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The ‘other’ possible consequence of unrecognized severe hypoglycemia
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As diabetes educators, educating people with diabetes — especially those with type 1 diabetes — about how to recognize and treat hypoglycemia is a key educational consideration. Because everyone does not exhibit or experience hypoglycemia in the same way, we often spend time discussing how to recognize one’s own body’s response to impending hypoglycemia and provide guidance in how to treat the symptoms promptly. The goal of the educational session is to prevent the hypoglycemia from becoming a serious event and, above all, to keep the person safe.
Diabetes educators are aware that aggressive refusal of help with severe hypoglycemia is common. Families and support teams are taught that some of the symptoms of severe hypoglycemia may include unpredictable and combative behavior. Anyone who has experience with a loved one with severe hypoglycemia is well aware that there is no way to rationalize, or “talk sense,” with him or her. Because treatment of severe hypoglycemia may require the assistance of another person, glucagon administration is also taught to a family member or support person. Additionally, diabetes educators recommend that some sort of medical alert identification be worn or carried by the person with diabetes in the event of an emergency.
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But, is this enough education and information about severe hypoglycemic symptoms and treatment to keep the person with diabetes safe? As diabetes educators, do we need to do more?
Lack of hypoglycemia awareness
A recent court case illustrates how diabetes educators must consider additional educational strategies regarding awareness and treatment of severe hypoglycemia. In March 2009, a 17-year-old with type 1 diabetes from the south side of Chicago was charged with two counts of aggravated assault as a result of an incident that occurred when paramedics were called to his home to provide medical emergency aid.
His girlfriend testified that he was ill for most of the day; she finally called 911 when he was not responding. She told the 911 operator that she had coaxed him to drink some juice, but was sure he was having a “diabetic reaction.” His girlfriend told the paramedics that he could get “feisty and combative when his blood sugar goes low.”
When the paramedics arrived, they attempted to check his blood sugar by holding down his arm. Allegedly, the teenager was uncooperative and assaulted one of the paramedics while he was trying to obtain a blood glucose sample. He was punched in the face several times by the paramedic and was forcibly restrained until police arrived and then handcuffed. At this point, his mother arrived on the scene and immediately checked his blood glucose level. He was taken to the University of Chicago Hospital.
He was later charged with two counts of aggravated battery and transported to the Cook County Jail. If convicted, he faced a possible prison sentence of 3 to 7 years. The state’s attorney’s office refused to dismiss the case or resolve the case, short of the teenager pleading guilty to some sort of felony charge. In June, after months of delay, a trial was held. The defense provided a convincing case that the teenager’s actions were a result of his diabetic condition and not a knowing, intentional act of aggression. Fortunately, the judge found the teenager not guilty. The judge also stated that the paramedics had acted reasonably to help the teenager.
This case is a sobering example of the lack of awareness of the symptoms of severe hypoglycemia by paramedics and law enforcement personnel. It is not unimaginable that this teenager could have spent years in jail as a result of an unrecognized severe hypoglycemic event. This case should serve as a call for action for all health care professionals who treat people with diabetes who may experience severe hypoglycemia. Unfortunately, this is not an isolated case. However, you can help prevent this from happening again.
Police training for emergencies
As a result of a 2003 court case for failure to provide appropriate care to people with diabetes (class action suit Rosen v. Philadelphia), the city of Philadelphia was ordered to make a police training video co-produced by the Philadelphia Police Department and American Diabetes Association (ADA). The video features actual police officers, police academy trainers and an ADA spokesperson.
This video is now part of standard training in the Philadelphia police academy. The video/DVD, “Treating Diabetes Emergencies: What Police Officers Need to Know,” is available for free (pay shipping only) from the ADA. The video is also available on YouTube in three segments.
Police departments across the country have incorporated the video into their own police training. Does your local police department have one?
Additionally, a poster on diabetes and custody, “Diabetes is serious: It can be life-threatening,” was ordered to be developed by the city of Philadelphia and is posted in every detention facility in Philadelphia. A generic poster is available for free (pay shipping only) from the ADA.
I encourage all diabetes educators to view the video and check with their local police, fire and emergency medical services departments to see if they are aware of these materials and if they have been incorporated into their training. This is an opportunity for diabetes educators to show how they can be a resource to their communities and help people with diabetes. Include this information in your preventing and treating hypoglycemia education, and it may save someone from the same experience as the teenager from the south side of Chicago.
Mary M. Austin, MA, RD, CDE, is president of the Austin Group, LLC, in Shelby Township, Mich.
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