DKA in Jail – Three Stories
Three people with Type 1 share their stories of inadequate diabetes care while in custody.
Recently, we reposted the story of Demarcus Alexander, who was denied insulin while in custody in a case of mistaken identity. We asked for others to share their experiences of diabetes care in jail and prison, and three readers volunteered their stories.
I was in jail for three weeks last year for a non-moving traffic violation and taken to the Sedgwick County Jail in Wichita, Kansas. My pump ran out of insulin two days after I was arrested, and I was placed on injections, which I expected. It took at least 36 hours to get any long-acting insulin.
What I did not expect was the complete lack of knowledge from the clinic staff. Once on injections, my blood sugar was over 300 mg/dL the whole time, and often far over. I was given the maximum doses of 15u of NPH at night and 15u of Regular before meals. For half of the day, I had no basal insulin, and for the other half I had a fraction of what I needed.
The meals, as one would expect, were mostly carbohydrates. I picked out what protein I could find, but otherwise did not eat in hopes of staying out of diabetic ketoacidosis (DKA). Everybody kept telling me to eat all of my food, and that they would adjust my insulin to account for the food. I tried that once, it ended about as badly as you would expect. The meter would read “HI” and I would get my same 15u; never a unit more.
More than once, I felt the acidic breath, shortness of breath, and inability to keep down even water that I know as the early stages of DKA in my body. I wasn’t actively in a coma, so nobody did anything. When I kept asking for 2- hour basal insulin, the physician assistant in charge of the clinic insisted that NPH was a 24-hour insulin. She patted me on the shoulder and said, “Don’t worry, 400 (mg/dL) isn’t a bad blood sugar.”
Read more: A DKA death in jail.
There are no visible lasting effects that can be directly attributed to my stay. I am dealing with some pretty heavy PTSD, and the emotion and stress makes my sugars hard to manage.
Brandon (last name withheld):
I was in custody in the Davidson County jail system a few times between 2009 and 2011, and developed Type 1 diabetes during that time. For a while, they treated my blood sugars as if I had Type 2 diabetes. I had to beg and plead to the guards and medical staff for insulin. Even then, I would only get injections before meals with no carb ratio. I would never get my blood sugars below the 500 mg/dL range. I developed nerve damage because of it and now have full blown neuropathy in my right thigh and in my hand. I’m truly lucky to be alive considering my blood sugar was over 900 mg/dL when I got out of prison.
About a decade ago, I was arrested and had to spend a night in a Kentucky jail. I got to the detention center just after midnight. I was wearing a pump and they forced me to remove it. I did and told them the facility doctor would need to give me insulin as soon as possible.
They didn’t let me see a doctor until 10 am the next morning, but by that time I was in DKA and going downhill fast. The doctor sent me to the hospital ER because I was beyond what he could do for me. You would think there would be a doctor on call for the detention center for people with issues like Type 1 diabetes, considering how quickly our health can deteriorate.
There are roughly 2.3 million people incarcerated in U.S. jails and prisons, according to a 2017 estimate by the Prison Policy Initiative, and roughly 1.26 million people with Type 1 diabetes in the United States, according to JDRF. If the rate of Type 1 diabetes diagnosis is the same for the incarcerated population as it is for the general population, then by a back-of-the-envelope estimate there could be 92,000 people with Type 1 diabetes who are incarcerated in the U.S. At Insulin Nation, we would encourage diabetes educators to offer training on Type 1 diabetes management at local correctional institutions.
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