Diabetes Misinformation on TV

TOUCH on TV not quite ‘in touch’ with diabetes

I’ve been a big fan of the TV show TOUCH since its early pilot, supported it online, non stop. I engaged with the interesting conversations on Twitter with the show’s people and found it stimulating and entertaining (and brilliant promotion).

Then, I saw the “Noosphere Rising” episode (aired 4/26/12) and something changed.

Please keep in mind two simple things: 1. I loved the show and think its concept is absolutely brilliant; 2. I have insulin dependent diabetes (type I) and it would be unethical on my part to let such glaring misinformation go uncorrected.

TOUCH not ‘in touch’ with diabetes

In the episode, Martin (Kiefer Sutherland) finds a brilliant university professor passed out in his office (roughly 25 minutes in, you can watch here). Martin Calls 911. Then calls the last number dialed on the professor’s cell.

The dialogue goes something like this (paraphrasing but true to what’s essential):

MARTIN: I found him passed out in his office… You’re the last number he called… What can I do?
GUY: He’s diabetic. Insulin’s in a box in the fridge.

Martin hangs up, gets the box and shoots the professor up with insulin. The professor comes to in less than 10 seconds.

I was hooked by the episode (and the series) but as soon as I saw this scene I looked at my wife, wide-eyed and jaw dropped. It took me completely out of the show because what we’d seen is dangerous misinformation.

Granted, we all know that “If it’s on television, then it must be true. – Not” (I wish we remembered this when watching the news, but that’s a different story). But it is also true that medical shows, legal shows, crime shows and any drama on TV that uses diseases or legal things to move the story forward endeavor to be 100% accurate (and 99.9% of the times are).

Doing research is very easy now (one could argue that Google should get royalties from almost anything written these days). If you Google diabetes coma, or hyperglycemia, or hypoglycemia, you get all the information you need in roughly 0.15 seconds. People are more and more educated and television strives to inform just as much as entertain. Reliability is part of the show’s hook. If shows use false facts, non-existing laws and medical inaccuracies, they lose their audience.

Searching online I found that other diabetics had reacted to the scene in the same way. Some were writing to FOX to explain how dangerously misleading the information can be. I reached out directly to the people connected to the show, but nobody Tweeted or Google+ back to me. I’ll try Facebook, maybe now that it’s public I’ll get a response (I don’t know what it means, but Facebook’s IPO’s made such great news I figure it’s worth mentioning).

Here’s why what was shown in the scene is misleading, potentially dangerous and even life threatening (I’ll keep it simple).

1. If a diabetic is passed out, DON’T DO ANYTHING before assessing if it’s hypoglycemia (low blood glucose level) or hyperglycemia (high blood glucose level).

To correct severe hypoglycemia you use glucagon (shot). To correct severe hyperglycemia you use insulin (shot), intravenous fluids, potassium, and sodium.
2. For insulin to get a diabetic to come to after being passed out (as shown in “Noosphere Rising”) it means the diabetic is in hyperglycemic Diabetic Ketoacidosis (DKA), which means the blood glucose level is incredibly high for lack of insulin and has been for a long time (this is how diabetics died during wars because they didn’t have access to insulin). This causes severe dehydration, vomiting, hyperventilation and tachycardia. It takes a while before the diabetic is restored to full functionality.

If this were the case, it’d mean that the well-educated professor should’ve gone a long time without insulin. This is a super intelligent man who needs his brain more than he needs his legs. In DKA, and in the phases leading up to it, you don’t function well, you can’t focus, you can’t think, you vomit often, your heart races, you’re severely dehydrated.

Why would the professor get himself in such a condition and handicap his thinking power over a long period of time? Plus, the character should’ve shown signs of dehydration, which he didn’t. He looked well manicured and fully hydrated (could’ve been at the gym an hour before he passed out).

3. More common and easier to occur is hypoglycemia, hypoglycemic coma or severe hypoglycemia, which gets a diabetic passed out for excessive insulin.

This is typical of high functioning individuals (like the professor in the episode) who can easily forget to eat and/or overcompensate with insulin. They remain functioning, until hypoglycemia sets in and they pass out.

This is the case when a glucagon shot is given (the opposite of insulin) to revive the diabetic.

Hypoglycemia is a relatively quick in and out experience. DKA hyperglycemia is a long phenomenon with destabilizing, long-lasting symptoms.

4. If a diabetic is passed out and you don’t asses if it’s DKA or hypoglycemia you risk killing the person.

If you shoot insulin into a diabetic in hypoglycemia, you most likely kill him/her or cause severe brain damages (because you keep pushing blood sugar level lower than it already is until the brain has no more energy to function).

If you shoot glucagon in the case of DKA, you also risk killing the person or causing severe damages (because you keep pushing blood sugar level higher than it already is).

VERY DIFFERENT, PAY ATTENTION. CALL 911.

5. There’s no insulin on the market (that I know of) that brings a diabetic back from DKA coma in less than 10 seconds. Plus, the diabetic needs to be hydrated before he/she can fully function.

On the other hand glucagon does bring a diabetic back from severe hypoglycemia or hypoglycemic coma quite fast (I know, it happened to me).

6. Just a simple dialogue adjustment would’ve avoided all this potentially dangerous, misleading information (same production cost for the episode):

GUY (on the phone): He’s a diabetic, goes in hypoglycemia a lot, glucagon’s in a box in the fridge.

Or (less realistic given he’s a well-functioning, educated professor, but still…),

GUY (on the phone): He’s a diabetic. Never takes insulin, gets in Ketoacidosis. The insulin box’s in the fridge.

7. So, it looks like in “Noosphere Rising” they depicted a severe hypoglycemic case but they mentioned and used insulin (instead of glucagon) to revive the professor.

Let me give you a simple scenario of why the mentioned scene in Touch can be seriously dangerous. Say, a kid watches the show and sees the episode, but has absolutely no idea about diabetes. The kid also loves a girl but doesn’t know if she likes him back. A few days later, the kid finds himself with a group of guys and galls, including the girl he loves. Suddenly one of the guys passes out and somebody says “He’s got diabetes!” The kid wants to impress the girl and remembers the “Noosphere Rising” episode, and yells out, “Where’s the insulin? I know what to do!” They find the insulin and the kid shoots up the passed out guy. The highest probability is that the diabetic guy will die and our kid will not get the girl.

I highly admire the talent and productivity of everyone working on TV, the standard they set, week in and week out, is phenomenal. I waited for a response from Touch because, like I said, I loved the show. I hoped I had misread or misunderstood something. But I didn’t hear anything.

So I have to publish this, because I really want the kid to get the girl.