This news is even worse than it might appear at first glance.
The most worrisome aspect of a 63yo falling at home is usually not whatever injury is sustained, but why she fell. A 25yo who breaks her shoulder on a ski slope is one thing. The “why” is no mystery, as skiing is inherently risky even for people in excellent health, and all the concern is over the injury. But a fall at home, and definitely a fall with enough force to “break a shoulder” (whatever that means) is unusual without some cause. Many of those causes are serious quite apart from damage caused by falling.
And then we have the more concerning issue of a hypoglycemic event in January severe enough to call 911. The patient may have some quite rare condition that makes her blood sugar that labile even with adequate attention from patient and medical providers. But the odds of that are way less than one in a million. Most likely this patient’s diabetes is receiving inadequate attention from patient and/or providers. She needs to fix that, now.
Hypoglycemia is a far more urgent problem than blood sugar that is riding too high. Hypoglycemia bad enough to call 911 is a life-threatening emergency, and the problem with her current management of her diabetes that caused this episode has to be identified and corrected immediately.
I appreciate your concern, but I don’t think we need to over-think this without all relevant info. I would bet that the good Judge’s doctors are on the case.
You are pretty ignorant about Type 1 diabetes.
Type 1 is inherently harder to control, and if you go for tight control – as a younger person should – you are going to have hypoglycemic episodes on the way. But even for someone who has Type 1, a hypoglycemic event so severe the patient can’t handle it without calling 911 is a serious matter calling into question the current treatment.
No patient’s medical status is anyone’s business but their own, until and unless they choose to make it public. But what they do make public needs to make sense, and therefore has to be complete enough to make sense, or it will be second-guessed. It has to be second-guessed in the case of patients whose well-being is absolutely not just their own concern.
Maybe the incompleteness comes from bad reporting, and perhaps the patient did choose to release a story complete enough to make sense, but the reporter didn’t understand that if you talk about a 63yo falling at home, you’ve got to talk about why or you’re missing the story. But it is also possible that the patient herself showed bad judgment in releasing partial information that she knows conceals the real story. I say poor judgment because if a 63yo falls at home, it’s Care of the Elderly 101 to ask why, and the idea that just announcing a fall was going to be the end of the story was foolish, because there are literally millions of people out there who see that headline, “63yo falls at home” and immediately know to ask why. Similar concerns, and even more pressing, for a hypoglycemic episode the patient couldn’t handle on her own
Which brings us to the last possibility, that the patient doesn’t understand the seriousness of one or both of these episodes, and that’s why there was a release of information that was incomplete and uninformative. You can’t give a complete and sensible account of something if you don’t understand the subject.
Bottom line, if this patient understands her own medical condition, and doesn’t want to be second-guessed by the public based on information she can’t control (If you show up for work in a sling, that’s info you can’t control. If EMS comes to your house, maybe you can’t control that either.), she needs to make sure whoever handles her public relations releases information that gives a reasonably complete account that doesn’t force people to second-guess where the lack of understanding that is on display might be located. Again, that’s assuming the problem isn’t reporting that received a reasonably complete account, but didn’t know to report the relevant details.
And maybe she tripped over her cat.
What a concern troll you are. When did age 63 become “elderly?”
The more you write here, the clearer it is that you don’t have a clue what you’re talking about. It’s really easy to overestimate the number of carbs in what you had to eat and go hypo because you took too much insulin. You do understand that that’s how it works? In basic terms, you eat something, and calculate how many carbs it contains, and adjust the insulin dose to metabolize that amount of carbs. However, it is further complicated by things like illness and exercise and coffee and a variety of other factors.
Fortunately, the technology for insulin pumps and continuous glucose monitors is getting better all the time, and one company is about to “close the loop” so these kind of problems will become less frequent. The biggest problem is getting accurate information about the carbohydrate content of foods.
If that’s so, it would have been much better to say that. It is perfectly fine to say not a damn thing about your medical problems, because they really are no one else’s business as long as you are doing your job, no matter what that job may be, Supreme Court justice or Walmart greeter. But if you do say anything about them, you shouldn’t stop until you’ve given a reasonably complete story. That is worse than refusing all comment.
I suggest forming a clearer picture of what we are told happened here. This wasn’t just a hypoglycemic episode. If you’re on insulin and going for anything even approaching tight control, yes, you will have hypoglycemic episodes from time to time. Someone who, like Sotomayor, has been at this 54 years, and must have been maintaining pretty tight control or she would be on dialysis by now, has had a lot of experience with hypoglycemic episodes. But she couldn’t handle this one herself. 911 had to be called. She was some combination of too unresponsive to take sugar orally, or taking a lot of sugar orally wasn’t bringing her sugar up. This wasn’t some everyday miscalculation of carbs. This was a life-threatening event. This level of hypoglycemia doesn’t happen to you on a routine basis and you’re still alive 54 years after your diagnosis.
This was a big deal event. I’ve had exactly three patients my entire career have hypoglycemic episodes so bad that EMS had to be summoned. I treated all three episodes like the big deal events they were. What’s your experience with hypoglycemia so bad that the patient and home caregivers have to call 911 because they can’t handle the episode on their own?
Well, I’m 62yo myself, and have been taking advantage of “senior” discounts for some time now. Just in general social usage, senior is just a nice way of saying elderly, so, yes, 63 really is elderly even in general usage.
Medically, understanding the mechanism of injury is important for any significant injury. The difference between a 33yo and a 63yo here is that, once you hit your fifties, all sorts of reasons for a fall become a lot more common than they are in 33-year olds. It is important to identify many of these reasons that are more common in the over-50 crowd because they are potentially life-threatening, quite apart from their tendency to cause falls.
Bottom line, while 63 may be two years shy of “elderly” for Social Security purposes, it’s elderly for the purpose of figuring out a fall. It may be caused by the same general klutziness or damn cat underfoot that can cause a fall in a 33yo, it’s just that all sorts of things that have to be excluded as causes are way more common in a 63yo.
Whatever your profession, it’s pretty clear to me that you’re not an endocrinologist. I sure hope you are not managing the treatment of diabetic patients because your notions are not consistent with current standards. Tight control is good for people of all ages, though it does indeed lead to more hypo events.
Lots of things can lead to serious hypo events. Distraction can lead to picking up the wrong pen and oops! short-acting and long acting insulin mixed up —> big hypo. (Fix for this is pump, by the way.) Turn off CGM alarm at a theater and forget to turn it back on —> big hypo. Take insulin, upchuck dinner —> big hypo. Get stranded someplace without food —> big hypo. Note these things are not age-related.
If you are yourself a provider, how many of your patients in the past year, at least those of them who have been doing this successfully for 54 years, have had hypoglycemia so big that they have had to call 911, or caregiver had to call 911 because patient is unresponsive? You don’t treat that like a big deal? That’s dog bites man? I’m just primary care, so maybe I’m more easily impressed than an Endocrinologist, but hypoglycemia requiring EMS intervention gets my full attention. Even lesser episodes are the one thing I always ask any diabetic, even type 2s, about any time I see them.
And if you’re a patient not a provider, or perhaps the caregiver for a patient, how often have you or the patient had hypoglycemia so big that 911 had to be called? If this has happened to you, you didn’t think it was a big deal?
My point about age (for the hypoglycemic event, not the fall) is that this patient has had diabetes since age 9, and she’s still here at age 63. That doesn’t happen if hypo so big that 911 has to be called is at all a common occurrence in your management of your disease. The other part of that is that you should assume that someone who has been handling this disease for 54 years doesn’t call 911 unless all else has failed, and is pretty good at all else, the things you do yourself to respond to hypoglycemia, however big. You have to assume that this event was a potentially fatal event, that it would have been fatal without timely EMS intervention, because a diabetic this experienced and successful at managing her disease would only call 911 in a very real emergency.
Just to reiterate, in case you’re confusing these two issues, for the fall, age matters because of all the life-threatening things that are much more likely to cause a fall in a 63yo than a 33yo.