Tuesday, January 6, 2015

Medical Halachah: Treating diabetes on Shabbos

I expect to deliver a shiur in Toronto on Sunday, on Treating Diabetes on Shabbat. Below are the questions I hope to address. I'd greatly appreciate feedback (from doctors or patients) on other questions I should be including:

Dealing with pikuach nefesh and possible safek pikuach nefesh
A situation that could become pikuach nefesh if left untreated
Compliance with medical advice, in halachah

Blood testing
Preparing the site of a stick
Drawing blood
Postponing a test until after Shabbos
Use of a blood glucose meter
Is a battery-operated CGM machine better than traditional lancing and testing?

Delivering insulin
Assembling a needle
Measuring insulin for injection
Status of subcutaneous injections
Carrying an insulin pump outside an eruv on Shabbos

For pills taken by people with Type II diabetes
Taking pills on Shabbos

Delivering sugar
Carrying candies outside the eruv, in case of need
Eating before davening

Concerns related to Shabbos meals
Kiddush – materials and shiurim
HaMotzi – materials and shiurim
Measuring food to gauge sugar impact
Eating seudah shlishit, where that will necessitate a blood test, as well as insulin or pills

What am I missing?


  1. A CGM machine doesn't necessarily reduce the number of lancings. It provide a continuous read, but generally the machine needs to be resynced to a blood test 3x a day or so anyway. Maybe the CGM would be a problem as a second machine when one is good enough; but I'm not sure what the thing does that would be assur -- it has no sound nor display, and it would only make the pump beep if there blood sugar was off and worth addressing.

    Also, should someone use a meter with an LCD display with no lighting? Our old meter was like that, but the one that bluetooths to my son's pump (and resyncs it against the CGM) has backlighting.

    I recommend FWD (Friends with Diabetes) as a resource http://www.friendswithdiabetes.org/guides.html
    Although R' Hirsch Meisels focused more on the chagim. (And he works with Rabbi M. M. Weismandl as halachic supervisor.)

    1. R' Micha-
      Thanks for commenting.
      1. Agreed re: CGM needing re-syncing.
      2. Backlighting - What is the mechanism triggering the backlighting, and what kind of lighting is it?
      3. FWD - Yes, that site has been invaluable, although it could use an update.

  2. The light goes on when you put a strip in (or hit the recall button or require the display for any reason).

    Backlighting is LED (always? almost always?), particularly if the battery is small. (E.g. cellphones).

    It also beeps when ready. I don't think that's a problem, as it's not derekh shirah, but I am throwing it in as a topic.

    In any case, my main point is that going to a CGM probably meant MORE Shabbos issues, because there is about the same amount of testing (just more knowledge between tests) and the fancier testers raise more issues.

    1. Also, does having a diabetic alert dog (a/k/a Mason) change the halachic arithmetic, as we can know about anything bad enough to pose immediate threat without using equipment at all?

      (Although discussing the halakhos of dog care might be out-of-scope. Can you pick up after your dog when walking? Graf shel re'i or nolad?)

    2. 1. Backlighting - Then presumably one should opt for one that doesn't have it, no?

      2. I do think CGM would be better for someone who needed more than 4 sticks a day, no?

      3. Didn't think at all about the dog possibility; interesting. How reliable is the dog?

    3. 1- I think so. I just don't know if there is one that talks bluetooth that has an old-fashioned monochrome LCD display.

      2- I am not sure yet, we've only been doing GCM for about a month now. But my understanding so far -- at least in my son's case -- is that it won't reduce the number of sticks much. If he's all over the map, you can't rely on GCM instead.

      3- The dog is very reliable. I don't know if Mason is typical, or we just lucked out. (He also comes in handy because Shuby also has Downs and could use a friend to play with; particularly on Shabbos.)

      BUT, the dog only responds to extremes. Shuby's diabetes is fragile, and he can hit a dangerous low and yet swing to a serious high in the same night. So, Mason saves us from setting the alarm and breaking up our sleep. He prevents danger levels, and is useless for replacing regular monitoring.

      I was suggesting that the dog might be enough to eliminate immediate piquach nefesh concerns, and therefore make heterim harder to justify.

  3. What about rechecking. Many times a diabetic can be low and must recheck their sugar after eating (depending on what they ate) or their sugar can drop again. The initial reading may be pekuach nefesh, but the later ones by not be totally necessary right now.

    1. A good point, and definitely one to address in the shiur. Thank you.

  4. I think I missed the deadline for your speech, but I wrote up a guide to testing on Shabbos, based on stuff I heard from Rabbi Meisels, here: http://judaism.stackexchange.com/q/48823. I'd love to get a recording of your shiur, if you have one.

    1. Very nicely done; I appreciate the pictures! I would not worry about the shinui in the way the needle enters, as someone raised in the comments there; the point is the shinui in your action, as I understand shinui.
      You can find the audio and source sheet here; I'd be very interested in your feedback, by email or on this post.

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