I‘ve done quite a bit of medical legal consulting/testifying in cases involving people with diabetes, and several cases that I reviewed recently prompted me to write this note to all of you folks on a pretty serious topic. The vast majority of these sad situations involve people with diabetes getting low while driving or an unfortunate “dead in bed” situation.
What would you think of a type 1 individual, who had a CGM device but was not wearing it, then got low while driving and killed a pedestrian? It was his first severe hypoglycemic event and ended up getting a two-year jail sentence in the type of prison shared with cold-blooded murderers. Some may say that is where he belongs (jurors, judges, family of the victim) and others would be more lenient or sympathetic. We don’t pretend to know the answer.
What about a truck driver with type 1 who had really poor control with A1cs, in the 14% range chronically, who did not use a CGM, rarely tested his blood glucose level, and skipped his insulin frequently. He passed out from diabetic ketoacidosis (a serious condition from very high glucose values over an extended period of time) while driving his big rig on a Midwest highway going 65 MPH and plowed into eight cars that were stopped due to a traffic issue. Six people died immediately, and the driver had no injuries but was hospitalized to treat his diabetes. Should this guy be locked up? Should the medical folks at the trucking company who cleared him medically to drive be liable? Did this driver have access to good docs and educators and motivational education? Did the DMV do their job? A lot to think about, but six people are dead and several more injured for life.
How about a type 1 cable repair guy who was also not motivated to take control of his diabetes, passed out from a low, which was the cause of three prior accidents where he was fined, and the DMV let him have his license back after the first few hypo accidents since he needed the job for his livelihood. This time a young couple who were soon to be married were killed as their car caught on fire from the collision and they burned to death.. Another complex case for sure.
Now a case of a businessman with type 1 who gets low and passes out fully dressed in his work clothes in a hotel room on the bed moaning. The maid came in to clean his room and saw him but just closed the door and left. She comes back with a co-worker six hours later and he is now on the floor on his stomach moaning and groaning wearing the same work clothes. She does not tell her supervisor and comes back the next morning to find him dead. Was the patient irresponsible? He had excellent A1c values and did fingersticks six times a day. His general doc never offered him a CGM according to the medical records, which could have saved his life. It would have for sure helped his wife know about him getting low immediately with the sharing features. Should the hotel be sued? Should his general doc be sued? He left behind a wife and two kids.
OK…last one that really hits home, because it involves one of my own patients. This patient has serious hypo unawareness and hears his Dexcom beep three times and then four times, indicating he was below 55mg/dl while driving on the freeway going 70 miles an hour. He thought to himself, “I do not feel low, so I will just keep driving”. Well he ended up having a major accident and luckily, no one was seriously hurt. What if someone was killed? Who pays for the property damage? Who pays for the CHP and firemen services that came to the scene?
When I hear these cases they really break my heart. I feel bad for the person struggling with diabetes, but of course also feel bad for any other innocent bystanders.
These things are still far too common, so remind yourself of the basics:
- Get a CGM and set up the share feature at least for severe lows (< 55mg/dl). This is especially important for when you travel.
- If at any time you dip below 80mg/dl you should pull over and treat yourself. I’m guilty of this one myself and really, really, really need to do better. It’s just not worth the 10 minutes you might save to take the risk of not pulling over.
- Make sure you have glucagon with you, you know how to use it, and somebody close to you knows how to use it.
- Wear a medical alert bracelet. CGMs and pumps don’t count! Paramedics aren’t trained to look for them.
- If you have frequent lows look into some of the hypo-mitigating technology, like Tandem’s PLGS, the Medtronic 670g, or LOOP.
- Keep low glucose snacks EVERYWHERE. In the car for sure, by your bed, in your travel kit, in your spouse’s bag, behind the toilet, and even at your favorite bar!
We’re lucky to have so many tools at our disposal these days to help manage diabetes, so be smart and use them!