One November night two years ago, State Police found Daniel Fried slumped behind the wheel of his van along Route 72 in Burlington County. He stared forward, eyelids drooping. He was incoherent, slurred his words and seemed to be falling asleep.

He may have looked drunk or like he was on drugs, but doctors say these are classic symptoms of diabetic shock. Paramedics found Fried’s blood sugar was so low he could have suffered a coma, seized or died, according to State Police records.

But two troopers took his erratic behavior for belligerence. They wrestled him down, hit him with a baton and arrested him, their reports said. The struggle was captured by a microphone on one of the troopers, and the recording was obtained by The Star-Ledger.

On the tape, Fried can be heard screaming and telling troopers they are hurting his arm, while they yell at him to stop resisting. Fried said in court records he suffered cuts, bruises and a broken wrist, and despite repeated requests, troopers refused to fetch the fruit punch he kept in his van.

"I was stuck somewhere between angry, frustrated and embarrassed," Fried told The Star-Ledger in an interview.

As the number of Americans with diabetes soars toward 26 million, there is growing concern around the country among diabetes advocates and medical experts that too many police officers don’t know how to recognize people in diabetic shock or how to help.

Brown said he initially did not think Fried was much of a threat. He said he asked Fried to get out of the van, but did not frisk him and left him alone when Tetzlaff arrived.

Before the struggle, Brown did not tell Tetzlaff about his conversations with Fried, the strange behavior and his suspicion of diabetes. He told his colleague "this guy’s giving me the runaround" and suggested Fried was being purposefully evasive, records show.

"In my experience with, you know, people that are having a medical issue, I haven’t — I never experienced that where somebody was just disregarding me completely, so I felt at that time, you know, that there was some intent there," Brown said in his deposition.

Tetzlaff said in his report Fried would not take his hands out of his pockets, and when he did, he put them back. Tetzlaff said he feared Fried might have a weapon, though none was found. He said Fried was belligerent and tried to walk away, so he grabbed him.

"He clenched his arms downward and pulled me close to his body with force," Tetzlaff wrote. "I took the accused to the ground and gained control of his left arm. … The accused was face down, kicking and trying to roll over on his back."

In the recording, Tetzlaff later scolded Fried for not being upfront about his condition.

"Hey you know what bud, if this is all about … the sugar you may have needed or something like that, this could have all been avoided by you just saying ‘I’m diabetic, I need sugar,’ " said Tetzlaff, who also had two years on the force at the time.

Fried was charged with disorderly conduct and resisting arrest in Woodland Township Municipal Court. The charges were dismissed.

A GROWING EPIDEMIC

Fried, of Springfield, Pa., in Delaware County, is among an estimated 25.8 million people in the country — including more than 589,000 in New Jersey, or 9.2 percent of the population — who have diabetes, according to the U.S. Centers for Disease Control and Prevention.

A diabetic since he was 8 years old, Fried said he has been active with the Juvenile Diabetes Research Foundation, helping educate the public and diabetics about the disease and how to best manage it. He owns an independent production company and has worked on everything from medical training videos to Discovery Channel shows, major network broadcasts and concert events.

PULLED OVER, WAITING FOR HELP TO ARRIVE

On Nov. 20, 2010, while suffering from diabetic shock caused by dangerously low blood sugar, Daniel Fried pulled over along Route 72 in Burlington County. A State Police trooper responded and suspected Fried had diabetes, but 38 minutes passed before he received medical care. Here's how the stop unfolded:

• 6:54 p.m.: Responding to a call of an erratic driver, Trooper Paul Brown arrives on scene and questions Fried about his condition. He asks if he has diabetes. Fried says yes, then says no, appears sleepy, incoherent and has slurred speech. The trooper does not feel threatened.

• 7:06 p.m.: Trooper Scott Tetzlaff arrives. Brown tells him Fried is giving him "the runaround" and being evasive, but says nothing about his observations, questions or suspicion of diabetes. Tetzlaff approaches Fried and asks him to take his hands from his pockets.

• 7:07 p.m.: Fried removes his hands but puts them back. Seconds later, Tetzlaff grabs Fried's arm to secure his hands and Fried resists. Tetzlaff takes him down and a struggle ensues. Brown hits Fried in the leg with his baton. Fried suffers cuts, bruises and fractured wrist.

• 7:14 p.m.: In the back of a patrol car, Fried asks for sugar. Tetzlaff decides to call paramedics and tells Fried if he had said he had diabetes and needed help, "this could have all been avoided." Fried asks to explain his condition, but Tetzlaff ignores him.

• 7:20 p.m.: Fried continuously asks trooper Tetzlaff what happened and is told he will be charged. Fried pleads with him to talk. The trooper responds, "What happened was you caused mine and two other troopers uniforms to get dirty, that's what happened tonight, all right?"

• 7:30 p.m.: Fried pleads for juice he keeps in his van, but troopers refuse to get it and Fried is told to keep his mouth shut. Fried asks for them to listen to him. "Same way I asked you to listen to me before, right?" Tetzlaff said. "I was in shock!" Fried replies.

• 7:32 p.m.: Paramedics arrive. Tetzlaff then searches Fried's van for juice. Fried's blood sugar tests at 26, a critically low level that requires immediate attention and can cause seizures, coma or death. Fried is stabilized and taken to Southern Ocean County Hospital.

Sources: Federal court documents; sworn court depositions; State Police patrol car audio and video recordings; State Police investigation reports.

He said he has worn a medical bracelet since his childhood, keeps a jug of fruit punch and insulin in his car, and has never before had a problem with the police. But even those who manage the disease best can suffer from low blood sugar, said Daniel Lorber, associate director of research at New York Hospital Queens and volunteer for the American Diabetes Association.

The symptoms Fried displayed were some of the most common, said Lorber, who has been treating people with diabetes for 35 years. "Hypoglycemia turns on your fight-or-flight reaction, so people get very anxious," he said.

The symptoms were also the same portrayed by the actress in the training video made by Fried around 2005. In the video, Lt. Jim Gould of the Philadelphia Police Department explains how officers should handle someone who appears to be in diabetic shock.

"When a person’s blood sugar continues to fall, disorientation and confusion can increase," Gould said. "If the person is having trouble thinking clearly when answering questions, a little bit more time should be taken to figure out what is wrong before taking any action."

Lorber said scolding Fried for not communicating his problem was "ridiculous."

"His brain was starving, that’s the real answer," Lorber said. "And to expect him to be able to handle something more complicated than saying, ‘I need sugar’ is cruel and unusual punishment."

LACK OF TRAINING

In their depositions, Brown, Tetzlaff and a third trooper on scene, Brian Oliver, said they received no specific training on how to identify and help people in diabetic shock. They also said they did not see Fried’s medical alert bracelet.

"I never received any training to say you need to check people for a medical alert bracelet whenever you have them in a situation like that, side of the road," Brown said.

Three sources with knowledge of State Police procedures said differentiating diabetes from intoxication was mentioned during first aid training, but they could not remember any specific instructions on identifying diabetic shock, its symptoms and how to help someone suffering from it. The sources were not allowed to discuss State Police policy and requested anonymity.

Alan Yatvin, chair of legal advocacy for the American Diabetes Association and the attorney who filed the class-action lawsuit against Philadelphia, said a lot of police departments across the country are stepping up training to help those with diabetes.

"It’s disappointing the New Jersey State Police is not doing anything," he said.

Yatvin said the New York Police Department recently asked for help. The city has faced several lawsuits, including one in 2010 that led to a $17.5 million jury award for a man who suffered brain damage after being refused insulin while in custody.

A number of other lawsuits have been filed against police in Nevada, Oregon and Maryland. Some have cost taxpayers thousands of dollars and prompted reviews of use-of-force policies and led to improved training to recognize medical distress.

Katharine Gordon, staff attorney for the American Diabetes Association, said she receives several calls every month from diabetics who had bad encounters with police.

"There can be issues from the smallest Southern town to a town you would think would have much better training," Gordon said. "It certainly is a concern across the country."

But Fabrice Czarnecki, chairman of the police physicians section of the International Association of Chiefs of Police, said officers should not be diagnosing diabetes, but should recognize medical emergencies and act appropriately, such as calling paramedics.

Czarnecki said the association was working on a model "extremely agitated persons" policy that would cover some of the issues related to people in diabetic shock.

BEFORE THE STRUGGLE

On Nov. 20, 2010, Fried said, he was driving home from his Shore house on Long Beach Island. He planned to meet his brothers at a nearby diner, but just before the exit, he said in court documents, he became disoriented and eventually pulled over.

Fried said he does not remember what happened from when he pulled over to when he was in the patrol car. According to the audio recording, after Tetzlaff arrived, he and Brown approached Fried.

"What’s gong on, bud?" Tetzlaff said, to no response.

"What’s happening, man?" he said.

"What?" Fried said.

"I said what’s happening?"

Fried makes a sort of grunt.

"Get your hands out of your pockets for me," Tetzlaff said.

"Why?" Fried replied.

"Because I said so, that’s why," Tetzlaff said. "Because you’re making me nervous."

"No, you’re making me nervous," Fried said. Tetzlaff said in court documents Fried briefly took his hands from his pockets but put them back.

"I’m making you nervous? All right. Well now you’re not going anywhere," Tetzlaff said. "Get your hands out of your pockets."

"Do not push me," Fried said, just before the sounds of a struggle begin.

I NEED SUGAR

Once in the patrol car, the recording reveals, Fried became more coherent and asked for sugar. He tried to explain his medical condition to troopers, who sometimes ignored him or told him to shut his mouth. He asked them to listen.

"Same way I asked you to listen to me before, right?" Tetzlaff replied. "I was in shock!" Fried shouted back at him.

Tetzlaff told Fried he would be charged and an ambulance was coming. Fried continued to ask what happened. "What happened was you caused mine and two other troopers’ uniforms to get dirty, that’s what happened tonight, all right?" Tetzlaff said.

The third trooper on scene, Oliver, said Fried asked for the juice he kept in his van. The fruit punch contains a lot of sugar and can quickly raise blood sugar levels.

"I don’t know what you’re talking about. I don’t know what juice. Just sit down, be quiet, first aid’s coming," Oliver said he told Fried, according to his deposition.

Oliver said he never asked Brown or Tetzlaff about the juice because he assumed they were looking for it and had things under control.

Tetzlaff said in a deposition he searched the van but only found fruit, and was told that would not suffice. But according to the recording, that happened after paramedics arrived. The trooper also wondered why Fried was suddenly able to talk more clearly.

Lorber, the New York doctor, said one way the body increases blood sugar is through adrenaline, and the struggle could have caused it to surge. When paramedics arrived, records show, they determined Fried’s blood sugar to be 26, a level that required immediate attention. He was taken to Southern Ocean County Hospital.

CHRONIC PAIN

Fried said in an interview his fractured wrist required multiple surgeries and he has constant pain. "I’m lucky it was only a broken wrist," he said. "It could have been brain damage."

Fried hopes the State Police realize they need better training.

"These are quick and easy things to learn," he said. "Please learn it. So people like me can live long lives."

RECOGNIZING DIABETIC SHOCK

A training video created by Daniel Fried for the American Diabetes Association and Philadelphia Police shows how someone in diabetic shock can act and how officers should respond. Seven years after producing it, Fried, a diabetic since childhood, exhibited the same symptoms minutes before New Jersey State Police troopers wrestled him to the ground and arrested him.

• Know the causes: Low blood sugar, also referred to as diabetic shock or hypoglycemia, happens at some point to nearly everyone with diabetes, even those who manage the disease best. Without immediate treatment, the condition can cause seizures, coma or death.

• Recognize the symptoms: People in diabetic shock can appear drunk, under the influence of drugs or uncooperative, but need immediate medical attention. Symptoms include sweating, shakiness, anxiety, confusion, difficulty speaking, uncooperative behavior, paleness, irritability, dizziness, trouble swallowing, seizure and loss of consciousness.

• Rule out drugs and alcohol: Absent the smell of alcohol or evidence of drug use, police officers dealing with someone exhibiting the signs of diabetic shock should continue to question if the person needs help and should ask for a medical identification bracelet. Extra time should be taken to determine if someone needs medical attention before escalating a situation.

• Know how to provide help: If someone with diabetes requests a source of sugar to treat diabetic shock, immediately provide them with a sugared soft drink, juice, or another fast-acting source of sugar, followed by bread or crackers, and call paramedics.

• Have proper training: An estimated 25.8 million people in the United States — including more than 589,000 in New Jersey, or 9.2 percent of the population — have diabetes. An increasing number of police agencies across the country are implementing training, but a lack of awareness continues to cause problems when police encounter people in diabetic shock or hold diabetics in custody.

For more information: Visit the American Diabetes Association website at www.diabetes.org or call 1-800-DIABETES.

Source: U.S. Centers for Disease Control and Prevention; American Diabetes Association; federal court documents