Insulin Indifference Disables Prisoners

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[Medical Care] [Riverbend Correctional Facility] [Georgia]

Insulin Indifference Disables Prisoners

For diabetic prisoners, prisons can perform up to 5 fingersticks and insulin administrations per day. A problem is some prisons have blanket policies of only 2 fingersticks and insulin administrations per day, and diabetics are frequently and indiscriminately transferred out to these prisons even though more than 2 fingersticks/insulin administrations per day are necessary to adequatly control their diabetes.

I think the medical treatises, and the other sources cited in the enclosed hand copy of the grievance I have recently filed at my prison will enable diabetic prisoners, as well as prison administrators who are not medical professionals (i.e. the warden, etc.), to recognize when a 2-fingerstick policy is an inadequate regime of treatment.

I also think the illustration of how diabetes and extremely elevated glucose levels harms the body (as evidenced by levels over 300 points, and the accompanying signs and symptoms of elevated glucose) is enough of a showing of physical injury to satisfy the Prisoners' Litigation Reform Act's (PLRA's) "physical injury" requirement necessary to allow a prisoner afflicted by this type of policy to recover additional damages for mental and emotional injury (42 U.S.C.A. Section 1997e(e)).

I am requesting you publish this information so that other prisoners throughout the country will know when their care is lacking and how to pursue proper treatment, through litigation if necessary.

Description of Incident

I am an insulin-dependent diabetic. Lunch is served for diabetics at 12:45 - 13:15 hrs. This is according to the Building Schedule. Like most other diabetics who require 70/30 type insulin, this schedule is too far outside the time frame my pre-breakfast injection of insulin works to lower my lunchtime glucose (by fingerstick at 17:00-18:30 hrs Diabetic Clinic). This is evidenced by the extremely elevated pre-supper glucose level in the 300s, 400s, and 500s. To prevent this, at all the other prisons I've been served lunch from 10:45-11:50 hrs. This is closer to the window period 70/30 insulin is effective to lower lunchtime glucose within. This was evidenced by a lowered pre-supper-time glucose level in the 200s, 100s, and below 100 points. (70/30 insulin is 70% intermediate-acting insulin and 30% short-acting insulin.)

I wrote a grievance on this problem, using information from the Prisoners Diabetes Handbook distributed by Southern Poverty Law Center, and Diabetes Solution by Jorge E. Rodriguez, M.D. On December 28, 2016 Counselor Johnson proofread my grievance for technical compliance before accepting it for processing. I will keep your staff at MIM(Prisons) informed of further developments regarding this.

Diabetes Summary

I also included in my grievance the following information so prison staff can understand the time frames insulin works within. There are 3 characteristics of insulin-onset (when the insulin starts to work), peaks (when the insulin is working the hardest), and duration (how long the insulin works for). The 70/30-type insulin I require is a mixture of 70% intermediate-acting insulin and 30% short-acting insulin. If you take short-acting (regular) insulin, and intermediate-acting (NPH) insulin, you need to eat on time by matching your meals to your insulin injections, so your insulin is peaking at the same time your glucose from your meals is peaking. Here are the time frames of 70/30 insulin:

Type insulinOnset after injectionPeak Duration
Short-acting (Regular)about 30 minutes 2-3 hours later3-6 hours
Intermediate-acting (NPH)about 2-4 hours4-10 hours later10-16 hours
*Note: Actual time frames for performance can vary based on each person's own individual response to insulin.

For me, as for many of the other diabetics who require 70/30 insulin, regular peaks about 3 hours after injection. (This is also the same time my glucose from meals is also peaking.) The NPH component peaks about 5-6 hours after injection. This was about the same time all the other prisons I've been to serve lunch. This was an adequate enough time frame to allow the insulin to lower my lunchtime glucose, measured by fingerstick at suppertime. But here at Riverbed Correctional Facility (RCF) lunch is served too far outside the peak performance cycle to lower my glucose at supper time.

The following information is from Diabetes Solution by Jorge E. Rodriguez, M.D., and my past conversations with diabetes specialists and educators, including this prison's own diabetes education facilitator, Registered Nurse Colin.

When you eat, food is broken down to the blood sugar, called glucose, which then enters the bloodstream where cells use it as food for energy. This process is called glucose-cell metabolism, and it can not occur without the hormone insulin. Insulin is made in the pancreas. Diabetes occurs when the pancreas either doesn't make any insulin, doesn't make enough insulin, or for other reasons the body cannot use its own insulin properly. When this happens glucose starts building up in the blood instead. This excel buildup is the high blood sugar (glucose) called diabetes. Diabetes is defined as a fasting glucose level over 125 points, or a random glucose level over 200 points.

Diabetes harms the body in the following way: A glucose molecule looks like a ball made of many sharp points. In high levels the points become abrasive which damages the insides of the veins of the cardiovascular system, kidneys, eyes, etc., causing heart disease, kidney disease, blindness, etc. When glucose becomes this dangerously elevated, the body will attempt to pass it off in the urinary tract. A sign of this is frequent urination. Other symptoms of glucose having become this high are blurry vision, extreme hunger right after eating, dry mouth, thirst, etc. This is happening to me right after lunch at this prison. These symptoms persist until my next shot of insulin begins peaking, 3 hours after supper time insulin administration. A sign I am suffering kidney damage is I can feel my kidneys since I've come to this prison.

MIM(Prisons) responds: This writer is setting a good example for others of sharing knowledge and work ey is doing to help others. Individual medical battles like this one are important for the survival of the individual, and we can make the impact much broader by writing up our successes and failures, documenting information needed by others, and building a movement capable of saving lives while organizing to ultimately dismantle this system of dangerous oppressive criminal injustice.