The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

I read the article on prescribing for people in custody1 with interest. It raised many valid points and covered several narcotics and other sedatives among high-risk medicines. I would like to draw attention to antihyperglycaemic drugs, especially insulin which requires expertise on site to monitor its use and potential misuse. This is more important for inmates with type 1 diabetes in high-security facilities who mostly do not have access to diabetic meals, and where food provided after hours is mostly not diabetes friendly. In my experience dealing with patients on insulin in custody is really challenging. Rigid schedules and limited availability of healthcare staff add to the complexity of this situation.

It is unfortunate that in spite of the high prevalence of diabetes in the community, especially in those who are disadvantaged, there is no specific policy on management of people with diabetes in custody.

Santosh K Chaubey
Staff specialist (Endocrinology)
Gosford Hospital
Gosford, NSW

Authors' comments

Stephen Hampton, Donna Blomgren, Jill Roberts, Tobias Mackinnon and Gary Nicholls, the authors of the article, comment:

We thank Dr Chaubey for his response. He has identified a number of challenges which make managing diabetes in the custodial environment more difficult when compared to the community. Systems vary between jurisdictions, facilities and patient security classifications, but the schedules mandated by the secure environment do not always coincide with the most appropriate testing and dosing times. Patients may not have access to glucometer testing without supervision by nurses. Meals can have high caloric loads and be given at unusual times. Also extra snacks can be ‘purchased’ by patients, which can be unhelpful for diabetic control. Specialist reviews may take some time to arrange through already burdened public systems and patients may be disinclined to travel to them.

Having said this, many of the people entering prisons have had little or no diabetic care or may not have known they are diabetic. Local chronic disease programs have been developed from national guidelines. Nursing care is available on a daily basis, and GPs and specialist nurses visit on a sessional basis. Finally, it should be said that staff and patients are very grateful for the support and advice from hospital specialist colleagues on the management of complex medical problems for people in custody.