How should Diabetes be managed in Jail?
Dealing with diabetes involves a number of strategies from physical activity to medications, injections and a healthy diet. However, accessing all of these cornerstones to health can be challenging while incarcerated.
Managing Diabetes in Jail
Medical care for diabetics in jail should meet the same standards of care as those not incarcerated. However, there are many restrictions that make this difficult to achieve such as security concerns, staffing levels, medication availability and access to nutritious foods. For more information on the types of problems diabetics face in jail, check out our other diabetes article.
About Diabetes
Diabetes is a medical condition where the body does not make enough insulin (or any insulin) to help use glucose for energy. There are two primary types, along with pre-diabetes.
- Type 1: The body doesn’t make any (or very little) insulin. Typically diagnosed in childhood or as a young adult. Causes are largely unknown, but occurs when the body’s immune system attacks and damages cells that produce insulin.
- Type 2: Insulin is produced, but the body isn’t able to use it properly. Can occur at any point in life, and is usually due to risk factors such as obesity or a family history of diabetes.
- Pre-diabetes: Glucose levels are high, but not high enough to be diagnosed as Type 2.
Recommended Care for Diabetics
The American Diabetes Association (ADA) recommends standards of care for facilities so that diabetics can receive adequate medical care. Some of these recommended practices are described here.
Medical Intake and Screening
It is important that all inmates are properly evaluated and screened for diabetes within 24 hours of entry to a facility. Any existing or previous treatment approaches should be reviewed and considered while developing a care plan. It is sometimes recommended to house diabetics in common units to help facilitate medication administration and access. This is also helpful for providing community support and implementing education opportunities.
Diabetes Care Plan
It is important to develop a diabetes care plan for each inmate that addresses A1C goals, and regularly monitors glucose levels. Treatment approaches will vary between each individual, but involve primarily insulin injections for Type 1 diabetics, daily medications for Type 2 diabetics, and close monitoring of glucose levels for both.
When an inmate has been using a Continuous Glucose Monitor (CGM) or insulin pump prior to entering jail, every effort should be made to continue with that treatment modality. And when security needs are appropriate, inmates should be allowed to self-inject. When not allowed to self-inject, inmates will need several touch points with medical staff to administer their daily insulin doses.
- Type 1 diabetics should test their glucose levels at least three times per day
- Type 2 diabetics should check their glucose levels at least once daily
- Both types of diabetics may require more frequent monitoring may depending on their care plan
The ADA recommends that facilities have a wide variety of medications available so treatment can be tailored to meet each inmates’ needs. They also recommend using a combination of approaches to minimize the risk of uncontrolled blood sugar levels that can result in diabetic emergencies.
Nutrition and Food Services
Diabetics need to closely monitor what they eat and drink each day, especially those with Type 1 diabetes. Nutritional counseling is highly recommended. The ADA also recommends nutritionally balanced meals with consistent carbohydrate counts at each meal, as well as methods to help inmates identify the protein and fat content of each meal. This is designed to help diabetics self-manage their condition and decrease their risk for other conditions.
Urgent and Long-Term Health Concerns
When diabetes treatment is mismanaged, there can be both short and long-term health impacts. Some of the more immediate diabetic complications include:
- Hyperglycemia – Dangerously HIGH blood sugar
- This can occur due to a lack of insulin or other medications, too many carbohydrates or inactivity, medication interactions, pregnancy or even stress.
- Can lead to a dangerous condition called Diabetic Ketoacidosis (DKA), or damage to vital organs such as the kidneys or heart
- Hypoglycemia – Dangerously LOW blood sugar
- Can occur due to receiving too much insulin, problems with the type and timing of various foods and medications.
- Severe low blood sugar can lead to seizures or a coma
Regular medical screenings are also recommended for diabetics. Some of the longer-term health risks and complications that should be routinely monitored include:
- Foot Care (wounds, risk of amputation etc.)
- Retinopathy
- Nephropathy and Kidney Disease
- Cardiovascular Disease (CAD)
- Thyroid Disease
Diabetes is a very manageable condition, but to do so effectively–it is important that inmates, the correctional facility and their medical team work together closely.
If you or a loved one has experienced challenges with receiving proper diabetic care while in jail, consider reaching out to one of our experienced attorneys.
Allison Kunerth
Allison Kunerth