage me at all, and it hasn't stopped me from doing anything."

Despite his diabetes, year-round training has allowed Boynton to endure the quick energy bursts required for an all-out, on-ice, 40-second shift.

"It doesn't really ever stop me," he says. "There's a handful of times in a season when I go low and I may miss a shift here and there because I need to if I get a little light-headed or whatever. It's a very physically intense sport, but the diabetes hasn't been a problem. You train the same way in the summer, for minute-on sprints and a minute off, and the diabetes hasn't really affected that at all."

When Boynton meets with young athletes who are type 1 diabetics, he encourages them to pursue their athletic goals.

"I advise them to check their sugar often and to find a routine, with their doctor, that works for them," he says. "It shouldn't stop them from doing anything. I've been fortunate and have played professional for 10 years now, and the diabetes hasn't been a factor in me playing or not playing.

"It's a scary disease, but, as long as you have a good doctor and you're in control, it's something that can be managed and managed well."

Boynton's great-grandmother died from complications of diabetes. His two young daughters, ages 1 and 3, have been screened but don't show signs of the chronic, lifelong disease. "Nothing so far, and hopefully it stays that way," Boynton says. "If it were to happen, I'm well prepared, I guess, to help them."

Diabetes: Investigating a "geneticist's nightmare"

Jackson Laboratory scientists are busy amassing the biomolecular insights essential to heading off the growing, global scourge of diabetes.

This serious, lifelong metabolic disorder impacts how the body converts digested food into the fuel required for energy and growth. In the United States, where the rate of diabetes has doubled over the last 10 years, diabetes is now an epidemic. More than 23 million Americans have the disease, with about 1.6 million new cases being diagnosed each year.

The least common—and most serious—form of diabetes is an autoimmune disease. In type 1 diabetes, the body's immune system attacks and destroys cells within the pancreas that produce insulin, the hormone required to deliver blood sugar to the cells. Type 1 diabetics require daily insulin injections. Also known as "juvenile" diabetes, this life-threatening disease is most commonly diagnosed in children and young adults.

After studying type 1 diabetes at The Jackson Laboratory for 25 years, David Serreze, Ph.D., describes the disease as "a geneticist's nightmare" by virtue of its complexity.

"Type 1 diabetes involves many, many interactive genes, with 30 to 40 contributing to the disease," he says. "The highest incidence is among people of northern European extraction, especially those from Finland. As the world becomes a more international place, what happens when a Finn marries a Brazilian in terms of the genomes of their children getting more and more complicated? As these different genetic combinations can contribute to diabetes, the reality of a heterogeneous human population is nightmare number one."

While type 1 diabetes affects the pancreatic cells that produce insulin, people with type 2 diabetes don't properly process the insulin they produce. When insulin binds with receptors on a cell, a transportation mechanism moves to the outside of the cell and, in essence, opens a door for glucose to enter the cell via glucose transporters. Type 2 diabetes disrupts the cell's ability to respond to insulin, making it much more difficult for glucose to enter cells.

Type 2 diabetes affects more than 90 percent of people with diabetes. For reasons largely unknown, type 2 diabetics are unable to effectively use the insulin their bodies produce. This insulin resistance interferes with the conversion of blood sugar into energy, putting type 2 diabetics at greater risk for heart disease, high blood pressure, stroke, kidney disease, nerve damage, amputations and blindness. Should they live long enough, type 2 diabetics eventually become insulin dependent, as are type 1 diabetics.

The role of genetics in the ongoing epidemic of type 2 diabetes is a complex puzzle complicated by the role that genetics plays in another public health epidemic: obesity. The interaction of many genes is associated with the clinical reality that, while about 7 percent of people who are obese develop type 2 diabetes, about 90 percent of those with type 2 diabetes are obese.

"This suggests that, in type 2 diabetics, obesity genes interact with diabetes susceptibility genes to produce the obese/diabetic phenotype that some have termed 'diabesity,'" says Jürgen Naggert, Ph.D., a Jackson Laboratory professor. "Obesity genes alone would only lead to obesity, while diabetes susceptibility genes alone may not cause this overt phenotype."