Sunday, April 01, 2012

Medical Advisory : Diabetic Sunstroke, Hypoglycemia in Tropical Environments

First person report:  5th Estate Editor almost bites the dust covering Indonesian protests

The 5th Estate
By Robert S. Finnegan

Deciding to cover the recent fuel subsidy protests here in Jakarta first hand, I immediately went about forgetting that I am no longer nine-feet tall and bulletproof, as age takes it's toll and Type 1 diabetes slowly eats away at my health as I get older, however ungracefully.  Adding a good ration of extreme stupidity plus a hot day, and I damn near succeeded in killing myself.

5th Estate Editor with protesters
In 2005 I developed a non-diagnosable, massive abdominal infection that was nearly fatal, also developing a necrotic pancreas in the process.  It had to be resected during a five hour emergency surgery that left me a Type 1 diabetic, taking daily insulin injections.  Upon exiting the United States for the last time, my surgeon and doctors (at least 20 of them due to the nature of the illness being undiagnosable) told me I would never survive a return to our home in Indonesia, giving me 5 years maximum to live because of my diabetic condition.  I am now on year 6 and still kicking, albeit feebly.

The day started out hot, a warning sign that like an idiot, I disregarded.  I also didn't wear or bring a hat, thinking I would work on my non-existent tan.  Second big mistake.  I had to hike about a mile in to the protest and then became so absorbed shooting images and taping interviews I ignored the first warning sign that I was getting hungry, a symptom that accompanies hypoglycemia. It was only when the shaking started that I realized I had better test my blood sugar.  I had purposely jacked it up knowing I would be taking on a stress load, pumping it up to 280, but this was eaten up just getting to the site.  I thought I had a lot in reserve but I was mistaken, big time.

Events then began spiralling downward rapidly, faster than I could react to it.  There was no shade available, and everyone had to hike into the area in front of the DPR (Indonesian Parliament) building as the police and military had sealed it off to all but foot traffic.  I had not taken this into account for my exit, and soon found myself in real trouble.  My eyesight started flickering and when I walked away leaving my camera equipment on the ground after testing my blood I knew I had to do something, fast (my eternal thanks to the Indonesian man that called my attention to the gear I had left behind).  I bought a bandanna from a vendor, but it was too late.

I was not even thinking about sunstroke, which I was now rapidly going into on top of my blood sugar reading at a very low 72.  Deciding to make for any shade available, I started down the crowded street weaving like a drunk.  By the time I finally found a place to lay down I was already going into shock and only halfway to my destination..  I had purchased water and proceeded to strip down and douse myself liberally, the breeze had just quit making the area into an instant steam bath.  I elevated my legs and forced down a large bar of chocolate I had for emergencies and always carry, another bad mistake:  how in the hell am I going to eat it if super-nauseated as I now was or unconscious?  Partially recovered and finally recognizing the dual nature of my predicament, I hoofed it back out to an area where I could get a taxi, and finally made it home (My thanks also to the man from Toraja who, recognizing I was in deep shit stayed with me until I had somewhat recovered an hour later).  The heat being generated by my body steamed the windows of the cab for the duration of the ride home.

My temperature even then was 102.7 degrees, a blistering, dangerous fever for someone my age even under normal conditions.  I immediately got into an ice-filled bath and got my temperature back down to normal.  I also took aspirin for good measure, which will reduce a fever quickly.  I am still recovering from the sunburn and the diabetic sunstroke three days later - it was once of the stupidest things I have ever accomplished.

Insulin pen injectors

Insulin is readily available here in Indonesia (if you have the money), however it must be studiously protected against the heat and any possible source of contamination.  It is available for the most part in "insulin pens" which make administering it fairly easy and comfortable, if you can call jamming a needle in your ass at any given time "comfortable."  There is also the compromised immune system that really needs to be remembered, we (diabetics) are far and away more susceptible to infection from what would normally be non-life threatening injuries.  With us, all the bets are off, and any small injury, especially to the feet must be dealt with immediately, usually with antibiotics.  Fortunately, they are cheap and readily available here in Jakarta, and they are always in the medical satchel I carry with me.

There was no way my wife (who chewed my ass out royally) - normally my savior in medical emergencies like this - could have found me in time, even with precise instructions it would have taken too long.  I was on my own, and extremely lucky not to have wound up dead.  In another act of lunacy I had left my diabetic bracelet at home, as it interferes with my shooting.  All in all a real bang-up performance for a guy who is supposed to be a medic.

Lessons Learned:

While not advisable, when attempting a journey alone always leave a note in a conspicuous place so your people or hotel staff can at least know where to start searching for you.

Take a hat and collapsible umbrella.

Take your insulin, if you are unconscious someone attending you may see it and know you are a diabetic.  Also, WEAR YOUR BRACELET.

Carry as much water as possible.

Memorize the symptoms and treatment for diabetic sunstroke and carry a copy so that others may find it and begin treatment if you are unconscious.  Write a synopsis of your medical condition, any medications you are on, mark it conspicuously and put it where someone helping you can find it fast.  Make sure you have two copies, one in English, and the other in the language of the country you are in.

Plan your trip in and out, stick to it.  This is one case where an alternate is unacceptable.

Have a cellphone if possible.  Make sure you have your numbers stored, confusion is a killer and unaviodable with hypoglycemia.

In an addition to an edible like chocolate, carry (as I do now) a vial or container of raw glucose (boiled cane sugar, not refined) or previously boiled pancake syrup and a syringe.  As a very last resort you can inject it subcutaneously, however this is only if you know you are on your way out.  Otherwise ingest it with water to speed entry into the bloodstream.

Don't ignore symptoms or put off testing blood sugar levels, test at the first sign of symptoms.

Vanity will get you killed.

Act your age.  Trying to bullshit yourself in any environment that you are normal will get you real dead, real fast, as I almost found out and I consider myself a cautious traveler.

Dr. Bob is a broken down old U.S. Marine with extensive experience operating in both jungle and arctic environments.  The treatments in this article have been tried and tested by Dr. Bob, however all medicine dosages should be checked on the Net or in the Physicians Desk Reference for applicable body weight, allergic reactions, renal and liver disease and any adverse symptoms that may arise.  Whenever possible, double check with a doctor before dosing or treating yourself.


U.S. National Library of Medicine 




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