I had been treating a middle-aged legally blind patient with diabetes.
His A1c had decreased from 9 percent to 6.9 percent with medication adjustment, diet and exercise. He was on glipizide and metformin. He was only checking fasting blood sugars which were normal.
During our visit, he told me he was taking Ciprofloxacin for a UTI. I warned that Ciprofloxacin can potentiate Glipizide to increase the risk of hypoglycemia and discussed symptoms.
I advised that he and his caregiver/girlfriend monitor pre-meal and bedtime readings, and decrease his Glipizide dose until off the Ciprofloxacin. He declined, stating that he did not see the need because he had never had hypoglycemia.
Unfortunately, the next day, my patient skipped lunch and took a nap.
By 4 p.m., his girlfriend had called for the police when he exhibited belligerent behavior. He refused to let the police in, so they forced entry and used restraint to handcuff him.
Finally, the patient's girlfriend realized that he was having a hypoglycemic reaction and EMS was called and my patient was treated for a glucose of 26.
Unjustly, the patient was arrested and jailed until he could post bail. He had no idea what had happened! I was stunned when I heard of the incident. Once the judicial system is activated, it is a costly and time-consuming endeavor to obtain justice.
I wrote a letter (citing references) to the judge on the patient's behalf, explaining that the patient's behavior was due to acute neurological impairment from lack of glucose to the brain complicated by his distorted perception of being legally blind. I was willing to testify in his behalf as well.
Four thousand dollars in legal fees and 6 months later, the charges from this unfortunate situation were finally dropped. But I was thankful that my patient had been exonerated.
Judy Birt is a nurse from Zionsville, IN.
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