This is the 5th out of 6 in this series of “5 things criminal attorneys should know about…” which I first posted a few years ago. Each month I highlight some areas of medicine that often cross into the criminal fields. This is not meant to be an in-depth review, but rather just bullet pointed facts. If you have any subject requests let me know!
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For this month we’re going to highlight Diabetes. High and low blood sugar levels often come up in DUI cases and it’s important to be aware of the potential affect it may have on the defendant and their ability to drive and complete FST’s. Diabetes may also come up in assault cases as some diabetes become combative when their sugar is low.
Diabetes Types
- Type I Diabetes Mellitus – Diabetes Type I is when the body is unable to produce insulin. It is most commonly discovered in childhood but it is possible to be diagnosed later in life – most commonly due to a major medical event.
- Type II Diabetes Mellitus – Type II diabetes indicates that the body is not able to produce enough insulin for the functioning of the body. It is possible to be diagnosed anytime during the lifespan.
- Diabetes Insipidus – an unrelated form of diabetes that is related to a kidney disorder.
Medications
- Insulin – Type I diabetics rely on insulin as they produce no insulin on their own.
- Oral (pills) – Type II diabetics may be on a combination of oral hypoglycemics, diet and/or insulin.
- Diet – All diabetics need to control their blood sugar through diet. Some Type II Diabetics are able to control their sugar without any medications.
- All diabetics can have high or low blood sugar, regardless of their method of treatment.
Low glucose levels
- Normal blood sugar levels are approximately 60-100. When the sugar levels fall below 60 it is called hypoglycemia.
- Symptoms mimic intoxication but patients do not immediately act like a “falling down drunk” when their sugar hits 59. Most patients will feel light headed, woozy and maybe just “not quite right” first. As their sugar drops the symptoms will become more severe and they will begin to slur their speech, have difficulty walking, exhibit confusion, etc. Without food or some kind of intervention to raise their blood sugar the patient may fall into a coma. Low blood sugars do not spontaneously resolve.
- Low blood sugar will not cause a breathalyzer or PAS test to come back falsely elevated.
High glucose levels
- Slightly elevated blood sugars (up to 200) are not likely to be symptomatic at all.
- From 200-400 there may or may not be symptoms, but the symptoms will likely be mild.
- Diabetic KetoAcidosis, or DKA occurs when the high glucose levels persist and may affect the breathalyzer results due to ketone release by the body.
- To confirm DKA the patient needs to have a urine or blood test for ketones and DKA is unlikely to resolve on its own as well, so one would expect treatment in the hospital to have occurred.
- Sugar levels have to be extremely high (usually 400 and above) for there to be symptoms that would affect the field sobriety tests.
Other long term complications
- Eyes – all can affect vision and/or cause blindness
- Diabetic retinopathy (damage to blood vessels in retina)
- Cataracts – develop earlier in diabetics
- Glaucoma – diabetics are twice as likely to develop glaucoma
- Neuropathy (Nerve damage)
- Peripheral – results in pain, numbness or weakness in the feet and hands
- Autonomic – affects the nerves that control body systems (i.e. bladder and heart)
- Wound Healing and infection – diabetics take much longer to heal from simple wounds, even scratches, and are much more susceptible to systemic infections.
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