Wednesday, August 28, 2013

Grave Mistake

An endocrine emergency takes place right next to an endocrinologist, but she cannot do anything about it. Why?

Endocrinologists have all resuscitated patients and dealt with common medical emergencies, as they must train in either internal medicine or pediatrics prior to sub-specializing. But when you spend all of your time in a subspecialty, you don’t routinely practice the other skills. Endocrine emergencies are limited to adrenal crises and episodes of DKA, not heart attacks and strokes.

I thought about this a few months ago as I was walking to the ENDO conference. Attendees were given bright purple tote bags, and the streets were flooded with purple. I laughed to myself thinking that despite thousands of doctors milling about, how useful would we really be in an emergency that wasn’t involving hormones?

I met a lot of different people over the four days that I was there. One was a physician from Europe hoping to train to be an endocrinologist and he hung out with me and a group of friends the whole time. He noticed my insulin pump over dinner one night and we had a long discussion about it, as they are not commonly used where lives.

He and a co-worker of mine went sight-seeing around San Francisco the next day, which involved a heavy amount of walking. A few hours into it, they were at a street corner waiting to cross and he suddenly went pale and started speaking incoherently. My friend who was with him, and who is an adult endocrinologist, feared that he was having a stroke or maybe displaying signs of encephalitis. She sat him down and called 911 because he was completely unstable and deteriorating rapidly.

EMS showed up and immediately tested his blood sugar. It was 31 mg/dl. It turns out he had Type 1 Diabetes. He had not told any of us about it, even after I had spoken very openly about my own diabetes the evening before. He was not wearing medical alert jewelry, but he did have a messenger bag full of glucose tabs. The only problem was that he went hypoglycemic so quickly that he was unable to verbalize that they were in there and she did not know to look.

How ironic that one of the few emergencies that endocrinologists are really good at dealing with happened right in front of one and she was still unable to help. People cannot help in an emergency unless they are equipped with the right information. Despite being a doctor in the company of doctors, he felt so self-conscious about his diabetes that he was uncomfortable sharing it.

He learned his lesson the hard way. Luckily for him, he got glucose in time and then started to think more clearly about being open about his health.

11 comments:

  1. Wait. Maybe he wasn't self-conscious. Maybe it was a choice and a rational decision. I have been T1 for 54 years and nobody beyond my wife, kids, mother and doctor know of my "condition." That will never changes. It doesn't need to change. I don't wear a medic alert either though I have a pump.
    Dealing with D alone is the cornerstone of my easy and successful life with D. I have no complications, I've never gone to the hospital for D, I have no fear, worry or regret. I honestly have never had a bad day.
    I didn't disclose it at school or work, to roommates at college or even when I covered wars in Iraq and Afghanistan.
    My care is my concern and only my concern. I would never have it any other way. It works beautifully, is totally liberating and gives D zero power.

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    1. My main point is not to encourage people to "give in" to diabetes - it is more about safety. If this guy cannot feel his BG dropping quickly, he is putting himself in a very precarious situation if no one knows he has diabetes. I'm glad your method has worked for you, and I hope it continues to work for you. But I cannot, as a physician, encourage people to deal with diabetes alone.

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  2. maybe it is cultural. maybe it is not something you talk about where he comes from

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    1. Yes, that is an interesting point. He did mention that diabetes is not very prevalent where he is (I should look into that) and that may have contributed to the silence.

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  3. You always have such interesting stories! Thanks for sharing...what a scary situation your friend was in but I'm glad it all turned out OK.

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  4. (From Maria M - too many accounts open @ work lol)

    I was like that for a long time. Didn't want pity or answering questions about it. Today I feel more comfortable, although it takes time for me to tell people - for some reason I feel like I want them to get to know ME first before they start thinking of me as "that girl WITH DIABETES" To this day, I still don't own any alert jewelry or even a wallet card (keep meaning to get one of those). I just think it's so interesting that you didn't think of BG because you assumed that he would've told you... I would've told you - I would never not "come out" to a fellow T1D (or T2D). But just goes to show everyone is different (as you can also see from the comments :)

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    1. Yup, definitely. I didn't tell people for the first 15 years for those same reasons. But when I started med school, I started seeing everything differently.

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  5. This story struck my heart. I totally understand DC Scribe's position ... But in the end I agree with you ... I hope in the future my T1 son will be open about his diabetes ...

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  6. My daughter (15) refuses to wear/carry any T1 identification. We haven't worried about it too much because up until the past couple of weeks she has worn an insulin pump. But she's decided she 'hates' the pump - and is in a very self-conscious phase. So much so that she has just started back on shots to be less 'visible' about diabetes. Yes, I'm stressed about it. Trying not to put pressure on her, let her be empowered etc ... but worrying that we're abetting a backward step.
    The physician from Europe makes me think about the balancing act faced by even the most 'informed' T1.
    Any tips on helping a teen feel less 'humiliated' by T1?

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    1. Sorry for such a delayed reply -- I somehoq missed this comment. Teen years are tough! Check out article by a mother with a Type 1 teen (she wrote a book, too!): http://www.diabetescare.net/content_upclose_detail.asp?id=447096

      I'm a strong believer that the best way to overcome diabetes "humiliation" is to actually be more open about it. Teens care more about things that are secretive and kept under wraps (rumor mill, etc). Once something is out in the open, no one cares about it anymore!
      As far as IDs go...I sometimes suggest an ankle bracelet. Emergency responders are required to check neck, wrists and ankles and ankle bracelets are more discreet for everyday life.
      Best of luck to you all! The good thing is that teen years don't last forever ;)

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