Imagine that you're a miner. Imagine you have diabetes (that, at least, shouldn't be too hard). Now, imagine that you have to spend two months trapped underground with other miners. How would you do?
It wasn't an imaginary exercise for Jose Ojeda, who was one of the 33 Chilean miners rescued last week. According to numerous news accounts and information from the Chilean rescuers, Ojeda has diabetes. What's more, he fared excellently in his two months underground.
How was that possible? It resulted from a fortunate combination of a smart official response, dedication on the part of the miners, luck, and a few peculiar facts about diabetes itself.
What we know
For all the coverage of the miners and their ordeal (10 million people watched the rescue on CNN, Fox News, and MSNBC), we don't know everything about them. For instance, we don't know whether Ojeda is a Type 1 or Type 2 diabetic.
A widower in his late 40s, he was the seventh miner rescued, which indicated that officials were concerned about his health. He also reportedly has kidney problems, and officials shipped him insulin during his confinement. All of those factors might point to a Type 1 diagnosis.
On the other hand, the miners survived for 17 days without outside contact after the initial cave-in, and Ojeda wasn't reported as being in worse shape than anyone else after that time. Accounts of his confinement also stressed diet over medication.
Regularly scheduled
Ojeda -- who wrote the original note informing searchers that the miners were alive -- faced a challenge that few of us could imagine. Yet the situation was surprisingly positive for a diabetic.
For one thing, the miners kept a strict schedule. Once contact was established with the outside world, they ate at precise times, their food sent through narrow holes drilled from the outside. Breakfast came at 8:30 a.m., lunch at 1 p.m. and dinner at 9 p.m. A couple of snacks were tucked in between.
The miners organized their days beyond food, too. They divided each day into three shifts: midnight to 8 a.m., 8 a.m. to 4 p.m. and 4 p.m. to midnight. Each miner would spend one shift sleeping, one shift working around the mine, and one shift relaxing -- writing those outside or exercising, for example.
Diabetics could well benefit from such a rigorous schedule. Consistent sleeping, eating and activity times make regulating blood sugars much, much easier.
Special meals
We've already touched on the meal delivery system. But the meals themselves are almost as important for our diabetic miner.
The Chilean Health Ministry worked up meal plans for the miners, balancing carbohydrates and protein. The average miner ate 2,300 calories a day, spread between the three meals and snacks.
Special meals were prepared for Ojeda and another miner who needed a special diet. For the diabetic miner, the changes seem to have been small. Instead of regular Coca-Cola, he received a diet version. Fresh apples replaced the canned papayas others ate, and he used sugarless marmalade instead of jam.
The overall attention to diet was appreciated. Dr. Jorge Diaz, who helped oversee the health of the miners, told the BBC that Ojeda's "medication is the same as before, but now he has such a precise diet, which he never had earlier. He feels better now than ever."
The applications for every diabetic -- Type 1 and Type 2 -- couldn't be clearer. So much of daily management of the disease comes down to a healthy, balanced diet. Sadly, we all don't have a team of experts calculating our daily intake!
Attention and exercise
All the miners -- not just Ojeda -- had the attention of Chile's best doctors. But there was a source of assistance much closer.
Miner Yonny Barrios had been trained as a paramedic, and he helped the doctors on the outside with tasks like drawing blood, taking miners' blood pressure and giving injections.
For diabetics, both kinds of care are crucial. We need experienced physicians to set our courses of treatment. But we also need people closer to us -- sometimes family members, sometimes friends, sometimes nurses -- who can help with day-to-day challenges.
Finally, the miners had a great luxury for a group of supposedly trapped people. They weren't confined to a small space.
"They had the run of the mine," Jeffery Kravitz, of the U.S. Mine Safety and Health Administration, told the New York Times. A half-mile of open tunnel gave them "places to exercise and to use for waste." One of the miners ran miles each day.
Every diabetic knows the importance of physical activity. Ojeda had the opportunity not just to eat balanced meals, but he had the space and time to work out regularly.
The challenges
From the sound of it, then, why don't all diabetics head down to mines? Given all those positives just outlined, wouldn't Jose Ojeda be in better shape now than ever?
Not necessarily.
The miners attracted public attention once they were found alive Aug. 22. But the mine had actually collapsed 17 days before. For more than two weeks, the men survived on two days' worth of supplies. Two days.
Their usual meal during those difficult days? According to the Associated Press, they ate two spoons of tuna and a bit of cracker, milk and peaches. And they only had that every other day. Small wonder, then, that when they were discovered, all needed careful attention.
Their digestive systems had nearly stopped, and their bodies were burning fat and muscle to keep them alive. Officials worked methodically to rehydrate them, adding in vitamins and a few more calories day by day until they were able to eat full meals again.
This kind of starvation regimen was tough on every one of the miners -- let alone the only diabetic. No report has mentioned specifically how Ojeda handled the challenge.
Isolation from friends, family and traditional support networks couldn't have been healthy either. Not to mention the instant fame that awaited them once they were rescued. Psychologists worked with the men to ensure that they would be ready.
The damp, warm environs of a cave posed another issue for Ojeda: skin infections. Many of the men developed fungal infections during their two months underground. Such infections are of particular concern to diabetics.
Post-rescue examinations, however, showed that none of the infections were serious.
Out and about
The miners came to the surface Wednesday, after an ordeal that few could imagine. News coverage raged, and gossipy reports (the miner who requested both his wife and mistress meet him on release) were legion.
We'll no doubt hear more about widower Jose Ojeda. We'll no doubt learn more about his disease, and how he fared during those two months. New reports Monday said his blood sugar was normal after his rescue, although his blood pressure was a bit high.
But the challenges of controlling diabetes, for him and for everyone else, will remain. Perhaps it's comforting to know that, even when he was trapped in the mine, Ojeda faced a common diabetic challenge. He celebrated his 47th birthday and didn't get any cake.
His fellow miners said they'd bake him a sugar-free one when they got out.
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Sources:
http://www.indystar.com/article/20101013/NEWS01/101013014/Chilean-miner-bios-ex-soldier-Elvis-fan-diabetic
http://www.diabetes.co.uk/news/2010/Oct/diabetic-amongst-the-33-chilean-miners-trapped-underground-92432071.html
http://news.yahoo.com/s/ap/20100824/ap_on_bi_ge/lt_chile_mine_collapse
http://www.usatoday.com/yourlife/health/2010-10-13-chilehealth13_ST_N.htm
http://www.bbc.co.uk/news/world-latin-america-11388894
http://thelede.blogs.nytimes.com/2010/10/15/miners-no-longer-forced-to-order-in/?scp=1&sq=Chile%20diabetes&st=cse
http://www.nytimes.com/2010/10/14/world/americas/14medical.html?_r=1&scp=2&sq=Chile%20diabetes&st=cse
http://www.diabetes.co.uk/news/2010/Oct/more-information-emerges-about-diabetic-chilean-miner-92863864.html
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