Call now to demand freedom & medical care for Mumia

From the Enewsletter of Prison Radio:

Dear friend, 

April 29, 2015

On Monday morning Mumia Abu-Jamal was ordered back to the infirmary at SCI Mahanoy in Pennsylvania. All that day his attorney Bret Grote was at the prison.  No visitors were allowed, he and Pam Africa could not see Mumia.  There has been no contact with Mumia since Sunday, by his family, doctors, lawyers or supporters and there is grave concern that his condition, untreated and mistreated by prison infirmary doctors, could result in his death.

All Out to the Capital

The Dept. of Corrections has turned down Mumia’s petition to be given a accurate diagnosis of his condition(s) and his need to be seen by appropriate medical specialists.  His doctor has been prevented from talking to treatment staff and visiting Mumia.   

On Wednesday, April 29th we will be holding a press conference at Gov. Tom Wolf’s office in Harrisburg, PA at the Capitol Rotunda at 11am. 

At this point we do not know what is happening with Mumia. Keep your eyes on Mumia! Demand family visitation, and legal access.  We must speak out for our brother Mumia, just as he has always spoken out for us. 

Call now to demand freedom & medical care for Mumia:

Often when we call in, prison and state officials have taken their lines off the hook. Know that every single action matters, even when they don’t pick up. If they don’t answer, please leave a voicemail:

John Wetzel, PA Secretary of Corrections: (717) 728-4109
Governor Tom Wolf: (717) 787-2500
SCI Mahanoy: (570) 773-2158, then dial zero
for a more complete list of addresses and faxes etc visit www.prison

Voices from Solitary: “No Wonder There Are So Many Suicides”

From: SolitaryWatch
Dec 17th 2012

The following comes from a prisoner currently housed in maximum security housing at Utah State Prison, Draper. He has spent, by his estimate, seven years in either supermaximum or maximum security housing. He recently had a heart attack in maximum security and reportedly has received minimal health care treatment while incarcerated. He describes here the  Uinta 1 facility, where over 90 inmates are held in long-term isolation. –Sal Rodriguez

I spent the first two years of my incarceration in general population at a county jail. I had my first heart attack while at the county jail due to misdiagnosed Type 1 Diabetes. Despite my repeated attempts to get medical help, the officials repeatedly denied that there was anything wrong with me even though I exhibited all of the symptoms and signs of diabetes. Eventually, the misdiagnosed diabetes led to the heart attack.

I spent nine days in Intensive Care at the University Medical Center before being released back to prison where I was promptly placed in supermax–Uinta 1. I had not committed any violations to be placed in supermax other than having a heart attack.

I wasn’t considered a protective custody case, as I had just spent two years in general population. No reason was given for my being housed in supermax. I spent only a few months in supermax before being shipped out to another prison out of state. Once back in Utah I was once again placed in supermax without due process or reason, and I spent the next 20 months locked down. I have spent about seven years or more now housed in either supermax or max. I have never had any write-ups or violations to warrant me being housed in maximum security.

I can tell you that life in supermax (Uinta 1) is inhumane. There are inmates still being housed in that unit who have been there for eight years or more, who started off completely sane but now have lost all sanity. Suicide was common in the Uinta’s just a few years ago, forcing the prison to take preventative measures by installing new vent-housings that wouldn’t allow a rope to be tied to it for hanging. There is still many suicides that occur there, although its not like it used to be years ago.

The abuses still continue today with some of the torture techniques used in foreign interrogation. Cells are kept cold, lights are kept on 24/7, guards purposely make noise at all hours to prevent sleep.
Windows are covered by a small door that is only opened when the guard occasionally  looks in, as for count. Mental health care is a joke, as the mental health worker goes cell to cell not spending more than five seconds at each door and only asks “Are you ok?” It’s no wonder there are so many suicides. Mental health shows a lack of concern for those in supermax. It’s the general attitude there.

Be ashamed, PA DOC! A female prisoner with diabetes dies as a result of direct medical neglect in a PA prison

We received this message from facebook. We urge the authorities to conduct an investigation into the death of this woman in prison who had diabetes and who needed insulin, a life-saving medication, together with her daily intake of food. We left out the name of the person trying to help her for fear of possible retaliation. Those responsible for the death of Tonya Green should be held accountable.

Tonya Green, the inmate in the cell next door, ‘cried and begged 6 days for help, and no-one helped her. She was unable to get herself up off the floor, and no-one helped her get up, so therefore they did not give her food and she did not take her insulin.’

The doctor came and shouted at her, ignoring her pleas for help. On the morning of the seventh day, the fellow prisoner found Tonya lying dead on the floor of her cell. She reported this to the guards but it took them another four hours to decide to go in and check on Tonya. Their attempts to revive her were, by then, futile.

I have no idea what Tonya had done to be serving a prison sentence but the way she was left to die was perverse and inhumane. Her death would probably be classified by law as caused by grave neglect. Manslaughter, maybe? Taking into account everyone knew Tonya was diabetic and needed insulin, you might even call it murder.

Posted earlier on here.

Be ashamed, PA DOC! A female prisoner with diabetes dies as a result of direct medical neglect in a PA prison

We received this message from facebook. We urge the authorities to conduct an investigation into the death of this woman in prison who had diabetes and who needed insulin, a life-saving medication, together with her daily intake of food. We left out the name of the person trying to help her for fear of possible retaliation. Those responsible for the death of Tonya Green should be held accountable.

Tonya Green, the inmate in the cell next door, ‘cried and begged 6 days for help, and no-one helped her. She was unable to get herself up off the floor, and no-one helped her get up, so therefore they did not give her food and she did not take her insulin.’

The doctor came and shouted at her, ignoring her pleas for help. On the morning of the seventh day, the fellow prisoner found Tonya lying dead on the floor of her cell. She reported this to the guards but it took them another four hours to decide to go in and check on Tonya. Their attempts to revive her were, by then, futile.

I have no idea what Tonya had done to be serving a prison sentence but the way she was left to die was perverse and inhumane. Her death would probably be classified by law as caused by grave neglect. Manslaughter, maybe? Taking into account everyone knew Tonya was diabetic and needed insulin, you might even call it murder.

Diabetes: Invest now or pay big later. Patient education essential.

NCCHC CorrectCare

Pay Now or Pay Later: Why the Goal Is Control With Diabetes
By Rebecca B. Jones, RN, BSN, CDE

An epidemic is sweeping the United States. Diabetes affects over 20 million people, almost a third of whom do not know that they have the disease. People with this disease often find out only when an organ has already sustained damage.

The impact extends beyond health. From 1997 to 2002, the annual cost for this disease in medical expenditures and lost productivity rose 35% and the average per capita cost for treatment rose more than 30%.

At any given time, nearly 80,000 people with diabetes are incarcerated. Most of those have type 2 diabetes, which for years was erroneously thought to be a less serious form of the disease. Although any inmate health problem has associated costs for practitioner visits, medications and adjunct therapy, the price tag is even higher for unrecognized and uncontrolled diabetes.

Controlling Complications
Numerous studies, the most familiar being the Diabetes Control and Complications Trial, offer convincing evidence that good control of diabetes, as shown by a lower hemoglobin A1C level, can prevent or reduce the complications (and their related costs) of the disease.

What are those complications? It is well-documented that people with diabetes are two to four times more likely to have a heart attack or stroke. They are 10 times more likely to have an amputation; in fact, comprehensive foot care programs can reduce amputation rates by as much as 85%, according to the American Diabetes Association. Diabetes also is the leading cause of new cases of blindness and of kidney failure in the United States.

The ADA Position Statement on Diabetes Management in Correctional Institutions reflects these findings and provides a framework of preventive and therapeutic interventions that can save health care dollars and achieve better inmate health. The statement addresses such issues as initial and ongoing screening for diabetes, frequency of testing for complications, diabetes management plans, and preventive and educational measures.

ADA clinical practice recommendations also form the basis of the National Commission on Correctional Health Care’s clinical guidelines on diabetes, which are tailored to care in correctional settings.

Although the details of these position statements and guidelines may seem formidable at first glance, good diabetes care primarily requires two things: good understanding of diabetes and knowledge about current therapies, and an organized, methodical approach to management of the inmate’s diabetes care.

One of the most challenging aspects of care is simply staying on top of who gets what test when! For me, an invaluable tool is a spreadsheet of all inmates with diabetes. It notes the required testing and the last results, making it easy to see at a glance who has elevated A1C levels or other out-of-range test results. Another plus of organizing the data this way is that it prevents unnecessary repeats of costly lab work as well as the dreaded FTC (fell through the cracks) syndrome.

Easy as A-B-C
Especially in a correctional facility, the goal is control. All inmates with diabetes should have a management plan that monitors and optimizes their glycemic control. The management plan should focus on three key components, labeled as the ABCs of diabetes management:

A — The A1C test, which measures the average blood glucose level over the past 60 to 90 days, is the gold standard for how well a person’s diabetes is managed overall. Although the goal should be individualized, the management plan should strive for the near-normal A1C goal of less than 7%.

Good glycemic control is achieved through therapies of diet, exercise and medication (if needed). Regular finger-stick blood glucose tests are necessary because they measure the daily effects of the therapies and give practitioners the information needed to make adjustments. Daily blood glucose tests tell us how to fine-tune the therapy; A1C tests tell us the overall success of those adjustments.

B — Blood pressure control is essential in diabetes management. People with diabetes are at especially high risk of coronary artery disease and kidney disease. Blood pressure should be controlled to less than 130/80 mmHg.

C — Cholesterol and triglyceride control are especially important for people with diabetes because of the increased incidence of coronary artery and other blood vessel disease. Often, lipid control follows normalization of blood glucose levels.

I also focus on two other components:

D — Diet, more correctly referred to as medical nutrition therapy, focuses on a healthy way of eating. MNT, by the way, could benefit all inmates in reducing their risk for chronic diseases.
There is no such thing as the “diabetic diet,” at least not any more. Instead, diabetes MNT considers the timing and amounts of carbohydrate intake and choosing “good” fats. It also seeks to add fruit and vegetables to meals and increase fiber intake. This can be very challenging in correctional institutions, but it can be done. Often, there is an almost complete lack of understanding by inmates of making better food choices and portion control.

Which leads to the last, and surely the most important, element of any diabetes management plan:

E — Education. For 25 years I have taught thousands of patients and professionals about diabetes management, and I have learned a valuable lesson: The more you know about diabetes and its management, the better the outcomes.

Knowledgeable health professionals provide better care for patients. And knowledgeable patients make better choices, communicate more effectively with the providers and self-manage their disease better. Diabetes self-management training (DSMT) is a standard of care in the free world, and it can improve the care and cooperation of inmates.

Staff education for both the health care staff and correctional officers should be ongoing to ensure that they have the information and skills to effectively manage inmates with diabetes.

The Bottom Line
Diabetes management really comes down to this: Pay me now or pay me later. You can invest in staff and inmate education, take the necessary steps to follow the standards of care, and make the effort to organize and optimize the medical management of inmates with diabetes, resulting in better outcomes. If you don’t, you most likely will find yourself continually throwing money after the medical problems that plague those with poor diabetes control.

Better glycemic control reduces the complications of diabetes. Fewer complications reduce the health care dollars spent. In the words of Dr. Robert A. Rizza, in an address at the 2006 annual scientific sessions of the ADA, “It costs less to properly treat diabetes than it does to treat the complications that you get if you don’t properly treat diabetes. It’s a wise investment no matter how you look at it.”

About the author: Rebecca B. Jones, RN, BSN, CDE, is a nurse consultant in Wetumpka, AL. To contact her, send an e-mail to
The position statements and clinical guidelines cited above may be accessed online. For the ADA documents, visit The NCCHC guidelines are posted at the Resources section of our Web site. Additional resources are available from the American Association of Diabetes Educators,

[This article first appeared in the Fall 2006 issue of CorrectCare.]

Diabetes care in prison: American Diabetes Association

This long article about managing diabetes in prison is from the American Diabetes Association’s journal, “Diabetes Care”, January 2008. Clicking on the title will give you the pdf version with charts and all the footnotes.

Also, a new widget has been added to the left margin of this blog, with the link to the National Commission on Correctional Health Care’s standards on diabetes management. Click on the large “Diabetes” sign for that pdf.


Diabetes Management in Correctional Institutions

  1. American Diabetes Association

At any given time, over 2 million people are incarcerated in prisons and jails in the U.S (1). It is estimated that nearly 80,000 of these inmates have diabetes, a prevalence of 4.8% (2). In addition, many more people pass through the corrections system in a given year. In 1998 alone, over 11 million people were released from prison to the community (1). The current estimated prevalence of diabetes in correctional institutions is somewhat lower than the overall U.S. prevalence of diabetes, perhaps because the incarcerated population is younger than the general population. The prevalence of diabetes and its related comorbidities and complications, however, will continue to increase in the prison population as current sentencing guidelines continue to increase the number of aging prisoners and the incidence of diabetes in young people continues to increase.

People with diabetes in correctional facilities should receive care that meets national standards. Correctional institutions have unique circumstances that need to be considered so that all standards of care may be achieved (3). Correctional institutions should have written policies and procedures for the management of diabetes and for training of medical and correctional staff in diabetes care practices. These policies must take into consideration issues such as security needs, transfer from one facility to another, and access to medical personnel and equipment, so that all appropriate levels of care are provided. Ideally, these policies should encourage or at least allow patients to self-manage their diabetes. Ultimately, diabetes management is dependent upon having access to needed medical personnel and equipment. Ongoing diabetes therapy is important in order to reduce the risk of later complications, including cardiovascular events, visual loss, renal failure, and amputation. Early identification and intervention for people with diabetes is also likely to reduce short-term risks for acute complications requiring transfer out of the facility, thus improving security.

This document provides a general set of guidelines for diabetes care in correctional institutions. It is not designed to be a diabetes management manual. More detailed information on the management of diabetes and related disorders can be found in the American Diabetes Association (ADA) Clinical Practice Recommendations, published each year in January as the first supplement to Diabetes Care, as well as the “Standards of Medical Care in Diabetes” (4) contained therein. This discussion will focus on those areas where the care of people with diabetes in correctional facilities may differ, and specific recommendations are made at the end of each section.


Reception screening

Reception screening should emphasize patient safety. In particular, rapid identification of all insulin-treated persons with diabetes is essential in order to identify those at highest risk for hypo- and hyperglycemia and diabetic ketoacidosis (DKA). All insulin-treated patients should have a capillary blood glucose (CBG) determination within 1–2 h of arrival. Signs and symptoms of hypo- or hyperglycemia can often be confused with intoxication or withdrawal from drugs or alcohol. Individuals with diabetes exhibiting signs and symptoms consistent with hypoglycemia, particularly altered mental status, agitation, combativeness, and diaphoresis, should have finger-stick blood glucose levels measured immediately.

Intake screening

Patients with a diagnosis of diabetes should have a complete medical history and physical examination by a licensed health care provider with prescriptive authority in a timely manner. If one is not available on site, one should be consulted by those performing reception screening. The purposes of this history and physical examination are to determine the type of diabetes, current therapy, alcohol use, and behavioral health issues, as well as to screen for the presence of diabetes-related complications. The evaluation should review the previous treatment and the past history of both glycemic control and diabetes complications. It is essential that medication and medical nutrition therapy (MNT) be continued without interruption upon entry into the correctional system, as a hiatus in either medication or appropriate nutrition may lead to either severe hypo- or hyperglycemia that can rapidly progress to irreversible complications, even death.

Intake physical examination and laboratory

All potential elements of the initial medical evaluation are included in Table 5 of the ADA’s “Standards of Medical Care in Diabetes,” referred to hereafter as the “Standards of Care” (4). The essential components of the initial history and physical examination are detailed in Fig. 1. Referrals should be made immediately if the patient with diabetes is pregnant.


  • Patients with a diagnosis of diabetes should have a complete medical history and undergo an intake physical examination by a licensed health professional in a timely manner. (E)

  • Insulin-treated patients should have a CBG determination within 1–2 h of arrival. (E)

  • Medications and MNT should be continued without interruption upon entry into the correctional environment. (E)


Consistent with the ADA Standards of Care, patients should be evaluated for diabetes risk factors at the intake physical and at appropriate times thereafter. Those who are at high risk should be considered for blood glucose screening. If pregnant, a risk assessment for gestational diabetes mellitus (GDM) should be undertaken at the first prenatal visit. Patients with clinical characteristics consistent with a high risk for GDM should undergo glucose testing as soon as possible. High-risk women not found to have GDM at the initial screening and average-risk women should be tested between 24 and 28 weeks of gestation. For more detailed information on screening for both type 2 and gestational diabetes, see the ADA Position Statement “Screening for Type 2 Diabetes” (5) and the Standards of Care (4).


Glycemic control is fundamental to the management of diabetes. A management plan to achieve normal or near-normal glycemia with an A1C goal of less than 7% onmouseout=”___yoonoLink.onYoonoOut(this)” onmouseover=”___yoonoLink.onYoonoOver(event,this)” onclick=”___yoonoLink.onYoonoClick(this)” keywords=”diabetes management” class=”yoono-link-hover yoono-link-active-link”>diabetes management at the time of initial medical evaluation. Goals should be individualized (4), and less stringent treatment goals may be appropriate for patients with a history of severe hypoglycemia, patients with limited life expectancies, elderly adults, and individuals with comorbid conditions (4). This plan should be documented in the patient’s record and communicated to all persons involved in his/her care, including security staff. Table 1, taken from the ADA Standards of Care, provides a summary of recommendations for setting glycemic control goals for adults with diabetes.

People with diabetes should ideally receive medical care from a physician-coordinated team. Such teams include, but are not limited to, physicians, nurses, dietitians, and mental health professionals with expertise and a special interest in diabetes. It is essential in this collaborative and integrated team approach that individuals with diabetes assume as active a role in their care as possible. Diabetes self-management education is an integral component of care. Patient self-management should be emphasized, and the plan should encourage the involvement of the patient in problem solving as much as possible.

It is helpful to house insulin-treated patients in a common unit, if this is possible, safe, and consistent with providing access to other programs at the correctional institution. Common housing not only can facilitate mealtimes and medication administration, but also potentially provides an opportunity for diabetes self-management education to be reinforced by fellow patients.


Nutrition counseling and menu planning are an integral part of the multidisciplinary approach to diabetes management in correctional facilities. A combination of education, interdisciplinary communication, and monitoring food intake aids patients in understanding their medical nutritional needs and can facilitate diabetes control during and after incarceration.

Nutrition counseling for patients with diabetes is considered an essential component of diabetes self-management. People with diabetes should receive individualized MNT as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of MNT for persons with diabetes.

Educating the patient, individually or in a group setting, about how carbohydrates and food choices directly affect diabetes control is the first step in facilitating self-management. This education enables the patient to identify better food selections from those available in the dining hall and commissary. Such an approach is more realistic in a facility where the patient has the opportunity to make food choices.

The easiest and most cost-effective means to facilitate good outcomes in patients with diabetes is instituting a heart-healthy diet as the master menu (6). There should be consistent carbohydrate content at each meal, as well as a means to identify the carbohydrate content of each food selection. Providing carbohydrate content of food selections and/or providing education in assessing carbohydrate content enables patients to meet the requirements of their individual MNT goals. Commissaries should also help in dietary management by offering healthy choices and listing the carbohydrate content of foods.

The use of insulin or oral medications may necessitate snacks in order to avoid hypoglycemia. These snacks are a part of such patients’ medical treatment plans and should be prescribed by medical staff.

Timing of meals and snacks must be coordinated with medication administration as needed to minimize the risk of hypoglycemia, as discussed more fully in the medication section of this document. For further information, see the ADA Position Statement “Nutrition Principles and Recommendations in Diabetes” (7).


All patients must have access to prompt treatment of hypo- and hyperglycemia. Correctional staff should be trained in the recognition and treatment of hypo- and hyperglycemia, and appropriate staff should be trained to administer glucagon. After such emergency care, patients should be referred for appropriate medical care to minimize risk of future decompensation.

Institutions should implement a policy requiring staff to notify a physician of all CBG results outside of a specified range, as determined by the treating physician (e.g., less than 50 greater than 350 mg/dl).


Severe hyperglycemia in a person with diabetes may be the result of intercurrent illness, missed or inadequate medication, or corticosteroid therapy. Correctional institutions should have systems in place to identify and refer to medical staff all patients with consistently elevated blood glucose as well as intercurrent illness.

The stress of illness in those with type 1 diabetes frequently aggravates glycemic control and necessitates more frequent monitoring of blood glucose (e.g., every 4–6 h). Marked hyperglycemia requires temporary adjustment of the treatment program and, if accompanied by ketosis, interaction with the diabetes care team. Adequate fluid and caloric intake must be ensured. Nausea or vomiting accompanied with hyperglycemia may indicate DKA, a life-threatening condition that requires immediate medical care to prevent complications and death. Correctional institutions should identify patients with type 1 diabetes who are at risk for DKA, particularly those with a prior history of frequent episodes of DKA. For further information see “Hyperglycemic Crisis in Diabetes” (8).


Hypoglycemia is defined as a blood glucose level less than 60

Security staff who supervise patients at risk for hypoglycemia (i.e., those on insulin or oral hypoglycemic agents) should be educated in the emergency response protocol for recognition and treatment of hypoglycemia. Every attempt should be made to document CBG before treatment. Patients must have immediate access to glucose tablets or other glucose-containing foods. Hypoglycemia can generally be treated by the patient with oral carbohydrates. If the patient cannot be relied on to keep hypoglycemia treatment on his/her person, staff members should have ready access to glucose tablets or equivalent. In general, 15–20 g oral glucose will be adequate to treat hypoglycemic events. CBG and treatment should be repeated at 15-min intervals until blood glucose levels return to normal (less than 70 mg/dl).

Staff should have glucagon for intramuscular injection or glucose for intravenous infusion available to treat severe hypoglycemia without requiring transport of the hypoglycemic patient to an outside facility. Any episode of severe hypoglycemia or recurrent episodes of mild to moderate hypoglycemia require reevaluation of the diabetes management plan by the medical staff. In certain cases of unexplained or recurrent severe hypoglycemia, it may be appropriate to admit the patient to the medical unit for observation and stabilization of diabetes management.

Correctional institutions should have systems in place to identify the patients at greater risk for hypoglycemia (i.e., those on insulin or sulfonylurea therapy) and to ensure the early detection and treatment of hypoglycemia. If possible, patients at greater risk of severe hypoglycemia (e.g., those with a prior episode of severe hypoglycemia) may be housed in units closer to the medical unit in order to minimize delay in treatment.


  • Train correctional staff in the recognition, treatment, and appropriate referral for hypo- and hyperglycemia. (E)

  • Train appropriate staff to administer glucagon. (E)

  • Train staff to recognize symptoms and signs of serious metabolic decompensation, and immediately refer the patient for appropriate medical care. (E)

  • Institutions should implement a policy requiring staff to notify a physician of all CBG results outside of a specified range, as determined by the treating physician. (E)

  • Identify patients with type 1 diabetes who are at high risk for DKA. (E)


Formularies should provide access to usual and customary oral medications and insulins necessary to treat diabetes and related conditions. While not every brand name of insulin and oral medication needs to be available, individual patient care requires access to short-, medium-, and long-acting insulins and the various classes of oral medications (e.g., insulin secretagogues, biguanides, α-glucosidase inhibitors, and thiazolidinediones) necessary for current diabetes management.

Patients at all levels of custody should have access to medication at dosing frequencies that are consistent with their treatment plan and medical direction. If feasible and consistent with security concerns, patients on multiple doses of short-acting oral medications should be placed in a “keep on person” program. In other situations, patients should be permitted to self-inject insulin when consistent with security needs. Medical department nurses should determine whether patients have the necessary skill and responsible behavior to be allowed self-administration and the degree of supervision necessary. When needed, this skill should be a part of patient education. Reasonable syringe control systems should be established.

In the past, the recommendation that regular insulin be injected 30–45 min before meals presented a significant problem when “lock downs” or other disruptions to the normal schedule of meals and medications occurred. The use of multiple-dose insulin regimens using rapid-acting analogs can decrease the disruption caused by such changes in schedule. Correctional institutions should have systems in place to ensure that rapid-acting insulin analogs and oral agents are given immediately before meals if this is part of the patient’s medical plan. It should be noted however that even modest delays in meal consumption with these agents can be associated with hypoglycemia. If consistent access to food within 10 min cannot be ensured, rapid-acting insulin analogs and oral agents are approved for administration during or immediately after meals. Should circumstances arise that delay patient access to regular meals following medication administration, policies and procedures must be implemented to ensure the patient receives appropriate nutrition to prevent hypoglycemia.

Both continuous subcutaneous insulin infusion and multiple daily insulin injection therapy (consisting of three or more injections a day) can be effective means of implementing intensive diabetes management with the goal of achieving near-normal levels of blood glucose (9). While the use of these modalities may be difficult in correctional institutions, every effort should be made to continue multiple daily insulin injection or continuous subcutaneous insulin infusion in people who were using this therapy before incarceration or to institute these therapies as indicated in order to achieve blood glucose targets.

It is essential that transport of patients from jails or prisons to off-site appointments, such as medical visits or court appearances, does not cause significant disruption in medication or meal timing. Correctional institutions and police lock-ups should implement policies and procedures to diminish the risk of hypo- and hyperglycemia by, for example, providing carry-along meals and medication for patients traveling to off-site appointments or changing the insulin regimen for that day. The availability of prefilled insulin “pens” provides an alternative for off-site insulin delivery.


  • Formularies should provide access to usual and customary oral medications and insulins to treat diabetes and related conditions. (E)

  • Patients should have access to medication at dosing frequencies that are consistent with their treatment plan and medical direction. (E)

  • Correctional institutions and police lock-ups should implement policies and procedures to diminish the risk of hypo- and hyperglycemia during off-site travel (e.g., court appearances). (E)


All patients with a diagnosis of diabetes should receive routine screening for diabetes-related complications, as detailed in the ADA Standards of Care (4). Interval chronic disease clinics for persons with diabetes provide an efficient mechanism to monitor patients for complications of diabetes. In this way, appropriate referrals to consultant specialists, such as optometrists/ophthalmologists, nephrologists, and cardiologists, can be made on an as-needed basis and interval laboratory testing can be done.

The following complications should be considered.

  • Foot care: Recommendations for foot care for patients with diabetes and no history of an open foot lesion are described in the ADA Standards of Care. A comprehensive foot examination is recommended annually for all patients with diabetes to identify risk factors predictive of ulcers and amputations. Persons with an insensate foot, an open foot lesion, or a history of such a lesion should be referred for evaluation by an appropriate licensed health professional (e.g., podiatrist or vascular surgeon). Special shoes should be provided as recommended by licensed health professionals to aid healing of foot lesions and to prevent development of new lesions.

  • Retinopathy: Annual retinal examinations by a licensed eye care professional should be performed for all patients with diabetes, as recommended in the ADA Standards of Care. Visual changes that cannot be accounted for by acute changes in glycemic control require prompt evaluation by an eye care professional.

  • Nephropathy: An annual spot urine test for determination of microalbumin-to-creatinine ratio should be performed. The use of ACE inhibitors or angiotensin receptor blockers is recommended for all patients with albuminuria. Blood pressure should be controlled to less than 130/80

  • Cardiac: People with type 2 diabetes are at a particularly high risk of coronary artery disease. Cardiovascular disease risk factor management is of demonstrated benefit in reducing this complication in patients with diabetes. Blood pressure should be measured at every routine diabetes visit. In adult patients, test for lipid disorders at least annually and as needed to achieve goals with treatment. Use aspirin therapy (75–162 mg/day) in all adult patients with diabetes and cardiovascular risk factors or known macrovascular disease. Current national standards for adults with diabetes call for treatment of lipids to goals of LDL ≤100, HDL >40, triglycerides less than 150


Monitoring of CBG is a strategy that allows caregivers and people with diabetes to evaluate diabetes management regimens. The frequency of monitoring will vary by patients’ glycemic control and diabetes regimens. Patients with type 1 diabetes are at risk for hypoglycemia and should have their CBG monitored three or more times daily. Patients with type 2 diabetes on insulin need to monitor at least once daily and more frequently based on their medical plan. Patients treated with oral agents should have CBG monitored with sufficient frequency to facilitate the goals of glycemic control, assuming that there is a program for medical review of these data on an ongoing basis to drive changes in medications. Patients whose diabetes is poorly controlled or whose therapy is changing should have more frequent monitoring. Unexplained hyperglycemia in a patient with type 1 diabetes may suggest impending DKA, and monitoring of ketones should therefore be performed.

Glycated hemoglobin (A1C) is a measure of long-term (2- to 3-month) glycemic control. Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control) and quarterly in patients whose therapy has changed or who are not meeting glycemic goals.

Discrepancies between CBG monitoring results and A1C may indicate a hemoglobinopathy, hemolysis, or need for evaluation of CBG monitoring technique and equipment or initiation of more frequent CBG monitoring to identify when glycemic excursions are occurring and which facet of the diabetes regimen is changing.

In the correctional setting, policies and procedures need to be developed and implemented regarding CBG monitoring that address the following.

  • Infection control

  • Education of staff and patients

  • Proper choice of meter

  • Disposal of testing lancets

  • Quality control programs

  • Access to health services

  • Size of the blood sample

  • Patient performance skills

  • Documentation and interpretation of test results

  • Availability of test results for the health care provider (10)


  • In the correctional setting, policies and procedures need to be developed and implemented to enable CBG monitoring to occur at the frequency necessitated by the individual patient’s glycemic control and diabetes regimen. (E)

  • A1C should be checked every 3–6 months. (E)


Self-management education is the cornerstone of treatment for all people with diabetes. The health staff must advocate for patients to participate in self-management as much as possible. Individuals with diabetes who learn self-management skills and make lifestyle changes can more effectively manage their diabetes and avoid or delay complications associated with diabetes. In the development of a diabetes self-management education program in the correctional environment, the unique circumstances of the patient should be considered while still providing, to the greatest extent possible, the elements of the “National Standards for Diabetes Self-Management Education” (11). A staged approach may be used depending on the needs assessment and the length of incarceration. Table 2 sets out the major components of diabetes self-management education. Survival skills should be addressed as soon as possible; other aspects of education may be provided as part of an ongoing education program.

Ideally, self-management education is coordinated by a certified diabetes educator who works with the facility to develop polices, procedures, and protocols to ensure that nationally recognized education guidelines are implemented. The educator is also able to identify patients who need diabetes self-management education, including an assessment of the patients’ medical, social, and diabetes histories; diabetes knowledge, skills, and behaviors; and readiness to change.


Policies and procedures should be implemented to ensure that the health care staff has adequate knowledge and skills to direct the management and education of persons with diabetes. The health care staff needs to be involved in the development of the correctional officers’ training program. The staff education program should be at a lay level. Training should be offered at least biannually, and the curriculum should cover the following.

  • What is diabetes

  • Signs and symptoms of diabetes

  • Risk factors

  • Signs and symptoms of, and emergency response to, hypo- and hyperglycemia

  • Glucose monitoring

  • Medications

  • Exercise

  • Nutrition issues including timing of meals and access to snacks


  • Include diabetes in correctional staff education programs. (E)


Patients with diabetes who are withdrawing from drugs and alcohol need special consideration. This issue particularly affects initial police custody and jails. At an intake facility, proper initial identification and assessment of these patients are critical. The presence of diabetes may complicate detoxification. Patients in need of complicated detoxification should be referred to a facility equipped to deal with high-risk detoxification. Patients with diabetes should be educated in the risks involved with smoking. All inmates should be advised not to smoke. Assistance in smoking cessation should be provided as practical.


Patients in jails may be housed for a short period of time before being transferred or released, and it is not unusual for patients in prison to be transferred within the system several times during their incarceration. One of the many challenges that health care providers face working in the correctional system is how to best collect and communicate important health care information in a timely manner when a patient is in initial police custody, is jailed short term, or is transferred from facility to facility. The importance of this communication becomes critical when the patient has a chronic illness such as diabetes.

Transferring a patient with diabetes from one correctional facility to another requires a coordinated effort. To facilitate a thorough review of medical information and completion of a transfer summary, it is critical for custody personnel to provide medical staff with sufficient notice before movement of the patient.

Before the transfer, the health care staff should review the patient’s medical record and complete a medical transfer summary that includes the patient’s current health care issues. At a minimum, the summary should include the following.

  • The patient’s current medication schedule and dosages

  • The date and time of the last medication administration

  • Any recent monitoring results (e.g., CBG and A1C)

  • Other factors that indicate a need for immediate treatment or management at the receiving facility (e.g., recent episodes of hypoglycemia, history of severe hypoglycemia or frequent DKA, concurrent illnesses, presence of diabetes complications)

  • Information on scheduled treatment/appointments if the receiving facility is responsible for transporting the patient to that appointment

  • Name and telephone/fax number of a contact person at the transferring facility who can provide additional information, if needed

The medical transfer summary, which acts as a quick medical reference for the receiving facility, should be transferred along with the patient. To supplement the flow of information and to increase the probability that medications are correctly identified at the receiving institution, sending institutions are encouraged to provide each patient with a medication card to be carried by the patient that contains information concerning diagnoses, medication names, dosages, and frequency. Diabetes supplies, including diabetes medication, should accompany the patient.

The sending facility must be mindful of the transfer time in order to provide the patient with medication and food if needed. The transfer summary or medical record should be reviewed by a health care provider upon arrival at the receiving institution.

Planning for patients’ discharge from prisons should include instruction in the long-term complications of diabetes, the necessary lifestyle changes and examinations required to prevent these complications, and, if possible, where patients may obtain regular follow-up medical care. A quarterly meeting to educate patients with upcoming discharges about community resources can be valuable. Inviting community agencies to speak at these meetings and/or provide written materials can help strengthen the community link for patients discharging from correctional facilities.

Discharge planning for the patients with diabetes should begin 1 month before discharge. During this time, application for appropriate entitlements should be initiated. Any gaps in the patient’s knowledge of diabetes care need to be identified and addressed. It is helpful if the patient is given a directory or list of community resources and if an appointment for follow-up care with a community provider is made. A supply of medication adequate to last until the first postrelease medical appointment should be provided to the patient upon release. The patient should be provided with a written summary of his/her current heath care issues, including medications and doses, recent A1C values, etc.


  • For all interinstitutional transfers, complete a medical transfer summary to be transferred with the patient. (E)

  • Diabetes supplies and medication should accompany the patient during transfer. (E)

  • Begin discharge planning with adequate lead time to insure continuity of care and facilitate entry into community diabetes care. (E)


Practical considerations may prohibit obtaining medical records from providers who treated the patient before arrest. Intake facilities should implement policies that 1) define the circumstances under which prior medical records are obtained (e.g., for patients who have an extensive history of treatment for complications); 2) identify person(s) responsible for contacting the prior provider; and 3) establish procedures for tracking requests.

Facilities that use outside medical providers should implement policies and procedures for ensuring that key information (e.g., test results, diagnoses, physicians’ orders, appointment dates) is received from the provider and incorporated into the patient’s medical chart after each outside appointment. The procedure should include, at a minimum, a means to highlight when key information has not been received and designation of a person responsible for contacting the outside provider for this information.

All medical charts should contain CBG test results in a specified, readily accessible section and should be reviewed on a regular basis.


Children and adolescents with diabetes present special problems in disease management, even outside the setting of a correctional institution. Children and adolescents with diabetes should have initial and follow-up care with physicians who are experienced in their care. Confinement increases the difficulty in managing diabetes in children and adolescents, as it does in adults with diabetes. Correctional authorities also have different legal obligations for children and adolescents.

Nutrition and activity

Growing children and adolescents have greater caloric/nutritional needs than adults. The provision of an adequate amount of calories and nutrients for adolescents is critical to maintaining good nutritional status. Physical activity should be provided at the same time each day. If increased physical activity occurs, additional CBG monitoring is necessary and additional carbohydrate snacks may be required.

Medical management and follow-up

Children and adolescents who are incarcerated for extended periods should have follow-up visits at least every 3 months with individuals who are experienced in the care of children and adolescents with diabetes. Thyroid function tests and fasting lipid and microalbumin measurements should be performed according to recognized standards for children and adolescents (12) in order to monitor for autoimmune thyroid disease and complications and comorbidities of diabetes.

Children and adolescents with diabetes exhibiting unusual behavior should have their CBG checked at that time. Because children and adolescents are reported to have higher rates of nocturnal hypoglycemia (13), consideration should be given regarding the use of episodic overnight blood glucose monitoring in these patients. In particular, this should be considered in children and adolescents who have recently had their overnight insulin dose changed.


Pregnancy in a woman with diabetes is by definition a high-risk pregnancy. Every effort should be made to ensure that treatment of the pregnant woman with diabetes meets accepted standards (14,15). It should be noted that glycemic standards are more stringent, the details of dietary management are more complex and exacting, insulin is the only antidiabetic agent approved for use in pregnancy, and a number of medications used in the management of diabetic comorbidities are known to be teratogenic and must be discontinued in the setting of pregnancy.


People with diabetes should receive care that meets national standards. Being incarcerated does not change these standards. Patients must have access to medication and nutrition needed to manage their disease. In patients who do not meet treatment targets, medical and behavioral plans should be adjusted by health care professionals in collaboration with the prison staff. It is critical for correctional institutions to identify particularly high-risk patients in need of more intensive evaluation and therapy, including pregnant women, patients with advanced complications, a history of repeated severe hypoglycemia, or recurrent DKA.

A comprehensive, multidisciplinary approach to the care of people with diabetes can be an effective mechanism to improve overall health and delay or prevent the acute and chronic complications of this disease.

Diabetics more liely to suffer depression.

Study links diabetes, depression

Thursday, June 19th 2008, 12:25 AM

A new study says people with Type 2 diabetes are more likely to be depressed – and vice versa.

Doctors concede they need to study patients more closely to determine whether the disease is causing depression or whether something about depression could lead to Type 2 diabetes.

“The psychological stress associated with diabetes management may lead to elevated depressive symptoms,” Dr. Sherita Hill Golden writes in a report in the Journal of the American Medical Association.

“We were able to show that there’s a bidirectional association,” she said.

Diabetes causes high blood sugar levels, which can be fatal if left untreated. It can be treated with insulin and changes in diet and exercise.

About 21 million Americans suffer from diabetes and 30 million have symptoms of depression.

To explore the relationship, Golden’s team at Johns Hopkins University School of Medicine analyzed data on nearly 7,000 patients who underwent three examinations between 2000 and 2005.

Among nearly 5,000 participants with no symptoms of depression at the start of the study, rates of occurrence of depression during followup were similar for people without diabetes and those with untreated Type 2 diabetes.

Those undergoing treatment for Type 2 diabetes were twice as likely to experience depression.

They also found that patients who had symptoms of depression were about 30% more likely to develop diabetes during the study than people without depression.

The doctors say the link between depression and diabetes may be related to lifestyle factors, such as diet and physical activity.

“Future studies should determine whether interventions aimed at modifying behavioral factors will complement current Type 2 diabetes prevention strategies,” Golden wrote.

Scott Watch: Prisoners are Patients, too.

st1\:*{behavior:url(#ieooui) } Here’s the latest on Jamie, folks. In addition to getting her into a more appropriate medical setting where Gladys can also help care for her, I’d like to see someone from Wexford take responsibility for educating their patients about their diagnoses, test results, medications, and treatment options. If Wexford doesn’t incorporate patient education into their health care service package for Mississippi prisons, then they are either being irresponsible or negligent – and they aren’t helping keep costs down – well informed patients can mitigate and manage medical crises much better than those kept in the dark by their health care providers.

Failing to fully inform Jamie about her medical conditions or health care options perpetuates the damage already done to women of color in particular by generations of others “possessing” their bodies and the legal right to do whatever they wanted to do to them – including 20th Century medical experimentation and forced sterilization on prisoners who were poor, mentally impaired, and/or people of color. They didn’t tell those prisoners anything about their medical treatments either.

I would hope this is the kind of issue that Dr. Perry would recognize as interfering significantly with women prisoners getting appropriate medical care, and assure that patient education becomes a central part of the work Wexford employees do with prisoners. If it is MDOC policy to keep prisoners ignorant about their health care, then the department needs to study up on the extraordinary public health implications of failing to provide adequate medical treatment to prisoners, who then return to the community in worse health than they were in when they left, quite likely infected with Hepatitis C. Keeping the people clueless about infectious diseases, chronic illness, long term symptom management, etc. guarantees an unhealthy population.

No wonder Mississippi prisoner death rates have skyrocketed to almost the highest in the country. Dr. Perry might want to take a look at whether or not there’s a connection between patient education/ empowerment programs and health care outcomes and costs. If the MDOC and Wexford were following best practice guidelines for correctional health care, Jamie would be in a setting more conducive to recovery, she would be able to explain her diagnosis, prognosis and treatment to others, she would be a more active and confident participant in her medical decision-making, and her family would be less traumatized, more informed, and more able to advocate for appropriate resources for her.

This was why I tried to encourage the Mississippi Kidney Foundation to offer some assistance. Education is what they do. Given the rate of diabetes and kidney disease in Southern prisons in particular, I would have thought they’d be right on this. Maybe the MDOC needs to make the invitation. Between them, they need to decide soon who will help educate Jamie’s family about what’s going on because lacking that information could have very negative consequences for her. She was sentenced to life, not death. The quality of her health care should reflect an investment in life – particularly if Mississippi aspires to foster a “culture of life”. Here’s a real good time and place to show the world they can do that.

st1\:*{behavior:url(#ieooui) }

So, either the MDOC lacks some sensitivity to these issues, in which case I hope someone there will enlighten them so that they take corrective action, or they have deliberately created a health care system that excludes patients from education or decision-making and ultimately – if they survive prison – sends them on their way with no idea what’s wrong with them or if they need follow up care or tests. This appears to be not for lack of having access to the information for them, but out of an explicit policy to keep prisoners uninformed and therefore powerless over their bodies – which affects their survival long beyond most state sentence terms.

Why would a health care provider not want their patients’ informed? Including patients as partners in their medical treatment is the best way to assure long term compliance with dietary and prescription and other medical requirements, which reduces long-term costs.

This is really basic stuff, folks. Jamie’s being totally disrespected as a human being, not just a woman, by her medical team withholding information from her. That kind of paternalism/ maternalism should have gone out of fashion with Jim Crow. Medical professionals in the south dealing with prisoners have an even higher duty to make sure the medical consent they get from patients for their care is INFORMED. That’s a legal standard that applies to prisoners, too.

Jamie should probably ask for every medical report in writing, and file a timely grievance when she doesn’t receive it – otherwise, she won’t have any legal recourse if their negligence results in her injury (avoidable progression of disease) – no matter how criminal the neglect, the courts will say she didn’t exhaust all her “administrative remedies” as provided for by the MDOC and Wexford’s agreement, and therefore the question of whether or not the MDOC assured access to appropriate care would never be heard in court.

I’m no lawyer, but that’s how I understand the Prison Litigation Reform Act (PRLA) has worked to erode conditions in US jails and prisons over the past 15 years or so. It established unreasonably high standards for prisoners to meet in order to bring prisons to federal court, so their cases of abuse and civil rights violations are seldom even heard because of technicalities – not because they have no merit.

That legislation needs to be fixed ASAP (Google “Prison Abuse Remedies Act” for how to fix it).
2/28 SCOTT SISTERS UPDATE ~ By Sis. Marpessa

Greetings all,

Thanks so much to all of the supporters of Jamie & Gladys Scott! Jamie reported that she was taken to a vascular clinic last Monday and an attempt was made to correct the displaced catheter in her neck, but the doctor had a problem getting into her vein. Tests were also run to determine whether she had remaining infection in her body. She is being told that she will return there next week to see her regular doctor, who was not present at the time of this visit. She was not given any information regarding any of the findings by staff.

On Wednesday she began having chest pains following her dialysis and was taken to the hospital. No blockage was detected following ultrasound and catheterization of her heart. She was returned to the prison on Thursday before she was told of any results.

Jamie sounded a bit stronger and her family and your activism have helped her to regain some of her fighting spirit! She was told by staff that she will be allowed to purchase some food on Monday and she is grateful for the donations she has received to be able to do so! Also, she has been told that the chaplain will be coming by a couple of days a week to do her laundry.

Jamie should not be in the prison infirmary, locked in a cell on a hospital bed on the mens’ side of the prison, where the care is absymal and frighteningly inadequate, she has had more than enough medical emergencies! There is a medical building on the prison grounds where the environment is greatly improved and where Gladys can help her tend to her activities of daily living, as other incarcerated family members are permitted to do with their ailing relatives. We need the prison officials to know that we want Jamie to be in the environment most conducive to her health and well-being as she struggles with her many life-threatening medical conditions.

Please continue to sign-on to the;

petition for the compassionate release of Jamie Scott at; pass the word!


The 2/27 Empowerment Hour Online University radio show hosted by Bros. Kermit Eady and Earnest McBride featured Mrs. Evelyn Rasco, Marpessa Kupendua (nattyreb), Nancy Lockhart, and Shakeerah Abdul al-Sabuur. There was a whole lot of good info put out and the archive is available to all at;


Empress Chi, coordinator of the MWM/Black Women’s Defense League, is organizing a Free the Scott Sisters Demo and Rally in Mississippi on March 26, 2010. To get involved in planning this and for more information call 267-636-3802 or or