Indian Engineering Student Saves Diabetic Passenger On Flight

Thanks to the quick thinking of IITK engineering student Karttikeya Mangalam aboard a flight from Geneva to New Delhi, a diabetic passenger’s life was saved.

AsianScientist (May 16, 2018) – It started out as standard-fare Hollywood medical drama: a diabetic passenger with a mid-air medical emergency and a frantic announcement by the air stewardess: “Is there a doctor on board?”

Except in this case, passengers on a flight from Geneva to New Delhi would soon meet a hero very different from those in your usual movie scripts.

This gripping episode was recounted by Indian Institute of Technology Kanpur (IITK) engineering student Mr. Karttikeya Mangalam, who was flying home in February 2018 after completing his final exams on an exchange program at the École Polytechnique Fédérale de Lausanne.

“My flight was about half full and luckily, the seats adjoining mine were empty,” recounted Mangalam in an experience that was shared on Twitter by IITK. “For the first three hours or so, I was enjoying the solitude when I heard an air hostess enquiring whether there [was] a doctor on board to deal with a medical emergency that [was] happening.”

Mangalam learned that the passenger in distress, a Dutchman named Thomas, was being assisted by a Russian doctor on the same flight.

The beginnings of a crisis

According to Mangalam’s account, Thomas had been looking forward to visiting India, and the Taj Mahal in particular. The Amsterdam native has suffered from type 1 diabetes since he was 11 years old, and relies on insulin injections, in addition to diet and lifestyle modifications, to manage his blood sugar levels.

“[Thomas] usually always carried his insulin pump with him. He kept the pump attached on his abdomen over his liver and would set the dosage of insulin to take before eating anything through a dial in the pump,” Mangalam wrote.

“However, he was required to take off his pump for [a] security check at Sheremetyevo International Airport, Moscow, and forgot to collect his equipment from the deposit tray in a hurry.”

By the time Thomas sought medical attention, it had already been five hours since his last insulin dose, and he had begun to exhibit symptoms of insulin deficiency. “[He was] starting to feel nauseous and [felt] that he might black out,” Mangalam shared.

A glimmer of hope, dashed

By sheer luck, it turned out that the doctor attending to Thomas was also a diabetic. He had on him an insulin injector pen, which is an alternative to using an insulin pump.

But the situation turned out to be trickier than expected. “Thomas’ insulin cartridges were thinner than the insulin pen’s diameter and so wouldn’t fit properly,” Mangalam wrote. In addition, the doctor’s insulin cartridges contained long-acting insulin, a form of insulin that can take up to four hours to enter the bloodstream.

Given the severity of Thomas’ condition and the lack of suitable alternatives, the doctor went ahead and administered the long-acting dose, Mangalam explained. Thinking that the emergency was over, Mangalam went back to his seat and took a nap.

“But as the reader could have guessed, that was not the case because otherwise I would not be writing this memoir,” Mangalam joked.

“After about an hour or so, I heard the air hostess announcing that they [were] planning to land at some airport in the Afghanistan-Kazakhstan region because of a medical emergency,” he wrote, adding that Thomas’ blood sugar levels had risen sharply and he had lost consciousness.

Using Thomas’ own (rapid-acting) insulin was the only timely way to help him at this point. “[The doctor] said that he [knew of] a way to adjust the cartridge holding tube’s diameter and he [was] going to use it to inject Thomas’ own insulin,” Mangalam wrote.

The adjustment worked and Thomas’ insulin cartridge now fit, but the needle of the pen failed to eject during the injection.

Springing into action

With all medical avenues exhausted and the plane one and a half hours away from the nearest airport, Mangalam knew it was time to put on his engineering hat. He inspected the insulin injector pen to find out what had changed from an hour ago when the pen was still working fine.

Unable to solve the problem, Mangalam decided to look up the pen’s manual online. He requested for Wi-Fi access, which—he made a point to note in his story—the air stewardess “reluctantly agreed” to, as the privilege was reserved for business class passengers.

“I looked up the manual and found a large engineering drawing style diagram showing how every part fits with each other. Now, engineering drawing (TA101) was something I loathed in my first year but had practiced enough to [score] a ‘B’ and which was also enough to understand this particular drawing,” Mangalam wrote.

“I started to methodically open the pen, all the while counting the parts that I had accessed while doing so. I realized that, somehow, there were only 12 parts in it now while the diagram clearly showed 13 different parts.”

“On cross-checking I realized that it was missing a spring that coiled before the cartridge and was essential to transfer the push motion from the back to the needle in front.”

An engineer to the rescue

As the plane continued its descent, Mangalam searched for the missing spring around Thomas’ seat and in the nearby aisle, with no success.

It was then that Mangalam had a stroke of genius—could the spring found in ballpoint pens be used as a replacement spring? Several ballpoint pens were quickly volunteered from “anxious passengers… terrified at the thought of landing in that terror-stricken region.”

“Quickly, I reassembled the pen and gave it back to the doctor,” Mangalam wrote. “He adjusted the dose, changed the needle and injected the proper dosage of Thomas’ own (rapid-acting) insulin.”

Within 15 minutes, Thomas’ blood sugar levels stabilized and he gradually regained consciousness. The emergency landing was no longer needed, and the flight to New Delhi could be resumed.

Mangalam remained at Thomas’ side for the remainder of the flight, and even accompanied him to the hospital for a check-up and to obtain a new insulin pump. Mangalam wrote of Thomas’ profound gratitude: “On the stretcher in the ambulance, he thanked me a lot and told me to come visit him in Amsterdam where he owns his own restaurant and brewery and where I supposedly would receive as much free food and beer as I want when I come!”

The unlikely hero in this real-life medical drama was an engineer, Mangalam mused.

“This incident has made me realize the importance of the basic engineering skills we are taught in our freshman year here [at IITK].”

“I think saving a man’s life is more than what anyone could ever imagine to achieve from the basic engineering knowledge endowed in that year. I am grateful to IITK for making me [able] to actually matter in such a critical situation.”


Copyright: Asian Scientist Magazine; Photo: Shutterstock.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Flora Teoh is a postdoctoral fellow at the Agency for Science, Technology and Research (A*STAR). She received her PhD from Nanyang Technological University, Singapore for her study of how evolutionary processes can influence the ability of human microbial colonizers to cause disease. When not sciencing, she can be found reading, baking, painting or dragon boating.

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