Randolph case in Columbia shines light on diabetes

jholleman@thestate.comJuly 26, 2013 

SC NAACP president Lonnie Randolph leaves Columbia courtroom after hearing July 26 on charges of disorderly conduct after an incident at a Five Points dry-cleaners.

TRACY GLANTZ — tglantz@thestate.com Buy Photo

— The recent arrest of state NAACP president Lonnie Randolph for disorderly conduct and resisting arrest puts the spotlight on the need for better understanding of the possible consequences of diabetes.

Randolph’s is the first highly publicized case of erratic behavior blamed on diabetes complications in the Midlands, but similar situations have popped up in communities throughout the country. Last month, police in Santa Fe, N.M., pulled a 67-year-old woman out of her car, handcuffed her and left her flat on the hot pavement when she refused their commands after a traffic accident. She was in diabetic shock.

Joe McCulloch, Randolph’s attorney, argued successfully that his diabetic client’s uncharacteristic behavior when he was arrested July 12 in Columbia was due to low blood sugar. On Friday, the city police opted not to dismiss the charges because prosecutors want to gather more information.

The publicity gives diabetes advocates a chance to stress an important message.

“We obviously need more education as far as the community and as far as the police department on what questions to ask,” said Christina Bickley, associate director of the Columbia division of the American Diabetes Association.

On its website, the association lists possible symptoms of low blood sugar, including confusion, delirium, impatience and shakiness. Of course, those also can be symptoms of inebriation. Recognizing the difference isn’t always easy, but diabetes advocates believe situations such as Randolph’s can be short-circuited with knowledge and understanding.

In the late 1990s, a well-publicized lawsuit led to a Philadelphia Inquirer newspaper series of stories on diabetics who were refused medical treatment after being arrested for erratic behavior. One of the results was an education component, put together with the help of the diabetes association, now included in the Philadelphia Police Department training program.

In Portland, Ore., in 2005, a police officer shocked Michelle Schreiner with a stun gun and handcuffed her after she acted odd and refused to drop a syringe. She is diabetic and the syringe had insulin, though she was too out of it to explain that to the officer. Schreiner, then 37, agreed in 2010 to settle a lawsuit against Portland for $37,000 and a city promise to teach officers about the symptoms of medical stress.

In Redwood City, Calif., in 2007, competitive body builder Doug Burns went into diabetic shock and began acting odd in a movie theater. When police arrived, he turned defensive and went into a fighting crouch. It took five officers to wrestle him to the ground and handcuff him. Charges of resisting arrest and assaulting an officer were dropped, in part because a test revealed Burns had remarkably low blood sugar.

When someone has diabetes, the pancreas doesn’t produce any or enough of the hormone insulin, which converts sugar and starches into energy to fuel the body. About 25 million people nationwide have diabetes, though only about 18 million have been diagnosed, according to the diabetes association.

Treatments range from weight loss to pills to insulin injections. Those diagnosed learn to prick their finger to check blood sugar levels or listen to the cues from their body when their blood sugar is dangerously low or high.

Gwen Bowers, inpatient diabetes educator at Lexington Medical Center, teaches new diabetes patients or those who have begun having serious problems how to best control their blood sugar levels. Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) can cause serious problems, though confusion and irritability are more common with low blood sugar.

“I stress importance of daily monitoring of blood glucose in hopes of preventing severe hypoglycemic/hyperglycemic episodes,” Bowers said. “Monitoring is a self care behavior for diabetes management that cannot be stressed enough!”

Typically, blood sugar below 70 milligrams per liter will lead to hypoglycemia, or low blood sugar. One of Bowers’ patients, whose blood sugar level dropped to 50 milligrams per liter, reported not being able to move and being extremely confused.

But even those who know how to manage their blood sugar levels can slip up.

“It’s sometimes tricky,” said Dr. Ali Rizvi, an endocrinologist at the University Specialty Clinics in Columbia. “Hypoglycemia (low blood sugar) can develop rapidly, from a few minutes to 30 to 40 minutes.”

The manifestations — including confusion and irritability — also can crop up quickly, Rizvi said.

That brings up the question of whether diabetics should be allowed to drive. In South Carolina, diabetics aren’t allowed to get a commercial driver’s license to operate large trucks or heavy equipment, but they are allowed to get a standard driver’s license.

Diabetics fall into the same category as anyone else with a medical condition, according to the Department of Motor Vehicles. When seeking a license, applicants are asked whether they have a mental or physical condition that prevents them from safely operating a motor vehicle, or whether they have experienced a loss of consciousness, muscular control or a seizure in the past three years. Anyone who answers yes to any of those has to provide a medical evaluation from a physician.

After the license is granted, it can be suspended if a medical condition is reported to the Department of Motor Vehicles by police, the courts or a physician. Licenses also are suspended for six months for anyone who loses consciousness. Follow-up medical evaluations also are required every year for three years after the last time someone lost consciousness.

The license application also allows drivers to have a medical symbol placed on their license to alert emergency personnel to their medical condition. In the Redwood City case, Burns was wearing a Medic Alert bracelet, which is recommended by health officials.

The woman involved in the accident in New Mexico last month, Revina Garcia, said when police approached her car she felt so lost “I didn’t know how to open the door,” she told local media.

After an officer broke her window and pulled her from the car and placed her face-down on the pavement, she mentioned to them she was having a diabetic crisis, according to the police report. They still left her there until medical personnel arrived.

Santa Fe County Sheriff Robert Garcia said the incident will serve as a reminder that there could be medical explanations other than inebriation for erratic behavior.

“We have to refresh our law enforcement personnel on this issue,” Garcia told the Santa Fe New Mexican newspaper.

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