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Not wearing medical alert identification can spell disaster for people with diabetes
I admit it: I've had diabetes for seven years, and only recently did I even think about buying a medical alert ID. It's not like me to be this irresponsible, but diabetes crept up on me, rather like type 2 does, although I'm a type 1. My diabetes is a slowly progressing adult-onset form, sometimes called type 1.5. For the first five years after my diagnosis, I controlled the disease with diet.
Scary lows (and dramatic spikes) are a fairly recent phenomenon for me. In response, I test my blood sugar vigilantly and am even planning to try a continuous glucose monitor. But somehow the medical alert tag didn't reach the top of my priority list. Learning what different foods and exercise do to my body, finding the right insulin, adjusting the dosage, making sure I always have testing supplies - all these seemingly more immediate concerns trumped it. Apparently, I'm not alone. According to the experts I consulted, most people with diabetes don't wear medical alert identification. But we're putting ourselves - and sometimes those around us - in danger by neglecting this simple purchase.
Brock Ryan, a medic in the Atlanta area for 14 years who now serves as medical coordinator for Juvenile Diabetes Research Foundation events, has tended to many diabetic drivers after hypoglycemia-related auto accidents. Because the person was driving erratically before the accident, "I think he's drunk," are usually the first words he hears at the scene. If medical alert identification isn't obvious, emergency medical personnel are likely to attribute unconsciousness to injuries sustained in the accident or to intoxication, Ryan says. Consequently, blood sugar treatment can be critically delayed.
If police pull over a person suffering hypoglycemia, the consequences can be dire as well. Police are trained to look for medical alert ID, but without it, an inarticulate, staggering, confused, and combative driver can be easily mistaken for a drunken one.
Doug Fenichel, a paramedic in northwest New Jersey, saw firsthand how police treatment can change if a driver is wearing medical alert ID. He was off duty when a car blew past him in the wrong lane of a major road. After phoning in a drunk driver report, he followed the vehicle as it forced cars off the road. Three police cars stopped the driver about six miles later. "The police approached ready to wrestle," Fenichel says. "They found a medic alert bracelet, and I went to work until the ambulance came. Medics treated him at the scene [with dextrose for hypoglycemia], and his wife took him home."
Things turned out differently for Ernest Griglen of Detroit. Police officers beat 59-year-old Griglen - whose blood sugar was low - after a traffic chase and stop. Griglen's family and police tell different versions of the June 15 encounter (a lawsuit is underway), but police say Griglen was resisting arrest and they thought that his insulin pump was a weapon. He wasn't wearing a medical alert. Doctors had to remove part of Griglen's brain during emergency surgery, and he's been in a coma since. Although wearing medical alert identification is no guarantee of safety in such circumstances - Mr. Natural Universe, Doug Burns, was wearing an alert bracelet when police at a movie theatre beat him during a hypoglycemic episode last year - the chances of receiving medical treatment are much better for those who do.
Extremely high blood sugar can be a medical emergency as well. Both hypoglycemia and hyperglycemia can lead to unconsciousness, coma, seizures, and death. A person suffering high blood sugar might be lethargic, weak, and nauseated to the point of being unable to communicate, says Sheila Matlak, registered nurse and certified diabetes educator at Mercy Hospital Diabetes Center in Baltimore. "Either end of the spectrum can cause problems," she says.
Chelle Cordero, an EMT with Stony Point Ambulance Corps in Rockland County, New York, says the majority of diabetes-related calls to which she responds are not the result of acute highs or lows, but other health problems associated with the disease. For a person with diabetes to receive proper medical treatment in any situation, even a non-diabetes-related one, it's vital for medical staff to know about the condition, says Marina Krymskaya, assistant director of the Friedman Diabetes Center in New York. "Everything affects blood sugar, and everything is affected by blood sugar," she says.
How a Medical Alert ID Can Help
On a business trip last year, 28-year-old Kerri Sparling, author of the diabetes patient blog Six Until Me, was sitting at the back of a plane when low blood sugar caused her to begin sobbing uncontrollably. A flight attendant approached and asked if she were nervous about flying, which she was. "Yes...but no," Sparling says she stammered. "'I have...I have...,' and I couldn't remember the name of the disease I've been living with for twenty-something years." So she raised her wrist and pointed to her medical alert bracelet. The flight attendant understood immediately and brought her some juice. "That piece of jewelry spoke for me when I couldn't speak for myself," Sparling says.
Brock Ryan, the medic, was off duty at a motorcycle convention when a man near him in the crowd fell to the ground and suffered a seizure. While other bystanders were "freaking out," Ryan noticed the man's diabetes medical alert bracelet. When EMTs arrived, Ryan told them the man had diabetes and they began treating him for low blood sugar. "I didn't have my medical kit with me, so I didn't have any test strips," Ryan says. "[Without the bracelet] I would have thought it was epilepsy." Ryan says that because he identified the man's condition, the EMTs didn't have to take the usual three to five minutes to observe the patient before testing his blood sugar. What difference does that amount of time make? "It can mean the difference in some brain damage or not with low blood sugar," Ryan says.
EMTs are not trained to look for medical alert ID on a person who is conscious and communicating. In those situations, the ID is "moot," says Rod Brouhard, a paramedic in Modesto, California. The first thing EMTs will ask a conscious, alert patient is "Do you have any medical conditions of which we should be aware?" Ryan says. Telling them you have diabetes is imperative.
Wearing ID could hasten a 911 call if you are out in public. When a person is behaving oddly, often others don't want to get involved, Brouhard says. But if they see an alert ID, they might recognize that the problem is medical rather than the result of drugs or alcohol and therefore be more likely to call for help. "Having it for the general public to see is probably as important as having it for the EMS folks," Brouhard says.
What to Wear and Where to Wear It
When I think of medical alert ID, I picture those commercials from the 1980s - the ones that featured giant silver tags and heavy-looking metal chains. Sparling remembers those days well. Her parents taped her first alert necklace to her chest so the large metal pendant wouldn't hit her in the face as she played soccer. "You had two choices then," she says. "Wear the necklace, which was massive, or wear the bracelet, which was massive."
When I began my quest, I was pleasantly surprised at the wide selection of medical alert products available. But the choices soon became overwhelming: bracelets, necklaces, anklets, rings, watches, charm bracelets, key chains, shoelace tags, backpack tags, dog tags, flash drives. and items that offered phone numbers or websites where medical personnel could retrieve a patient's full medical history. Ironically, it was an advertising phrase - combined with barely noticeable medical symbols on some of the products - that caused me even more anxiety: something along the lines of "keeps your medical condition private." Um, doesn't that defeat the purpose?
Ryan thinks so. "I hate to burst their bubble, but I would rather see the silver with the red medical symbol and information. If you get something too fancy, it may be missed." Cordero agrees, but adds a caveat: "If the decorative nature means a patient will wear a tag in a highly visible location, good. All medic alert jewelry should have a highly visible star-of-life so that a first responder knows to look for details."
A good compromise, Ryan says, are beaded bracelets that attach to a standard-size, silver medical alert plate with red medical insignia. Sparling wears this type of alert. "Looking at it, you would know it's a medical alert, but it's not big or garish," she says.
Matlak, who's had diabetes for 35 years, wears a MedicAlert bracelet with a 1¼-inch plate displaying the medical emblem. She likes the fact that her bracelet displays an 800 number that medical personnel can call to get more information about her medical history and condition than can be displayed on the tag. Brouhard says that a piece of paper in a wallet or purse - and an alert inscribed with "see info in wallet" - can be just as effective. "That is as low tech as it gets, and it's perfect," he says.
Ryan, Brouhard, and Cordero say that as first responders, they've never called an 800 number - mainly because they're too busy addressing the emergency situation. The information is helpful later, however, in the hospital, especially if the patient hasn't been to that facility.
Matlak says that she sees many patients whose incomes don't allow expensive medical alert products and services, and she advises them to buy the diabetes bracelets that drugstores sell for $10 to $15. In emergencies "they work just as well as the others," Ryan says. "As long as it's visible, we'll see it and know what's going on."
All sources interviewed for this article said that medical alert ID should be worn on the body, preferably around the wrist or neck. "Something that's on the person is going to be much more beneficial than something like a backpack tag," says Andrea Hulke, national outreach manager for JDRF. "Who knows when you're going to have an emergency? If it's not on you, it's not beneficial."
I opted for a simple sterling silver beaded bracelet with a standard ID tag. The front of the tag features a red star of life symbol and "diabetes" engraved in capital letters. On the back are my name, the words "insulin dependent," and my husband's cell phone number.
I was tempted to go with some of the prettier, more stylish designs, but decided against them for a few reasons. First, I was worried about it looking too ornate and obscuring the medical message. Comfort was a big factor. I wasn't planning to take off the bracelet, and multiple strands and big, bumpy beads could be bothersome when I'm trying to sleep. I also wanted the bracelet to be neutral enough to look nice with any outfit.
After learning about the risks I was taking by not wearing a medical alert - there were more than I'd thought of - I'm relieved to have my bracelet in place and feel much safer, whether at home, on the road, or in a store.
Are Most People With Diabetes Wearing Medical Alerts?
There are no official statistics, but with one exception, all sources interviewed for this article say that fewer than 50 percent of diabetes patients they treat wear medical alert identification. The exception, Rod Brouhard, a paramedic in Modesto, California, says that 55 to 60 percent wear alerts. He notes, however, that he works in the county where MedicAlert, the best known maker of alert ID, is headquartered.
Most children with diabetes wear ID because their parents make them, says Andrea Hulke, national outreach manager for the Juvenile Diabetes Research Foundation. Judy Waks, a diabetes educator in Miami, says that the elderly are more likely to wear ID as well. More type 1s than type 2s wear medical alerts because the use of insulin makes them more attuned to the potential of hypoglycemia, says Sheila Matlak, a diabetes educator in Baltimore. Marina Krymskaya, assistant director of the Friedman Diabetes Center in New York, says that only 10 percent of her type 2 patients wear medical alert ID, compared to about 90 percent of type 1s.
I know it sounds like a cop-out, but I suspect that one reason it took me so long to buy a medical alert is that no one ever told me I needed one, although I've been a patient of two endocrinologists and have met with diabetes educators. Krymskaya says that an emphasis on alert IDs is not a significant part of the education process - something that needs to change.
ID for Boys and Young Men
While shopping for my medical alert ID, I noticed that the selection of wearable products for boys and young men seemed sparse compared to that for women and girls. Kathy Koch of Lincoln, Nebraska, mother of two type 1 sons, ages 19 and 23, confirmed this. "Companies and entrepreneurs have done a good job of addressing the younger kids and women with more feminine designs, but these young men are left out in many instances," she says. "The bracelet can have all the information just right, but if they won't wear it, it's not going to matter." A friend who owns a jewelry store recently began engraving the medical alert symbol and health information on popular titanium and stainless steel bracelets, and Koch bought a pair for her sons.
Judy Waks, a diabetes educator and mother of a 25-year-old son with diabetes, says dog-tag style necklaces appeal to many teenage boys, but her son never liked them. He wears a sports band around his ankle instead. She says that although it's not the preferred location, "in my mind, it's better than not wearing anything at all."
I hope that the information in this article has inspired you to wear your own medical alert ID. If so, check out these websites for a diverse range of types and styles.
For boys and young men:
12 comments - Feb 24, 2009