# Willfully or stupidly noncompliant diabetics



## mycrofft (Jan 17, 2013)

Not exactly PEMS, but two interesting cases:
1. Patient has long history of alcohol abuse, IV drug abuse, poorly controlled insulin-dependent diabetes, and short one of robbing a bank but his driver drove off  prematurely. Was limited by facility commander to buying non-sugar commissary foods ("dietetic candy"). Pt ate two entire packages of sugar-free Gummybears in one sitting and wound up with a high bowel obstruction requiring hospitalization.

2. Patient fought trial for two years, occasionally making sure he didn't eat before he received insulin, not reporting hypoglycemic episodes, performing favors for other inmates to receive candy, etc. When we made him eat where we could monitor him, he would go to his cell and vomit before receiving insulin. We then had him on Reglan and watched him  for half an hour after each meal before he received insulin. One hypoglyc crisis a nurse tried to mainline a Bristoject of D-50 into an antecubital vein, missed, and we spent ten grand on rehab and surgery to repair the necrosis. Finally, he developed a retinal detachment about the time he was sentenced to a midwestern specialized facility. Knowing he couldn't fly until his retinal reattachment hd taken hold, he willfully kept from lying prone (to allow retina to knit and injected air bubble to reabsorb) fpor as long as he could, which resulted in a poor outcome.

Had any like this who seemed to be oblivious to personal harm as long as they could impose their will?


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## mycrofft (Jan 17, 2013)

Or as we call it in "nursing diagnosis"-speak, a deficit of compliance due to autonomy issues.
Thanks, Marjorie Gordon.


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