[xMenace]

Originally Posted by owlyn

Please be careful with that advice. While hypoglycemia itself may not kill you, the car accident (or other disaster) you get into because of it might.

Great point. It's not so much the hypo but our incapacity to function that's dangerous. I drive a lot, and I enjoy a solo hike in the woods along some rather dangerous trails. Hypos always seem to find dangerous friends.

[xMenace]

Originally Posted by Oradev

Thanks guys. I will reevaluate my treatment and get back to you.

I do this constantly

[Harold]

Originally Posted by Oradev

Does anyone know if any scientific evidence exists that supports the "death by hypoglycemia" theory? (Insulin shock)

Thanks,

Adam

Originally Posted by BlueSky

The short answer is that death is extremely unlikely. The often -quoted anecdotal reports of this happening are mostly urban myths.

You really shouldn't get too tense about the consequences of a hypo. You liver will pull you out a hypo before it becomes life threatening. Unless of course if you Glycogen Storage Disease, in which case you could be in big trouble.

Guess the two I knew whose deaths and one other that never recovered mentally were, attributed to insulin shock in those days, must have been caused by something else. Since meters were not available back in the 60's and 70's it's easy to understand how they could have made a mistake.

[LancetChick]

My grandmother died of hypoglycemia in her sleep. I suspect she had no rebound response to low blood sugar because I don't (assuming it's a heritable trait)...... rebound responses vary widely among individuals, from those who have none at all to those who rebound when their BG hits 70 (or even higher). You just have to figure out what your own response is and judge your danger with that in mind. Testing often helps enormously. I wish I had some documentation or statistics about death from hypoglycemia, but it's hard to find.

[castinneford]

My dad was a Type II diabetic and also an alcoholic, unfortunately. He died in his sleep while on a business trip in 1973 and an autopsy was performed. I remember vividly that the death certificate listed the cause of death as hypoglycemia. Ingestion of alcohol was listed as a contributing cause and diabetes as the underlying cause of death. He was 57 at the time and had been diagnosed with Type II for about 12 years at that point.

[BlueSky]

Excessive alcohol consumption leads to fatty liver disease. And the accumulation of fat is known to displace and inhibit the synthesis of glycogen. So an alcoholic is certainly more vulnerable to hypoglycemia. Especially after drinking heavily, as it compromises the process whereby liver glycogen is mobilised. And in the elderly, all kinds of things can go wrong.

The purpose of my previous post was to point out that dying from hypoglycemia is very unlikely to happen to a healthy person. I was trying to be reassuring. Living with T1 diabetes is stressful enough, and many of us struggle to keep depression at bay. Uneccessary concern about dying because of a hypo is just not helpful.

This reminds me of an interesting murder case we had here a few years ago. A doctor murdered his wife using insulin, but it took him three weeks! She was ill at the time, and he was supposedly attending to her needs. He injected insulin every night, but it took 3 weeks to kill her. Trying to kill someone with insulin is hard work. Presumably he did this because insulin is not a poison and leaves no trace. But all the injection puncture marks gave him away.

[Lloyd]

It is thought that "dead in bed", rare as it is, is due to heart arrhythmia brought on or made worse by the low glucose.

[kstreeter513]

Originally Posted by BlueSky

This reminds me of an interesting murder case we had here a few years ago. A doctor murdered his wife using insulin, but it took him three weeks! She was ill at the time, and he was supposedly attending to her needs. He injected insulin every night, but it took 3 weeks to kill her. Trying to kill someone with insulin is hard work. Presumably he did this because insulin is not a poison and leaves no trace. But all the injection puncture marks gave him away.

You've sparked my couriosity. Lets say that a normal day's insulin intake is 30 units (that's pretty close to mine). If I injected the entire contents of a 1000 unit bottle into a healthy person, that wouldn't kill them? That would seem like too much of a shock to anyone.

[EasyType2]

My lowest meter reading ever was 38, and I was flat in the floor, unable to do anything. The wife found me and helped.

[EasyType2]

I have no idea of any complicating factors, but a fried, who is a nurse, had a patient die on the ER examining table. DX was

hypoglycemia

[BlueSky]

Originally Posted by kstreeter513

... If I injected the entire contents of a 1000 unit bottle into a healthy person, that wouldn't kill them? ...

1,000 units is a lot of insulin ... . The liver holds only 100-120 grams of glycogen. And glycogen stored in muscles can't be used to support blood glucose. Even if we assume that all liver glycogen gets turned into a similar amount of glucose, it wouldn't last long under the onslaught of 1,000 units of insulin. And I don't know if enough glucose could be produced via gluconeogenesis quickly enough to stop essential systems from shutting down. The murderous doctor I was refering to obviously didn't think it would work .... . Suicide attemps using massive amounts of insulin are seldom successful. They cause a comatose state that persists for long enough for medical assistance to be provided.

[SGT Shoutmore]

I have heard of "death by hypo", but I am more of the belief that this is more an urban legend, not to say it doesn't happen, but I am convinced it is a rarity. I have been on calls while working for AMR (Ambulance) where I have found insulin dependent diabetics passed out at home, typically early morning from overnight hypos where we hooked them up with an IV and a D-50, (Nothing NPO to unconcious patients) and they will rise like dracula popping up out of a coffin, a trip to to the ER to monitor and a meal and they are up and running again.

I *cough* have been low to where I was *cough* "gorked" out, and *cough* went through that myself. *blush* My own darn fault and pretty much avoidable... Bad Shoutmore... Bad Shoutmore... *Hangs head*

Now, operating machinery of ANY kind where a hypo is likely is an insane notion, a more likely even is where trauma was secondary to a hypo resulting in death.

Botton line, CAN hypos cause death? Yes, while uncommon, the answer is still yes, I am also convinced that there are other things going on systematically where the hypo was contributory, perhaps even antagonizing and exascerbating other systemic issues/other complications that are common with diabetics, more likely hypoglycemia combined with driving, swimming, operating machinery, etc, where hypo was more of mechanizm of injury.

[mark-TN]

Here is my take on this topic. Copy and paste of this post from 12-7-07:

I agree … deaths from hypo are rare when you are safely at home. Most deaths from hypo are the result of accidents that are the result of impaired cognitive function. That being said it is important to understand the biology of what is going on and how it is that the body can or can’t bring itself out of hypoglycemia. The liver for the most part will not kick in to start raising blood sugar until the level of circulating insulin drops to a certain point. Low blood sugars are the result of higher than needed circulating insulin levels. In this state the liver thinks that blood sugar is elevated (even though in an insulin dependant diabetic the blood sugar level could be dangerously low) so it starts storing circulating glucose either as glycogen in the lever, or when glycogen stores are full as fat in fat cells. Hormones released during hypoglycemia such as epinephrine, cortisal, norepinephrine and growth hormone will help produce glucose and lower the level of circulating insulin, but the “work horse” hormone for countering high insulin levels is glucagon and its release is greatly blunted by high circulating insulin levels. When circulating insulin drops to a point the liver determines to be lower than normal the liver will signal the pancreas to release glucagon and this will trigger the release of glucose through the processes of glycogenolysis. Also at lower insulin levels the liver will create new glucose from circulating amino acids by the process of gluconeogenesis. In an insulin dependant diabetic these glucose raising processes will continue until insulin levels are normalized regardless of how high blood glucose levels get (FYI: Glycogen stores are limited, so the body can run out of glycogen during long periods of low insulin levels, but the availability of amino acids (proteins) is endless and gluconeogenesis will continue until circulating insulin levels are normalized). So the reason there are a lot of stories of diabetics surviving night time hypoglycemic attacks is eventually the levels of circulating insulin gets to the point where the liver is capable of raising blood sugar levels without any outside help. However, the ride most certainly is one that no one wishes to repeat after the first experience.

Mark

[REDLAN]

I have heard of "death by hypo", but I am more of the belief that this is more an urban legend, not to say it doesn't happen, but I am convinced it is a rarity.

It's very difficult to find actual figures. Most data lists death due to coma, which can mean either through DKA or insulin shock, which to say the least is not very helpful.

From one paper's intro I read (sorry don't have the link anymore) death due to hypoglycemia, was almost invariably associated with excessive alcohol consumption, and was more common amongst people more recently diagnosed. There was also an association with intense exercise.

below is a link about dead in bed syndrome, which causes around 6% of deaths in people with diabetes below the age of 40. No cause is found, but patients often have a history of night time hypos. These events are extremely rare - a 1 in 30,000 chance each year.

http://journal.diabetes.org/diabetes...ent299/B40.asp

As has been pointed out, your biggest risk with hypos is experiencing an accident.

[mwd]

My sister who was also a T1 died in her sleep from a low blood sugar 2 years ago. it was probably a prolonged untreated hypo that no one noticed as she was alone in a hotel room on a holiday with some friends fm work. she was found dead the next morning. apparently its called "dead in bed syndrome" which causes 6% of all diabetic deaths. apparently the heart malfunctions if hypo goes on without relief for hours.

they wouldnt find anything in autopsy unless it is done within 4-6 hrs...maybe thats why it is not realy documented as a cause of death.

liver glucagon gets depleted w repeated hypos and body takes some time to make more...so u might, sometime, not have any in the liver to bring u around.

she lived in UK and was on an insulin pump. had no diabetic complications. was diabetic for 30+ years.