Diabetic Seizure, Return to game?

[Jurassic Referee]

Originally posted by Mark T. DeNucci, Sr.

Mark,let's say you're watching a game where one of your two sons is playing.Your son is sitting on the bench when he is definitely knocked unconscious by the elbow of a player trying to save a ball from going OOB.When he comes to,his coach immediately subs him into the game.The officials allow the substitution.What is your reaction,if any,as a parent? [/B][/QUOTE]


If my son were knocked unconscious as you just described, he would not even be on the bench, therefore the coach would not have the opportunity to consider subbing him into the game. But that is not the point in this case.[/B][/QUOTE]No,Mark,that is exactly the point.You would not let some goof-*** coach make the decision in your son's case,but you also say it's OK for him or some clueless parent to make the same decision in ALL other cases?I agree fully with your decision not to let your son play.It's too dangerous.I'd do the same thing as a parent.As an official,though,I'm responsible for the welfare of every player on every team that I do.If I thought different,I'd hang the whistle up to-morrow.I can't really believe that your letting your love of "rulebook semantics" over-ride your common sense in this case.

[chayce]

Well, I finally can speak authoritatively on this one! I am a diabetic referee and can tell you that this was not a diabetic "seizure", this was simply a case of low blood sugar which is very commonplace in the life of a diabetic. The remedy is very simple: eat or drink something with sugar in it. I normally slip glucose tablets into my mouth during games just to make sure that my blood sugar doesn't get too low during games.

I realize that you can not expect all refs to understand every disease that is out there but in this case the parents obviously are fully aware of the kids condition and the easy remedy for the problem because this is something that happens several times a week. Let him play. This is different than an injury or physical reaction that occurs during the course of play.

[firedoc]

The question dealt with the risks to the brain after a diabetic seizure as compared to a traumatic event. My opinion is that there is more risk to the brain after a traumatic event than after a diabetic event although I have no specific medical evidence to support the notion.

Remember that unconsciousness does not need to occur for a concussion to exist. Often, after a concussion, the player/patient will only complain of a headache or repeatedly ask the same questions even though the question was answered previously. I often hear patients ask "what happened to me" even though I fully explained to them not 60 seconds earlier.

If anyone else has any questions for me on this subject I will be happy to reply to the best of my ability.

[rainmaker]

Originally posted by chayce
Well, I finally can speak authoritatively on this one! I am a diabetic referee and can tell you that this was not a diabetic "seizure", this was simply a case of low blood sugar which is very commonplace in the life of a diabetic. The remedy is very simple: eat or drink something with sugar in it. I normally slip glucose tablets into my mouth during games just to make sure that my blood sugar doesn't get too low during games.

I realize that you can not expect all refs to understand every disease that is out there but in this case the parents obviously are fully aware of the kids condition and the easy remedy for the problem because this is something that happens several times a week. Let him play. This is different than an injury or physical reaction that occurs during the course of play.

Chayce, if you are having low blood sugars several times a week, not only your health, but your very life are in jeopardy. Talk to your doctor about how long it takes your liver to regenerate adequate store of glycogen. If my son had low blood sugars several times a week he most definitely WOULD NOT be playing basketball until we had better control of his blood sugar.

But even if the kid only has them once a month, it still takes about an hour or so for the glycogen in the liver to be released, taken up and distributed. Which means that for an hour or so, he is still subject to another low blood sugar which can hit very quickly and cause him to lose consciousness quite suddenly. Even if he is taking large amounts of sugar orally.

As a parent who has dealt with a child who has Type 1 diabetes and participated in sports, I encourage all of you to respect the rule about not letting kids play after an episode of seeming unconsiousness. It is definitely not worth the risk.

[chayce]

Rainmaker,

I appreciate your feedback and want to reiterate that diabetes is a disease that frequently results in low blood sugars if the patient makes a genuine attempt in trying to maintain normal blood sugars of 80-120mg. As such, I personally believe that blood testing is a critical part of the diabetic lifestyle.

I have been a diabetic for 30 years and probably average a couple of low blood sugars per month and detect LBS symptoms very quickly and also recover quickly. My point in this case is that the patient is familiar with what is happening and with their recovery time and this is just a normal part of being a diabetic. I am also in medicine and understand that each patients case is different and I want them to be in control of their life! Not allowing a kid to play if he has truly been unconscious is the right thing to do, but if he has just been a bit weak-kneed and sweaty with an LBS, an official should not take that control away.

[Larks]

Originally posted by rainmaker

Chayce, if you are having low blood sugars several times a week, not only your health, but your very life are in jeopardy. Talk to your doctor about how long it takes your liver to regenerate adequate store of glycogen. If my son had low blood sugars several times a week he most definitely WOULD NOT be playing basketball until we had better control of his blood sugar.

But even if the kid only has them once a month, it still takes about an hour or so for the glycogen in the liver to be released, taken up and distributed. Which means that for an hour or so, he is still subject to another low blood sugar which can hit very quickly and cause him to lose consciousness quite suddenly. Even if he is taking large amounts of sugar orally.

As a parent who has dealt with a child who has Type 1 diabetes and participated in sports, I encourage all of you to respect the rule about not letting kids play after an episode of seeming unconsiousness. It is definitely not worth the risk.

Well put Rainmaker. It comes back to risk. The underlying question for me....Is this child at RISK for another episode on my watch? I submit he is and therefore I should take steps within my authority to protect him from potential injury in the same way you would protect a kid with a concussion. I'm sticking to my guns....If I see this again, I wont let him back in.


One other point that hasnt been made here....We are talking about ONE GAME with the key emphasis on the word GAME . Heck, maybe even a quarter or a half out of a whole season. Is it really worth it? Have a seat son, theres another game next week....and mix in a meal for cryin out loud!

Larks - Veteran In Training

[Larks]

Originally posted by chayce
Rainmaker,

Not allowing a kid to play if he has truly been unconscious is the right thing to do, but if he has just been a bit weak-kneed and sweaty with an LBS, an official should not take that control away.

Chayce....in this case, the coach said it was a diabetic seizure and that it happens from time to time. I personally witnessed this kid with his hand grasping his neck almost as if he was choking....basically locked in that position for about 2 minutes.

Thats a little more than weak-kneed and sweaty IMHO.

I do appreciate your perspective on this and respect that you have your situation under as much control as you can. See my previous post though....we're talking about 1 game.

Larks

[rainmaker]

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Chayce, I took the words in the original post "seizure" and "holding his own neck" to mean worse than just sweaty and weak-kneed.

But my real point is that, as others have said, there if no way for a ref to know and understand the various diseases or injuries that may cause unconsciousness. If the ref decides the kid is unconscious even once, then the kid is out. Period. This is because the risks aren't worth it.

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[Mark Padgett]

Originally posted by rainmaker
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Chayce, I took the words in the original post "seizure" and "holding his own neck" to mean worse than just sweaty and weak-kneed.

But my real point is that, as others have said, there if no way for a ref to know and understand the various diseases or injuries that may cause unconsciousness. If the ref decides the kid is unconscious even once, then the kid is out. Period. This is because the risks aren't worth it.

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Juulie - were you having a seizure while typing this post?

[rainmaker]

Originally posted by Mark Padgett

Juulie - were you having a seizure while typing this post?

No, everyone in my family has diabetes EXCEPT me. (and my daughter, but she's adopted). I was just keeping the contributions of my charming little rugrat limited to a place where they "won't affect the play."

[chayce]

It's amazing how much you reply when it the topic is something this personal but I would like to make one more comment:

I see this as analagous to a player with asthma. I had a situation last week when a player had an asthma attack and was choking during the game. He never went unconscious although his breathing was very labored. I immediately stopped the game and asked the coach to assist the player which he did by providing an inhaler. After substituting a new player, we re-started the game with the old player on the bench recovering.

After approximately 3-4 minutes, the coach reinserted the "asthma" player back into the game. I DID NOT ask for a doctor's note! The player new what was happening, sought treatment, and came back into the game. A diabetic with LBS seeks treatment and comes back into the game! I promise that is my last post on this one. Please know that I am also in full support of everyone's effort to make safety a top priority! In this instance however, it is not just one game; for a diabetic, this could potentially happen every game and the patient engages in self treatment as part of the medical plan!

Thanks

[Mark Dexter]

Originally posted by rainmaker
I was just keeping the contributions of my charming little rugrat limited to a place where they "won't affect the play."

It's great to see that they're posting on this board at such a young age! Now all they need to do is get out on the court, and they'll have NBA games by the time they turn 18!

[daves]

Originally posted by chayce
Well, I finally can speak authoritatively on this one! I am a diabetic referee and can tell you that this was not a diabetic "seizure", this was simply a case of low blood sugar which is very commonplace in the life of a diabetic. The remedy is very simple: eat or drink something with sugar in it. I normally slip glucose tablets into my mouth during games just to make sure that my blood sugar doesn't get too low during games.

I realize that you can not expect all refs to understand every disease that is out there but in this case the parents obviously are fully aware of the kids condition and the easy remedy for the problem because this is something that happens several times a week. Let him play. This is different than an injury or physical reaction that occurs during the course of play.

Chayce, I can also speak authoritatively on this subject as an emergency room RN and I disagree with you. You can in no way state that it was not a diabetic seizure. You weren't there so you don't know how profound the person's hypoglycemia was. Consciousness as well as hypoglycemia(low blood sugar)has varying degrees as you well know. In your case, you recognize the symptoms early and intervene with some extra glucose. I have seen patients who were profoundly hypoglycemic and are completely unconscious. I have also seen patients whose blood glucose is slightly low and had a slight alteration in their level of consciousness. If a patient comes into the ER for a hypoglycemic reaction that resulted in loss of consciousness they would be there for an hour or longer and have serial monitoring of their blood glucose. They would be given a meal after their blood glucose was increased by IV administration of concentrated glucose and watched for a while. In the original scenario, I would conclude that the person was unconscious ,or had been unconscious, as the coach stated he was having a diabetic "seizure". As has been been stated earlier you cannot have a conscious seizure. You also state that the remedy is simple in eating something with sugar in it. Wait just a minute. I would NEVER give an unconscious person ANYTHING to eat or drink. You run the risk of aspiration and death. I would be seriously hesitant about giving a minimally conscious person anthing by mouth either. By the way, I tend to get hypoglycemic at times too and my dad is an insulin dependent diabetic. I know what to watch for and treat it before it gets too bad.

[daves]

Originally posted by chayce
It's amazing how much you reply when it the topic is something this personal but I would like to make one more comment:

I see this as analagous to a player with asthma. I had a situation last week when a player had an asthma attack and was choking during the game. He never went unconscious although his breathing was very labored. I immediately stopped the game and asked the coach to assist the player which he did by providing an inhaler. After substituting a new player, we re-started the game with the old player on the bench recovering.

After approximately 3-4 minutes, the coach reinserted the "asthma" player back into the game. I DID NOT ask for a doctor's note! The player new what was happening, sought treatment, and came back into the game. A diabetic with LBS seeks treatment and comes back into the game! I promise that is my last post on this one. Please know that I am also in full support of everyone's effort to make safety a top priority! In this instance however, it is not just one game; for a diabetic, this could potentially happen every game and the patient engages in self treatment as part of the medical plan!

Thanks

I do not consider an unconscious person from hypoglycemia analagous to the asthmatic player who uses their inhaler and returns to the game. If that asthmatic player became unconscious as a result of their asthma I would not allow them to return to the game without a physician's note either. I have seen people die from asthma. It can be a serious medical condition.

[Edited by daves on Jan 10th, 2002 at 05:55 PM]