Hypoglycemia’s Dangerous Enough :: Diabetes Self-Management

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Sep 25, 2008

Hypoglycemia’s Dangerous Enough

Eric Lagergren

A few days ago, a colleague of mine who also happens to have Type 1 diabetes forwarded me a link to an article with the headline "Wife: Diabetic man mistaken for drunken driver and beaten." The subheading for this article: "Family’s attorney say [sic] man has been in a coma since June 15."

What actually went down during the June 15, 2008, incident is currently being contested by the parties involved. The police have their side of the story; the wife and family of the man with diabetes have their side. And although this may be a cop-out on my part, I'll let you read the article rather than summarize it here.

(And here now is the brief interlude during which you navigate over to the Detroit Free Press article and give it a look-see. I'll play some soothing music right now.)

So, did you read it? I hope so. I want to know what you think about this story, about stories like this.

What happened to Mr. Griglen could happen to any us who have diabetes. Sure, my gut reaction is to say, "But I take better control of myself; I wouldn't be driving if I was in danger of having a low blood sugar." Really? Any number of things can add up and get in the way of good self-management, and—while I doubt I'd end up in these exact circumstances, being beaten to the ground by the police—when I think about it, the emotional reactions possible during a hypoglycemic episode are not unique to Mr. Griglen. (And did he think that day, after leaving the movie theater, "This is a good afternoon to have a hypoglycemic reaction while driving, disagree with my wife, become belligerent, and end up in a coma from which I may not wake up?")

Mr. Griglen was beaten into a coma about 20 miles from where I live, in a part of southeast Michigan I've driven through many times. Proximity to something has a tendency to increase the impact, so knowing this happened a few towns to the east has caused me to spend a bit more time contemplating the what-ifs of diabetes and public episodes of hypoglycemia. The news this time has hit home moreso than did last year's news about Doug Burns, at the time the current Mr. Universe, who was arrested for intoxication when he was also experiencing a hypoglycemic episode (see "What We're Reading: Hypoglycemia Mix-Up Leads to Arrest").

Mr. Griglen, a 59-year-old Detroit man, is still in the hopital, comatose and on a ventilator. He's been there since what happened happened.

To what lengths do we need to go to to identify ourselves as persons with diabetes? Was the presence of an insulin pump and diabetes supplies in the car sufficient? Would the police have even looked at medical ID's, or do they go into a situation such as this with a preconceived notion about how the incident will play out? They're prepared for the worst-case scenario, not for assuming that it may be a man who's got severely low blood sugar.

We live in a culture in which how something looks is what it is: If you seem drunk, then you are drunk. And for good reason—most of the time, inebriation is inebriation.

But for those of us with diabetes, for those of us on insulin or medication and who could potentially suffer a hypoglycemic episode in public (which, be honest, is any of us if we actually live in the world), we are not intoxicated.

So, yeah: Did you read that article? Did you finish this blog entry? Do you have a response?

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The big issues I see facing the diabetes community is that of the education of our policemen, and that of what they believe to be their personal safety.

In my state (New Jersey), the curriculum for local and county police training is determined at the county level and can be addressed at the county level. (I addressed this in my blog entry about National Night Out back in August.) Our local cops are trained to understand that alcohol intoxication is not the only cause of erratic driving (and erratic behavior) -- but if you're not able to self-identify as having diabetes, and if you are being combative, I can understand how the police officer might consider his own life to be in danger and respond defensively.

The negative breathalyzer test alone should suggest that there was another underlying issue -- and the specific paraphernalia (insulin pump, etc.) should have argued against "illegal drug use". If Mr. Griglen did not cause any personal or property damage, then a suit *should* settle in his favor (at least it would in NJ, according to my local police officers).

While what happened to Mr. Griglen and others like him is certainly a tragedy, what are really needed is more education -- of both police officers, state troopers, etc. and of drivers with diabetes -- and awareness. (The addition of CGMs with trending data would not be a bad thing, either: the alarm warning you to pull over and snack. But I think that's a few years down the road.) Can we rally our advocacy groups to further bring this issue to light?

Posted by: tmana | Sep 26, 2008 11:02 AM

Dear Eric.

What a tragic and sad story. In Canada you would be promptly Tasered and if that doesn't kill you the fall to the ground could. I hope that the poor man's injuries were caused by his fall and not the police beating him. Hope that they win the law suite so that this problem gets the proper attention from the police for the future. A Person who teaches our Mounties (i.e. Federal Police force) said to me that the arm to arm combat skills of the police force are appaling. Leaving them no option but Tasering or shooting. Guns are not cool in Canada since the NRA does not have the political power. But Tasers still kill, like the poor Polish visitor to the Vancouver airport. Wonder if he was a diabetic too and disoriented by low BG.

Posted by: CalgaryDiabetic | Sep 29, 2008 05:39 PM

Yes, CGMSs would be extremely helpful in this case, or any. Unfortunatley, bc they are still new, insurance companies do not cover them. And most people do not have thousands of dollars to spare on them. I have had episodes myself and my family has urged me to get a CGMS, and I have inquired about it since I do live alone and had a friend who died in his sleep due to a hypoglycemic episode who also lived alone. But the insurance companies won't foot the bill, or even part of the cost. Some of them won't even foot the bill for an insulin pump, even tho that would decrease the requirement (and their cost) for medical care & supplies in the long run.

Posted by: luvsun | Oct 01, 2008 12:35 PM

I had a similar situation I have had diabetes for 39 years Type 1 and was taken to a local hospital semi concious. The attending dr assumed I was a drug user and did everything but treat my diabetes. Dispite the fact that the emt who I grew up with and my boss were telling him different. When an old time nurse did a check my gluclose was 15 .The dr could have killed me and my unborn child because he said he had never seen anyone with a sugar that low . Needless to say we have never been to that hospital again and the administrator and the dr got an ear full. On any employment app I also direct them not under any circumstances take me to that hospital.

HOW DO WE PROTECT OURSELVES FROM EDUCATED PEOPLE WHO THINK THE WORST???????????

Posted by: Lora | Oct 01, 2008 12:58 PM

i wear a medic alert bracelet and i can't even get the docs and nurses and paramedics to look at it especially as i am also deaf and it also says that on my bracelet and i pay every year and keep that info updated what's a person to do?? even my endo who complimented me on always having it on was shocked when i told him the things that don't happen with it my my real world out there isn't it???

Posted by: mary | Oct 01, 2008 02:20 PM

1. Keeping the peace is a technology that involves a blend of psychology, medicine, EMT, public relations and combat. The best applicant is a highly intelligent, compassionate, empathetic and educated individual who can also kick your ass. People who fit that bill likely become leaders in various fields. They are in demand. So you take the best of what you can to fill the ranks of law enforcement.
2. Most of the EMT guys I have talked to in the last year admit to having "check if he's a diabetic" at the top of their list when encountering an accident scene or something like this fellow in the article. They all have glucometers in their kit. I also ask cops and one for one they are oblivious. So I don't think the EMT side of an encounter, or how it can relate to the "incident", is even taught in a polcie academy, or maybe only as a half day sidebar. This is apparent in the admission that one of the officers saw the insulin pump but took no action to check for a diabetic condition. She exhibited no evidence of even knowing what a diabetic condition is.
3. There is a huge bit of missing data. I didn't read anywhere that this man was beaten, except in the allegations. But that wasn't based on evidence. The cops may have mishandled him. They may have treated him roughly. They may have been responsible for him hitting his head on the ground and thus his brain condition. But beating is another thing entirely. It is a rage filled punishment. It is a felony.
4. In my talks with law enforcement officers, mabye two dozen total, they feel it is unavoidable to profile citizens as potential threats whose physical appearance and/or ethnicity indicate the likelihood that they come from the same groups as those the majority of street crime come from. This is a tough one. The best approach in my opinion is for street level reform of ethic communities by its own citizens. It really is a shame that it has to be that way and it is a tough thing to accomplish, but it has been proven to work in many urban areas. Building better community relations with law enforcement, commerce and local government, rather than waiting for THEM to do it (won't happen)puts a ball in your court you can make a play with.

Posted by: Peter Mead | Oct 01, 2008 06:42 PM

I also almost suffered the same fate as this poor man, the only thing that saved me was the bumper-sticker on my car that said "I run on insulin". When you are harder to approach because of your bloodsugar level the cops aren't going to take the time to look for medical signals that may or may not be available in your car. You can forget looking in the wallet for one of those little cards that says you are diabetic. You need something glaringly obvious like the bumpersticker that saved me. I would tell any diabetic to get something similar for themselves, and to be sure to wear your medic-alert bracelet or necklace for backup.

Posted by: cdettloff | Oct 01, 2008 07:08 PM

I know someone who had an episode of low blood sugar leading to having an accident with his car. The police just threw him in the back of the cruiser and were just going to haul him off to jail. Luckily for him at that time, an ambulance had been sent due to the accident and they checked him blood sugar when he again told them that he was diabetic.

One issue to watch out for is the effect of alcohol on your diabetes. You may be legally sober without question, but the alcohol can affect your blood sugar. My doctor had warned me about this possibility. I don't seem to have a problem with beer, although my father does. However with liquor I have found that it does drop my blood sugar and wine does sometimes as well.

Posted by: George | Oct 02, 2008 12:41 AM

I am appalled with the incident of Eric. My
reasoning would say the family needs to go straight to the best lawyer they can find and start the legal processes going. What happened to Eric is nonsense and something should be done about it with compensation to Eric and the family. Once I was diagnosed with urinary track infection with possible kidney infection. I kept falling down and couldn't get up. Finally in a large dept. store parking lot I got out of my truck to get some fresh air and I started going backwards [I couldn't go forwards], people were laughing at me as if I was drunk. I finally fell down and couldn't get up. My wife saw me and came to my rescue and took me straight to ER. People thought I was drunk; ha, I don't even drink alcohol. I'm pre type 2 diabetic and have hypogycemic attacks. This issue needs to be addressed futher; the person with the attack has little or no control of themselves.

Posted by: lpoteet58 | Oct 02, 2008 02:42 PM

I'm Type 2 and don't normally have a dangerous low such as described. However, you never know when one could happen. I did test myself at 35 once. Thought, no way. Tested again... 32?!?! And I was still coherent enough to get my glucose tablets. Will i be that coherent if it happens again? Who knows. Do I get belligerant when I'm low. Oh, yes. Just ask my family!

I've considered getting a tatoo on my wrist. Right where they'd be checking my pulse. Has anybody else considered this? I'd love some feedback and ideas.

Posted by: Ephrenia | Oct 02, 2008 02:54 PM

Hi lpoteet58,

Just so you know, umm, the story about Mr. Griglen in this post is about Mr. Griglen, not me. Just, you know, in case someone were to misconstrue that I am in a coma. I'm not.

;-)

Eric

Posted by: Eric L. | Oct 02, 2008 03:16 PM

IT AIN"T THE FIRST TIME!
Finally got to read the article and thought you all might want to know of a similar though not as bad incident that occurred on the San Francisco Peninsula a little over a year ago. This one got some media attention because the victim was a "natural body builder" who held some national titles.
His hypoglycemic incident led to a serious beating by law enforcement personnel for his "non compliance" despite the best efforts of the victim to show his Medic Alert bracelet to the responding officers.
I hope as part of the settlement that the "involved officer's" get a dose of reality and get to expose themselves to "insulin shock therapy"-They'd at least have the benefit of attending medical care during that experience! Don't kid yourself. After 44 years of living with this I can tell you without equivocation that it can happen to you. The tighter you care for yourself the more likely you are to have something like this occur. I'd call that a conundrum for sure! Wish I could tell you there was a simple answer to this problem-Maybe all Type !'s should be forced to wear a boldly displayed "SCARLET LETTER D"-That's humor folk's, but this ain't funny stuff!

Posted by: James D.Taylor | Oct 13, 2008 03:42 PM

I experienced a hypoglycemic episode while walking two blocks to my home. I was unable to remain standing, severe muscle cramping, unable to make eye contact, unable to remain still, thrashing around on the grass next to the sidewalk. I walk shouting and talking but making no sense.

Police were called. Four police officers decided to handcuff me. They had difficulty doing that so one officer put all of weight with a knee into my back while the others held me down. This happened 11 months after quintuple bypass heart surgery. I survived and tried to communicate with the police department. They did an investigation and exonerated all officers involved. I requested to meet with those officers to discuss what happened so someone else may not have to go through what I did. The police department refused to let me speak to the officers. I was determined to find out how and why I was handcuffed and injured. In order to hear those officers I filed a civil rights lawsuit in Federal Court. I had my meeting in the form and lengthy depositions off all officers involved and conducted by my aggressive and highly skilled attorney. This lawsuit was settled out-of-court.

That what happened was the result of a combination of "cowboy" police tactics and lack of education/traing. Training has been implemented in the local department. I would like to have input into how effective education and training can be achieved.

Intoxication of alcohol/drugs, epilepsy, traumatic brain injury, side effects of prescribed medications; all can cause unusual, erratic or combative behavior. Many skilled law enforcement officers know how to effectively deal with such conditions. How some officers use such behavior to set up license to use force. Little can be done to prevent these individuals from re-victiming the victims. The "blue wall of silence" prevents effective intra-department discipline. Negative publicity and lawsuits are neccessary to address these destructive and criminal actions.

However, many officers simply lack the rraining to identify the medical situations mentioned above. Yes, alcohol/drug intoxication is a medical condition. Refer to the Diagnostice and Statistical Manual of the American Psychiatric Asociation if you believe otherwise. Officers need to be trained to identify medical siturations that may appear otherwise. Please post any suggestions you may have about ideas for such training.

I have found that this disease demands education of self, family, friends, coworkers, teachers, employers, physicians, nurses, other medical professionals, dieticians, technicians, government officials, bureaucrats, law enforcement and most of all, self. No one can do such an enormous task effectively. As a group each of us can do our "piece". If each of our pieces are large enough, such a task can done with some success.

I dream of a dvd training tool to be used with other teaching techniques and tools to form a curriculum to train law enforcement to identify and deal with medical situations that may appear to be something else.

Posted by: andsoitgoes | Oct 13, 2008 10:57 PM

I apologize for the multiple typo's and mistakes in grammar and syntax in the above comment. Some of it is difficult to read. For instance: the last sentence of the first paragraph should read, "I was shouting and talking but making no sense." Thank you for the post.

Posted by: andsoitgoes | Oct 14, 2008 04:41 PM

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