On Hypoglycemia and the Power of Community
Outraged citizens come to the rescue in ones man legal battle.
with Amy Tenderich
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
July 2007 —Anyone taking insulin on a regular basis runs the risk of hypoglycemia – abnormally low levels of blood glucose that can temporarily disable us. These "lows" can make us feel jittery, disoriented, or paranoid. If untreated, people undergoing extreme "insulin shock" can act irrationally and aggressively. So here's the question: just how responsible are we for our actions when we lose control this way?
If a person commits some wrongdoing during a hypoglycemic reaction, should they be treated as a potential criminal, to be tried in court as if no medical condition existed?
You may have read about the recent case of reigning Mr. Natural Universe, Doug Burns, which brought this conundrum into the limelight.
Defending Mr. Universe
In a nutshell, Doug (a successful bodybuilder with type 1 since childhood) had been assaulted by police during a low blood sugar episode in a local movie theater outside of San Francisco, CA. He was confused and uncooperative at the time, but not violent. Police nevertheless maced and beat him before transporting him to a local hospital for help – where he clocked in at a perilously low 26 mg/dL.
Afterwards, Doug assumed the matter would be dropped once he provided ample evidence of his diabetic condition. Instead, the local district attorney charged Burns with criminal assault and resisting arrest, and a trial date was set for July 2.
That's when I got the phone call. It was late May, and Doug seemed a bit in shock at the prospect of going to jail simply for having a severe low blood sugar. He asked me to help spread the word that the diabetes community needs to take a stand on this kind of police mistreatment of hypoglycemia.
A number of cases have been reported around the country in which people experiencing insulin shock – often wearing conspicuous medical ID – were nevertheless severely mistreated and physically injured by police. The American Diabetes Association (ADA) is even backing a lawsuit on this issue.
Still, the Redwood City DA was unwilling to drop Doug's case, and pushed ahead for a jury trial – meaning Doug would face all the expenses, inconvenience, and negative publicity that entails. Essentially, he was stuck between a rock and a hard place: the only way to achieve a plea bargain would be to plead "no contest," which means admitting guilt and accepting the punishment – in this case up to a year in county jail. But Doug strongly believed that having a blood sugar low is no crime in the first place. His only other option would be to counter-sue, in order to "punish" the authorities for their missteps. But this would have forced him to take the position of "diabetic victim," something he's avoided all of his life and which "sends the wrong message to the diabetic community," he says.
The D-community was outraged. On my blog, I posted a "call to action", including names and phone numbers of the responsible DAs. A number of other diabetes and health blogs picked up the rally cry, and within hours, the DA's office was flooded with phone calls.
The happy ending here is that the authorities made an abrupt decision to dismiss Doug's case the very next morning, May 30. What a testament to the power of citizen journalism and the Internet-connected diabetes community! We spoke out, rapidly and clearly, and accomplished a change.
Doug is now working with his lawyer and representatives of the ADA to help train police personnel to better recognize and deal with hypoglycemia.
When People Get Hurt
Unfortunately, there is a darker side to this issue as well. Right here in the same part of California, two diabetic drivers were recently involved in separate car accidents in which people were killed. Both drivers were experiencing insulin shock at the time.
The newspaper explains: "The cases highlight a complex and emotional debate: To grieving families who believe diabetes can be managed, drivers must be held accountable. But the diabetic community says it's not that simple, because insulin use is hardly an exact science."
Too right it isn't! We all know how easy it is to take too much insulin. My point in supporting Doug Burns was that severe hypoglycemia incapacitates people, in the way a seizure or blackout does. Thus they cannot be criminalized for what may occur while in this state.
But what about when people die? What then? I don't pretend to have the answer.
Once again I'm relying on the Power of Community. With an open dialogue, I'm sure we can collectively come up with some excellent strategies for dealing with this difficult issue.
Dozens of commenters have weighed in already. One gentlemen in the UK points out that using a new continuous glucose monitor system (CGMS) while driving may be the answer. "Perhaps here liability insurance could play a role by obliging diabetics to wear CGMS while driving, which then health insurance / Medicare would be obliged to pay," he suggests.
An excellent idea for saving lives and improving diabetes care at the same time. Thank you, Community Members, and may your hypoglycemia always be mild and treated immediately.
* Amy Tenderich is co-author of the new book, Know Your Numbers, Outlive Your Diabetes. Read more about Amy Tenderich.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
Hamburger-Pepperoni Pie Fruit Salsa Tahini Yogurt Dressing Smoked Cheese and Nut Roll Fresh Asparagus Soup Holiday-Spiced Peach Dessert Cajun Chicken Indian Chicken Salad Pitas Vegetarian Burgers Peach and Mango Chutney
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...