Mysteries of Laura: Giving Insulin

The NBC detective show Mysteries of Laura might need a new medical consultant. In one of the first episodes of this season we have a boy that’s been kidnapped and of course– he’s a diabetic in need of insulin or he’ll die in short order.

Cut to scenes of distraught parents wringing their hands wondering if the police will get there in time to administer the life-saving medication.

Of course, when they find the young boy, he is unresponsive. One quick insulin shot into his leg and within mere seconds– he’s awake and crying.

This doesn’t happen in real life.

The first thing to understand about why the medical approach to this scenario is bad is to understand why a diabetic who doesn’t have their insulin gets sick. In a Type I diabetic, their body doesn’t produce insulin. Insulin is what moves sugar from your bloodstream to the inner part of your cells for energy so they can function. When there is a lack of insulin, the sugar can’t move from the outside to the inside of the cells and that’s not a good set-up for sustaining life.

As a rescue measure, the body begins to metabolize fat and muscle for energy. The byproduct of this type of metabolism leads to a build up of acids in the blood called ketones. You can also get a build up of ketones in the blood from not eating carbs as well. When you do this, even though you may produce insulin, your body still perceives a starvation state and will enter into the same process.

In the case of the diabetic, the sugar is “stuck” in the bloodstream which is why they have high blood glucose levels. However, the reason a diabetic is so sick is not really from the high blood sugar– it is really from the build up of acid in the blood from the break down of fat and muscle. This is also known as diabetic ketoacidosis or DKA. The more acidic a diabetic’s blood is when they seek medical treatment– the more emergent the condition.

So, in this episode we can assume that the diabetic is in DKA. The question is how long does it take to reverse this process?

In a nutshell– hours– not minutes. If a diabetic comes in unconscious then it will take them some time to regain consciousness after treatment is instituted to lower the acid levels in the blood and of course, by also lowering blood glucose levels.

What would have been a realistic medical scenario for this episode would be for the boy to have trouble with hypoglycemia or low blood sugar. Or, to have it be that the criminals were giving insulin but giving too much of it.

When a patient’s blood sugar is too low, we give glucose IV. In this instance, an unconscious patient WILL wake up very quickly because glucose (sugar) given IV becomes immediately available to the cells for processing and a patient can and will wake up very quickly.

You can still be dramatic using an accurate medical scenario.

Author Question: Juvenile Diabetes

Carol Asks:

I have a 5y/o girl who was recently diagnosed with diabetes.

Is it possible to need insulin sometimes but not others if she’s eaten “correctly”? Does stress play a role? What is she has lunch at noon and doesn’t get another real meal for at least 24 hours? Maybe some crackers, granola/protein bar, peppermints,etc but she’s trapped in a post-Katrina-esque situation from about 1700 until the next afternoon/early evening.

She has a pediatrician with her. How often would he need to check her blood sugar during that time? How often would she need insulin?

Jordyn Says:

A diabetic always needs insulin. They cannot live without it (Type I or juvenile diabetes). Basically, their body is not producing insulin anymore. Insulin carries sugar from your blood to the inside of the cell where it is used for cellular energy. In the absence of glucose, the body will begin to burn fat and muscle for energy. This leads to a build up of acid in the blood and evidence of this is ketones spilling over into her urine.

Diabetics typically check their blood sugar before each meal and before bed time. Some diabetics check their blood sugar up to eight times a day. Usually, they look at what they’re going to eat and decide how much insulin they need to “cover” themselves. Even if they don’t have insulin and are not eating– their blood sugars will still go up. Typically, diabetics are using insulin pumps that will give them a small but continous dose of insulin all the time but it really depends on the age of the patient and parental involvement to decide if an insulin pump would be a good idea. Also, when diabetics are newly diagnosed, it is hard to get them regulated.

Your pediatrician is going to have to stay on top of things– particularly if they are stuck in a situation where the child doesn’t have insulin– she’s going to get sick and it could happen pretty fast.  

Check out some previous posts I did concerning diabetes.

Diabetes Primer Part I and Part II.