Managing Diabetes in Prison

By Timothy Hinkhouse

From PHN Issue 41, Winter 2020

I conducted an interview with my neighbor, J. Parker, who is a man I have known for several years. He is a 51-year-old man who has been diagnosed with diabetes for the past 13 years of his life. He has had lots of things on his plate that he has had to face in his lifetime in addition to diabetes. He has been incarcerated for the past 25 years, and he has an out date of 2023. This makes him worried about how he will take care of his diabetes, eat healthy, and still keep his positive outlook on life. In prison, everything has been taken care of for you. Out in the free world, we have to take care of ourselves, which can be scary for someone getting out after spending over half their life in prison.

All those years ago, when he found out that he was diagnosed with diabetes, Mr. Parker was in the Intensive Management Unit (IMU). This is a super-max housing facility. During this time, he was going through all kinds of issues with his body, such as having sores on his face that wouldn’t heal, for example. Then medical staff decided to order a complete blood work-up, including a hemoglobin A1c test, which determines if there is diabetes mellitus in an undiagnosed patient.

Mr. Parker could not remember with certainty what his original A1c number was. He did know that at his first finger-stick test, his glucose level was 579 mg/dL. The ideal glucose numbers for a person with diabetes are in the range of 70 to 130 mg/dL. The target A1c number is 6.5% to 7%.

I had asked him about what it was like when he first started taking insulin shots. He told me, “When I first started taking insulin shots, it would affect my sleep and wake me up in the middle of the night. I would feel as if there was someone taking their thumb and pressing it into my brain, which was very painful. My vision was also affected while I was awake, which was very scary to not have control over my vision [This is also known as microvascular damage]. The pains that I experienced in my head felt as if my head was caving in on itself.”

I asked if there were any additional physical differences that he may have noticed. He told me, “There really isn’t anything that I’ve noticed when my blood sugar was low. I did think there was a connection between my hormones and my attitude.”

Mr. Parker told me that every time he had an opportunity to read up about diabetes, he would take full advantage of this educational opportunity. He went on to say, “This has made me more aware of my feelings, emotions, and the thoughts I’ll have that seem to be connected to this illness.” This chronic illness has him testing his blood sugar three times a day, with the first before breakfast. This is one of two times he will take an insulin shot. Before lunch, he will again test his blood sugar to monitor his levels. Then in the evening before dinner, he will test his blood sugar levels for the last time that day, and he will take his second insulin shot then too.

I asked Mr. Parker how he or medical staff keep track of his glucose readings. He said they get logged onto his medical chart as the permanent record. He went on to tell me that he has a blood draw every three or four months, which tracks his A1c number. He was proud that his last test showed it being around 6%, which is really good. He told me that when he gets a blood draw he also has to submit a urine sample to find out if his body is dumping mass amounts of glucose in his urine. Until I read about this in the 8th edition of Pharmacology for Nursing Care by Richard A. Lehne, I didn’t know this happens.

Mr. Parker tells me that his life depends on his eating as healthy as he can—like all the fruits and vegetables he gets. This is easier for him because of his job being in the kitchen. Staying away from baked bread coming out of the ovens takes will power. His consumption of pastas and potatoes is usually half of the servings given here. This is also important in controlling his weight and avoiding high blood pressure. I did ask what was his kryptonite that he can’t avoid eating. He told me that hot apple fritters fresh from the oven is what he can’t leave alone. He will eat three in a row and live in regret when he checks his blood sugar the next time. Chocolate ice cream is his close second favorite thing.

This chronic illness is a real inconvenience, Mr. Parker tells me. “What I mean is that when I am at work in the bakery and my body tells me that my blood sugar needs to be checked … I have to stop what I am doing for at least the next 25 minutes, which distracts me from my rhythm. I then have to walk across the prison to the medical department to check my glucose levels.”

“After I’ve stuck my finger and get the reading from the glucometer, the nurse has to draw up the right amount of insulin before I inject myself with a needle. There are two types I take, which are a short-acting dose and a longduration dose. I then have to walk back across the prison to get to work. I have to eat a snack like a piece of fruit or sandwich before I get back to work. One thing that really bothers me about this illness is that my coworkers see me sitting down and eating when they are working. This really bugs me about what they are thinking when they see me doing this.”

I asked what kinds of side effects he experiences, if any at all. To my surprise, he didn’t have as many as I would think. The only real complaints were dry mouth and an aggressively ravenous appetite. “This is where I stuff my face as fast as I can swallow the last bite of food I took.” When he eats like this and others are watching him in judgement, his words to me are, “The people that see me eating like this should mind their own business.” Everyone reading this should remember that what we eat and how we eat it is our own business, and this should not make you feel self-conscious about that.

Mr. Parker wanted to share with me an important tip to pass on to you. He told me, “Pay attention to how full your stomach gets when you are eating. The best way to fill your stomach so that feeling will last—and this is the healthier choice—is to eat all of your vegetables and fruits. Another thing is to stay hydrated and drink lots of water all day long. Before you start eating, look at what you are eating. Cut out the calories of any carbs and focus on eating proteins and fibers, which last,” like what was previously mentioned. One last tip for you is to keep on hand peanut butter, a piece of fruit, or a Top Ramen soup to eat if you can’t immediately access medical attention. Your body will tell you when there is something wrong and it needs medical attention. Listen to it! This little bit will boost your levels until you can get your glucose levels checked.

Here is some parting wisdom that I want you to use while you are incarcerated. Mr. Parker says, “When dealing with medical personnel or security staff, I want to encourage you to be polite. Staff don’t want to deal with someone who is unpleasant, no matter how urgent you think your issue(s) are.” What is the old saying? You can catch more flies with honey than you can with vinegar. Words to live by.

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