Diabetic flyer comatose after he's denied a scary liquid: insulin

A chef from New Zealand was not allowed to take his clearly-labelled meds on board by Qantas check-in staff, who cited the War on Moisture. The New Zealand Herald reports that 43-year old Tui Russell later had a severe diabetic attack mid-flight, fell into a coma, and was hospitalized for two weeks. Link (thanks, noizyboy and Nik Coughlin)

Reader comment: Chris Town says,

As a Type 1 diabetic, I can assure you, a lack of insulin will not send you into a comatose.

Type 1 diabetes is a condition where your body no longer produces insulin, and it has to be injected several times a day. An overdose of insulin, which can happen if you don't get food to match the insulin you intake, or you don't balance food intake with exercise with insulin intake, can send you into a "coma" called hypoglycemia. Having experienced my fair share of these throughout my life, I can also assure you, 2 weeks in hospital would never be required. A day at most for older people, a few hours for people in the 20s like me.

Not taking insulin will not send you into a coma, you'll just be very uncomfortable as your blood sugar rises and rises, which will cause minor organ damage, but will not send you into a coma. Type 1 Diabetics denied insulin will live for months and months, but will eventually go blind, experience kidney and other organ failure and die a long and painful death.

Here's the wikipedia links for type 1 diabetes and hypoglycemia.

There's plenty of misconceptions about insulin-dependant diabetes around, so keeping people informed could save lives. After all, if I'm experiencing hypoglycemia the very last thing I need is for someone to give me insulin.

Will Loker says,
I'm writing in regards to your reader's comment on Type I diabetes. As a medical student I know that a lack of access to insulin for a long enough time can send a type I diabetic into a coma.

Chris is right in that too much insulin will cause hypoglycemia. What he doesn't mention is that without insulin the diabetic's body thinks that there isn't any glucose in the blood even when there is an excess. Without insulin the body can't take the glucose into the cells and since glucose is necessary for cells to generate energy the body attempts to correct the perceived lack of glucose. At a certain point the body enters starvation mode and starts to generate ketone bodies which can led to a life threatening condition known as diabetic ketoacidosis or DKA. DKA can led to coma, hospitalization and, if it persists long enough, death.

It worries me that a diabetic would be so misinformed about the consequences of type I diabetic without access to insulin and the DKA that can result.

Here are the wikipedia and eMedicine links for DKA.

MD Ken Walton concurs:
I can see what reader Chris Town is saying about this not being a hypoglycemic episode, and that if you were hypoglycemic you wouldn't need a couple week stay at the Hotel Hospital. I'm sure what they meant was he went into Diabetic Ketoacidosis, otherwise known as DKA ( Link), a scary situation if a type I diabetic doesn't get any insulin.

As a physician, I can't count the number of times people have forgotten or otherwise been denied insulin and required an ICU stay for a week or two. Just to clear some things up.

p.s. - boingboing makes life worth living on call

Stephen Wake says,
Just a quick addition to the comments you've already received about this post: What Dr Walton fails to mention is that the process leading to DKA does not happen rapidly:

Diabetic Ketoacidosis (DKA)

Severe, out-of-control diabetes (high blood sugar) that needs emergency treatment. DKA happens when blood sugar levels get too high. This may happen because of illness, taking too little insulin, or getting too little exercise. The body starts using stored fat for energy, and ketone bodies (acids) build up in the blood.

Ketoacidosis starts slowly and builds up. The signs include nausea and vomiting, which can lead to loss of water from the body, stomach pain, and deep and rapid breathing. Other signs are a flushed face, dry skin and mouth, a fruity breath odor, a rapid and weak pulse, and low blood pressure. If the person is not given fluserids and insulin right away, ketoacidosis can lead to coma and even death.

The flight time from Australia to New Zealand (Sydney to Auckland) is 3.5 hours certainly not enough time to end up in a coma due to DKA alone.

As an ED nurse I've seen many diabetics with a high blood sugar level have a significant wait (2 hours plus) to be seen in the ED without lapsing into coma. The airline may have taken the guys insulin, but on a trip to NZ it wouldn't have done him much harm.