CINCINNATI -- Only 13 players in the major leagues this season have hit more home runs than Adam Duvall's 28. His .522 slugging percentage ranks in the top 30.
Duvall, 27, has square shoulders, a square jaw and thick arms, and he weighs about 225 pounds. He stands 6-foot-1 but looks taller in the on-deck circle. Of the five traditional tools in baseball, Duvall's meal ticket is power. It has earned him a coveted everyday job on the Cincinnati Reds, batting behind Joey Votto.
Duvall's power prompted the league to select him for the Home Run Derby in San Diego. There, he helped put on an entertaining show, filling the outfield stands with baseballs, along with Giancarlo Stanton and the game's other notable sluggers.
Yet it was a lack of strength that alerted Duvall to a serious illness four years ago. Gone untreated, it could have put him in a coma or even taken his life. The Reds' left fielder has Type 1 diabetes. Every time he steps on a major league field, he has a quarter-sized glucose meter stuck somewhere on his body. He moves it every six days to find fresh insertion sites. Another needle inserted in his skin is connected to an insulin pump that he stashes in his back pocket. The tiny computer, protected by the same plastic that makes up bicycle helmets, is battered from a couple of years of sliding on it. The devices are connected via Bluetooth technology.
They are his lifelines.
A Type 1 diabetic has an immune system that attacks certain cells in the pancreas, and as a result, the pancreas no longer produces insulin, the hormone that controls blood glucose levels. If Duvall were to give himself too much insulin or skip a meal at the wrong time, he could lose consciousness, have a seizure or even die.
"There are instances of people getting low overnight who don't sense it," said Washington University endocrinologist Cynthia Herrick. "They don't wake up."
Duvall is playing a higher-stakes game than virtually any other major leaguer. His ability to regulate his blood sugar is crucial to his ability to have the necessary energy to play the game and the required alertness to succeed. Like everything else in baseball, Duvall's condition gets sized and fitted for the game's jocular culture.
"I know it's super-serious, but we kind of mess with him because he's having a great year," teammate Tyler Holt said. "Every time he hits a home run or does something well, I joke with him, 'What'd you give yourself, a couple of extra pumps to get you going a little more?'"
In December 2011, Duvall was puzzled that he was waking up five or six times a night to urinate. The following month, weightlifting became unbearable. He felt weak much of the time. He sometimes became lightheaded. By the time he got to minor league spring training with the San Francisco Giants, he estimates he had lost 20 pounds.
During a game that March, he felt so lightheaded he had to come off the field.
"The trainer gave me some orange juice, and I started to feel better," Duvall said. "We hadn't gotten the tests back, but all the signs were there."
Most people are diagnosed with Type 1 diabetes -- sometimes called juvenile diabetes -- by the time they are 20. Duvall was 23. At the time, he was entering high Class-A baseball and was older than many of his teammates, and thus anxious not to lose time adjusting to a different regimen. So when the doctor informed him he was diabetic, he took it surprisingly in stride.
"It wasn't a huge ordeal just because I really just wanted to find out what was going on," he said. "When I found out, I took a deep breath and was like, 'OK, where do we go, what do we do now, and just take care of it.'"
"He's a really good dude. He's kind of quiet, keeps to himself, goes about his business and works hard," Kiekhefer said. "The only thing I thought was crazy was that when we were growing up, he was an unbelievable shortstop. I thought he would be a major league shortstop. Now he's playing the outfield, and it just shows the work ethic and talent he has."
Kiekhefer said he has encountered players in the minor leagues who carry insulin pumps in their back pockets.
"Who knows if 20 years ago they'd have been able to play," he said. "They might have had to run off the field all of a sudden."
When Hall of Famer Ron Santo was playing for the Chicago Cubs 50 years ago, he concealed his Type 1 diabetes, worried that he would be forced into retirement if he was found out. He gauged his blood sugar by his mood, snacking on a candy bar if he felt low. Until the advent of insulin pumps, Type 1 diabetics had to administer insulin shots to themselves at least three times a day, usually before meals.
Although Santo was diagnosed at 18, he didn't reveal the struggle until he was close to retirement. Santo had each of his legs amputated below the knee, one in 2001 and the other in 2002. He died in 2010 at 70. Insulin pumps were invented in 1976, two years after Santo retired.
"It probably was a lot harder," Herrick said. "The thing about the pump is it allows us to do a lot more fine-tuning of the insulin regimen people are on."
The most common form of diabetes, Type 2, is a condition in which a person's body does not process insulin properly. It is associated with obesity and lack of exercise as well as other factors. Cardinals Hall of Famer Lou Brock was diagnosed with Type 2 diabetes 17 years ago and had his left leg amputated below the knee last fall.
Duvall has done volunteer work with the Juvenile Diabetes Research Foundation both in San Francisco and southern Ohio. It's an exciting time in diabetes research, according to Herrick. Engineers have designed pumps in trial stages that are capable of monitoring glucose levels and then infusing either insulin or glucogon, the counterbalancing hormone. The pumps act as an artificial pancreas outside the body. Other researchers are exploring ways of using stem cells to differentiate into the kinds of cells that can replace those destroyed by antibodies in a Type 1 diabetic's pancreas.
Duvall monitors the research from afar via contacts with the JDRF. He's hoping before long to have one of the more advanced pumps to help simplify his regimen. Like most athletes, he is always searching for the latest and greatest breakthroughs in performance technology.
In this case, it simply helps him stay on the field. The rest of it, including the prodigious power, is up to him.