The story of Doug Burns’ arrest during a low blood sugar episode has generated a lot of comments from the diabetes community. How did it happen, why did it happen, and how could it have been handled differently?

Two days before the incident, Doug ran out of infusion sets for his pump.  They were shipped, but hadn’t arrived yet.  Because he couldn’t use his pump until they arrived, he temporarily shifted to daily injections of Lantus and NovoLog. The first night was completely fine, but the next day he trained hard.  His blood sugar dropped as a result, but he ate enough to bring it up and then began an afternoon of appointments and errands.  He took some NovoLog and ate something, but it apparently wasn’t quite enough and he felt himself beginning to go down a little. He had last tested his blood glucose at about 5:20 pm, about an hour and a half after he left the gym. Because he was headed for the movie theater, he figured he’d just eat something at the theater snack bar to bring his sugars up. He arrived at the theater about 6:45.

In the theater parking lot, Doug was approached by some rough kids who wanted to talk. Because he’d worked with “kick-aside” kids like these in juvenile hall, he spent some time chatting with them and giving them tips about lifting.  By the time he got upstairs, ten minutes had elapsed.  As he walked into the theater, he ran into two acquaintances with whom he exchanged the usual pleasantries.  By the time they parted, twenty or thirty minutes had passed since his arrival.  At that moment, Doug, who has hypoglycemic unawareness, realized that he was pretty low, but it was almost too late.  He could no longer read the marquee listing the movie titles, but he bought a ticket and headed in for the snack bar.

Doug only partially recollects what happened next, but a witness has provided some information.  By the time Doug got halfway up the stairs, his vision was failing.  According to the witness, he was stopped by a security guard to whom he mumbled, “I am a diabetic, I need sugar.” Nevertheless, the guard took him by the waist and escorted him down the stairs and out the door. Once outside the theater, Doug went right back in, heading for the snack bar again. The security guard ran out and hailed a police car in the parking lot, telling the officers that there was a drunk person in the theater. By that time, Doug had lost the ability to stand and was collapsing.  One officer attempted to stand him up, and Doug tried to push him aside.  It was at that point that he was apparently pepper sprayed by police, but he does not recall what happened next.  He would not be surprised if he did respond aggressively after being pepper-sprayed, but given that he wasn’t able to stand well, he doubts that he was very effective. At some point the police hit him with clubs.  His medic alert bracelet was apparently broken during the scuffle; it was seen by the paramedics, however, and he found it later in his pocket.

Doug’s next memories are intermittent snapshots because he was going in and out of consciousness.  He remembers the sounds of the police dogs, and he recalls hearing a paramedic tell the officers to take the handcuffs off him because he was in insulin shock.  At the scene, his blood sugar was 23 mg/dl.

What could Doug have done differently?  He had sugar tabs in his bag, but he left his bag in his car and didn’t take it into the theater.  He lost time talking to the kids and his acquaintances, but during that time he did not realize how low he was getting.  He is a gregarious man whose first instinct is to interact generously with other people, and the time passed before he knew it.  He can usually catch low blood sugar at about 65 mg/dl if he is alone, but if he is socially engaged, he becomes so outwardly focused that he misses the few premonitory signals his body supplies.

Another element was the change in insulin.  Doug, who was familiar with the pump’s slow infusion, was unused to having so much background insulin in his system, It made the NovoLog much more aggressive and caused him to plummet very quickly. Because he is in such good shape right now, the amount of Lantus he needed was much less than it used to be.

Doug notes that if even one person had realized that he was in insulin shock before the pepper spraying began, the whole incident could have been averted. It could have ended so simply. That’s why Doug’s goal is to use the publicity generated by this incident as a tool for education. Instead of taking legal action against the police, he is asking them to develop a realistic video about diabetes for presentation to officers and security personnel.  A number of people, including Doug’s endocrinologist, are willing to contribute to a video that clearly demonstrates the signs of low blood sugar, the signs of DKA, and how to handle it without violence.

Doug notes that when medical presentations are too clinical and sterile, without real world content, they tend to be forgettable and have no impact.  He envisions a police officer describing possible scenes and how to handle them, so that the information carries weight to fellow officers. It should be very clear that clubbing is not the way to proceed. He’d like the presentation to also include people with diabetes, maybe himself and Chris Dudley. Even the JDRF would like to get involved, having heard from so many people with similar experiences since Doug’s arrest. 

To everyone with diabetes who has read about his recent tribulations, Doug wants to reiterate that although lows happen, it’s important not to feel ashamed or frightened. No matter who you are, if you have type 1, you may crash occasionally.  You have to brush yourself off and move forward.  You did not fail, he says, so don’t beat yourself up–lows are simply a hazard of the disease that you do your best to avoid and learn from.  Doug’s going to remember his glucose tabs from now on, and he’s going to be careful about keeping enough infusion sets around.  If he has to go onto injections again, he’ll be more prepared.  But he came out of the incident okay, and a great deal of positive education has resulted, both for the police and the general population. If the police think twice now when they encounter someone with low blood glucose, his misfortune will have served a valuable purpose.

See also:

Doug Burns interview on Diabetes Health TV