Diabetes A Possible Cause of Altered Mental Status

When interacting with a person who has an altered mental status (just not acting right) it is very commonplace in the law enforcement community to come to the conclusion that the person that we have made contact with is either drunk, high, or both. For this Medical Monday we are going to discuss diabetes (another cause of altered mental status), what it is, and how to treat it. We are also going to examine a case that made it all the way to the supreme court in regard to use of force by law enforcement.

Before we go into what exactly diabetes is, it is important to go over a couple of quick definitions.

GLUCOSE – Sugar
PANCREAS – A gland / organ that sits behind the stomach that produces the hormones insulin and glucagon. It also secretes stuff (enzymes) that helps break down food.
INSULIN – The key (hormone) that unlocks the cells allowing glucose to enter which creates energy. Insulin also has the ability to store glucose for future use.

Now that we have those definitions out of the way, we can begin to explain diabetes. Diabetes is a condition where the amount of glucose in the body is being poorly regulated because of the amount of insulin being released by the pancreas. There are a few different types of diabetes.

Type I – This type of diabetes occurs typically at an early age. It is a condition in which your body does not produce any insulin. These patients typically have a small device that they used called an insulin pump. It is a small computer device that is worn on the belt with a tube that goes into the body to supply the insulin. The other option for diabetics is an insulin pen. The person must inject a set amount of insulin throughout the day.

Type II – In this type of diabetes (typically found in adults) the body has developed either a resistance to using the insulin it produces, or the body does not produce enough insulin for the amount of glucose in the body. This type of diabetes is managed by the person being prescribed an insulin pen as well as following physician recommended lifestyle changes.

Gestational Diabetes – Due to hormonal changes, some women will experience incurring diabetes while they are pregnant. After the woman has delivered their baby, their glucose levels will return to normal. There is research that shows women who experience gestational diabetes have a higher risk of developing type II diabetes.

Now to the point of what all of this has to do with altered mental status and us as cops… A person with blood sugar that is too high (HYPERglycemia) or blood sugar that is too low (HYPOglycemia) can present with an altered mental status. To give some sort of frame of reference, think about a time where you were not able to eat for a long period of time. You were most likely hangry. After you were able to eat, you felt better. You become hangry because your glucose level is too low. After you eat, it rises back to a normal level. With people who are diabetics they will often be very slow to respond and appear that they are under the influence of either drugs or alcohol. There are several diabetic calls that I have responded to where the patient is being combative and acting erratically. In general, it is definitely a great idea to have an EMS unit respond. Every ambulance is equipped with a glucometer (a device that can measure blood glucose). If the person is experiencing HYPOglycemia, they need a medication (D10 preferably or D50) that can be given intravenously, or a different medication (glucagon) that can be given as a shot so that their glucose level can rise back to a normal level. If the person is experiencing HYPERglycemia the person will need to be transported to a hospital where their glucose level can be lowered safely in a monitored environment. It is important to note that people that are breathing deeply and rapidly (Kussmaul respirations), complaining of extreme thirst, urinating frequently, and have a dry mouth are most likely experiencing HYPERglycemia.

On November 12^th, 1984, a person experiencing a drop in his blood sugar asked his friend to drive him to a convenience store so that he could purchase some orange juice to raise his blood sugar back to a normal level. When he went into the store, he encountered a long line, so he decided to exit the store, get back into his friends car and ask his friend to drive to another friends residence where he hoped to find something to eat or drink to get his sugar back into a normal range. The trip to the store was observed by Officer Connor. It appeared suspicious to Officer Connor that the subject entered and then exited the convenience store so quickly, so Officer Connor conducted a traffic stop. Officer Connor directed the subjects to stay in the vehicle, however one of the subjects, Mr. Dethorne Graham exited the vehicle, ran around the vehicle and then passed out. Officer Connor placed Mr. Graham in handcuffs. Mr. Graham woke up and reportedly plead with the officers on the scene to get him some sugar. The officers ignored the requests believing that the suspect was intoxicated. During the encounter the suspect sustained multiple injuries including a broken foot. When it was determined that the suspects had not committed any crimes, Mr. Graham was released. This case wound up in the supreme court known as Graham VS Connor. It is a landmark case dealing with reasonableness when it comes to use of force. The good news for us is that the actions of the officer must be judged from the perspective of a reasonable “officer” and not from that of a responsible “person.”

Here are the key take-aways from this Medical Monday:

Hypoglycemia & Hyperglycemia can both become life threatening medical conditions.
Keep an open mind as to what the underlying cause of the altered mental status is.
1 out of every 10 Americans is affected by diabetes.
Consider an EMS response early when encountering any type of altered mental status.
In some areas of the country a person with diabetes will tell you that they have “the sugars.”
The normal range for blood glucose is 80-120 milligrams per deciliter.
Do not attempt to give any sugary food to anyone who is not conscious, breathing deeply and rapidly, or who is complaining of severe thirst, a dry mouth, and needing to urinate frequently.

I hope that you were able to take away something from this Medical Monday. As always if you have any comments or questions, I would love to hear them in the comment section below.