Columbia, SC — I FIGURED DR. Lonnie Randolph must have been drunk when he got into an argument over his dry cleaning bill, became agitated and erratic and ended up in a tussle with police.
When I heard he has Type 1 diabetes, I figured any controversy over the encounter would end there.
I figured wrong on both counts.
I doubt I’ve had more than a dozen conversations with the president of the state NAACP over the quarter century I’ve been at the newspaper, and I don’t have strong feelings about him. What I do have strong feelings about is people’s understanding of Type 1 diabetes, which I’ve had for more than 40 years.
It seems that the longer this discussion drags out, the more misperceptions about the disease crop up. In fact, I don’t think I’ve read anything about the incident that doesn’t involve at least one bit of misinformation about diabetes.
As in: People don’t become belligerent when they’re having low blood-sugar reactions; they’re too exhausted.
As in: Low blood-sugar episodes don’t just come on suddenly the way we’re asked to believe Dr. Randolph’s did.
As in: Anyone who would get into the condition he was in must not be taking care of himself.
As in: It’s crazy to allow diabetics to drive. (OK: That’s an opinion, not a factual claim — but it’s badly misinformed.)
As in: City manager Teresa Wilson was right to go to the scene if she knew Dr. Randolph had diabetes. (OK: That’s an opinion too — but it’s badly thought-out.)
First, the basics: In Type 1 diabetes, the pancreas stops producing insulin, the hormone that allows the body to turn food into energy. So patients have to take regular injections of insulin; on most days, I take at least five shots. How much insulin you need depends on what you eat, how physically active you are and a host of hormonal and emotional variables that I still can’t predict reliably enough. And therein lies the problem.
While the body of a non-diabetic adjusts the amount of insulin it produces based on all those variables, it’s simply not possible for diabetics to always predict the precise amount of insulin they need. Take too little, and you increase your chance of long-term problems, from kidney failure and blindness to heart attack and stroke. Take too much, and the amount of sugar in the blood stream drops too low, starving your brain of the energy it needs to function. This most often produces spikes in body temperature and lethargy; if the blood-sugar level falls too low, it can lead to unconsciousness or even death.
When I was diagnosed with diabetes, I was instructed to carry an identification card from the American Diabetes Association that shouted, in bold red letters: “I am a diabetic. I am not intoxicated.” I still carry a diabetes ID card, though for reasons that escape me it no longer includes the reference to intoxication, and I’m not sure police would rifle through my billfold to find it if I had a run-in with them.
Low blood-sugar reactions are easy to treat: Eat something high in carbohydrates, and wait; it generally takes about 15 minutes for the sugar to get to the brain and start alleviating the systems.
At least they’re easy to treat if you realize what’s happening.
When I told my endocrinologist I thought it was possible for a diabetic episode to create the sort of behavior Dr. Randolph displayed, he replied without a moment’s hesitation: “It happens all the time.” He has told me of patients whose spouses had to wrestle them to get sugar into their mouths when they woke up in the middle of the night and realized the diabetic’s blood sugar level had dropped too low.
I’ve been fortunate not to have any horrible, terrible reactions since just a few months after I was diagnosed, at age 8. That one time, I’m told, my father and adolescent brother had to struggle to hold me down while my mother forced orange juice into my mouth. All the other reactions — thousands of them by now — I’ve treated on my own, without incident.
In fact, the main problem I have with low-blood sugar episodes, besides the fact that they feel awful, is that I sometimes eat way too much to correct them, because the part of my brain that involves self-control isn’t firing on all cylinders. This sets me up for an hours-long roller-coaster ride: If I don’t calculate correctly how much insulin to take to compensate for my overeating, my blood sugar shoots up too high, and then it frequently drops too low when I treat that.
But while I haven’t been physically combative since that one incident, I have in recent years developed a new symptom of low blood sugar: extreme irritability. I’ve learned that it’s time to check my blood sugar whenever I realize that I’m getting more irritated than the situation warrants.
Which brings us back to the Randolph case.
Beyond the ridiculous suggestion that his behavior was unrelated to diabetes, two strains of criticism have been particularly disturbing.
First is the healthier-than-thou second-guessing among some diabetics, suggesting that Dr. Randolph obviously wouldn’t have such episodes if he took appropriate care of himself. And if he has horrible, terrible episodes like this on a weekly or even monthly basis, then they might be right — although he certainly wouldn’t be in the minority of diabetics if that were the case.
Or they might be wrong. What if these episodes occur once a year? Or once every few years? That could be often enough for people who know him well to be aware of the problem without indicating that he’s terribly out of control. It could simply indicate that when his blood-sugar level drops really fast and really far, his brain reacts more violently than most of us are used to.
The other over-the-top suggestion is that diabetics should be stripped of their driver’s licenses. I’m sure there are some diabetics who shouldn’t be allowed to drive. Just as there are some senior citizens who shouldn’t be allowed to drive.
But state law already requires applicants to get a physician’s approval to renew their driver’s licenses if they experienced loss of consciousness, muscular control or seizure in the past three years. To suggest that no diabetics should be allowed to drive is … well, it’s sort of like suggesting that we require people to trade in their driver’s licenses for their Medicare cards.
None of this, by the way, made it OK for Ms. Wilson to show up at a crime scene involving a politically prominent member of the community. If she was worried that the police wouldn’t realize Dr. Randolph had diabetes, she should have instructed the police chief to alert his officers to what could have been a medical emergency that demanded immediate action, rather than wasting time driving to the scene herself.
Anything beyond that had nothing to do with diabetes, and everything to do with poor judgment or politics.
Ms. Scoppe can be reached at email@example.com or at (803) 771-8571. Follow her on Twitter @CindiScoppe.