The glyburide incident
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The glyburide incident is John Kiriakou's account of his own treatment by the medical unit at FCI Loretto, set out in a Letter from Loretto dated 12 September 2014.

Kiriakou has type 2 diabetes and was not insulin-dependent. After a routine quarterly blood test whose results were never communicated to him, he was called not to the physician's assistant but to the pharmacy, and handed a bottle of pills. "What is this?", glyburide. "What's it for?", diabetes. Because only insulin-dependent diabetics were permitted testing meters, he had no way of knowing his own blood sugar; asked whether he had a problem, the pharmacist said he did not know.

The crashes

He took a pill a day with food as directed. At two in the morning on the second day he woke drenched in sweat, head swimming, and reasoned his way to his locker to eat a cookie, which helped almost immediately. The next evening he took the next dose; the following morning he woke soaked again, nearly vomited, and set off for the bathroom a hundred feet away. He got a few steps before becoming dizzy. A fellow prisoner named Waheed, a pharmacist on the street, told him his blood sugar was crashing and to sit down, and fetched a Coke. Kiriakou took two sips and passed out on the concrete floor.

The medical unit

He came round fifteen minutes later in a wheelchair in the medical unit. His blood pressure was 88 over 60, twice. Told what he was taking, the nurse suggested "perhaps you're not taking it the way you're supposed to." Kiriakou said he had taken three pills in three days. The nurse then diagnosed dehydration; asked whether he would get a drip, he said "we don't do that", and ordered an EKG instead, which was normal. A blood test read 138, consistent with the two sips of Coke, and the nurse returned to dehydration, took the blood pressure twice more at 90 over 60, and told him to sit in the hall until the 8.25 move and then take it easy for the day. Kiriakou never saw a doctor, and had still not seen a medical professional three weeks later when he wrote the letter.

The diagnosis from outside

His father-in-law, a physician and former pharmacist, told him to stop the drug at once: glyburide is a last resort before insulin, Kiriakou was nowhere near that stage, it can ruin the pancreas, which is why many physicians will not prescribe it, and continuing it could be expected to lead eventually to heart failure. He threw it all away. On the day he wrote the letter, he received an electronic message that his glyburide refill was ready.

He ends the account by placing it in proportion: what happened to him was minor compared with what happens to other prisoners across the Bureau of Prisons, whose approach he summarises as ignoring medical problems in the hope they go away or that the prisoner is released and becomes someone else's problem.

The prediction his father-in-law made about the drug's destination proved right about the disease if not the mechanism. Kiriakou dates his type 2 diabetes to the years after he left the CIA for a desk job, and says that by 2021 it had reached the maximum dose of every available medication plus four insulin injections a day, the position from which he had his stomach removed to reverse it.

See also

- Letter from Loretto
- Medical care in federal prison
- Frank's heart attack
- Larry
