Local girl died; feeling a bit freaked out - are there ways to reduce risks of diabetic comas?

[-Artemis-]

Hi there,

Feeling a bit freaked as a girl in my small town just recently died. She was type 1 and had a nighttime hypo and went into a coma that they couldn't get her out of... I didn't know her, but I guess cos she was the same age as me and lived so nearby it's just really playing on my mind.

Of course I do know insulin comes with these risks... But I've just started taking insulin and live alone - so this news has kinda freaked me out.

Are the ways to reduce the risks of nighttime hypos that you don't wake up from, or is it just purely a 'luck' thing?

I'm still new to understanding insulin so would appreciate any tips that would ease my fear... Thank you x


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[Indiana91]

Always make sure you check your bg before you go to bed. I never go to to bed if I'm below 5, also make sure that you have hypo treatments by your bed.

Do you get hypo symptoms?

It's very tragic about what happened but it is quite a rare thing to happen.

Indiana x


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[Kathryn321]

Hi I was diagnosed in dec 2013 and seemed fine at first, then when my dr told me about hypos I went a long time worrying before I went to bed, couldn't sleep and would even set alarms in the middle of the night to wake me up so I could check, so you're definitely not alone. But after a while I was fine I just make sure they are around 6 before bed. I don't know the details of this case but was to hypos like this usually occur if glucose levels are low before bed or you have had a lot Of alcohol. If I have a bit of alcohol I usually have carbs before bed just in case. Don't worry.


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[-Artemis-]

Thank you Indiana x

I'm literally on my fourth day of insulin injections - so it's all very brand new to me.... so far I've not had any hypos, but they've started me on a very low dose as I said I was freaked out about living by myself and scared of having hypos and noone being there.... so they said it's better for me to start with a super low dose and be a bit higher than is ideal, and work my way down to being in a good range, than starting with a higher dose and frightening myself with the potential drops... so that's where I'm at, at the mo...

At the moment my numbers are still too high anyway, so even more unlikely to be at risk.... But I just saw this post about this girl on facebook this am and it's kinda set off my fears again

Thanks for the reassurance it's rare - this is so new to me that I just don't know how "big" the risks are... I know it's there - I just don't understand it that much yet, which I guess is what makes it scary. It's useful to know that 5 is benchmark for bedtime too x

 

[-Artemis-]

Thanks Kathryn - yea, that's exactly where I'm at right now - I haven't slept properly since starting (it's super early days though - not even a week yet) and am waking up and testing two times a night at least... which is silly cos I know worrying won't help! Even more ironically, cos I've been high for a while, my liver is actually going nuts overnight and chucking out loads of glucose cos of the insulin (I think my benchmark is high, so my body thinks I'm dropping when i'm not) - so right now I'm waking high anyway!

I did know the risks before starting the insulin, but it's cos this girl was the same age as me, and in the same town that's really bothered me I think.... Plus as I said above, I think its cos I don't fully understand whether people can randomly have hypos in the night, or what causes them, that's possibly making me freak out more...x

 

[Kathryn321]

Worrying definitely won't help it sounds unlikely that your glucose levels will go low at the moment anyway. Mine were always high at first and still are now sometimes. I've found stress and worrying, especially around exams and deadlines at uni have made mine high, so this might also affect yours. I have never had a hypo in my sleep so far, I once woke up really sweaty and thought I might have been but it was the opposite and they were high around 19.


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[diamondnostril]

Of course I do know insulin comes with these risks... But I've just started taking insulin and live alone - so this news has kinda freaked me out.

Are the ways to reduce the risks of nighttime hypos that you don't wake up from, or is it just purely a 'luck' thing?

I'm still new to understanding insulin so would appreciate any tips that would ease my fear... Thank you x


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Hi Artemis,

I am a T1 that lives alone.

In the last 2 years I have discovered the Ketogenic diet, and this has been a complete revelation to me. In addition to preventing high blood-sugar levels it also protects against the unpleasant effects of low blood-sugar levels (because the metabolism switches to feed the brain primarily with Ketones rather than with Glucose).

I know the idea is a bit controversial and when I've stated this idea on previous threads I've received some negative responses; if the same happens here I won't respond, so that this thread doesn't get pulled off track.

There are several published medical studies that confirm the idea that a Keto-adapted brain does not experience a loss of function even when blood-sugar levels are extremely low.

Even if you don't buy into the above idea, the very fact of eating Ketogenic (LCHF) means that you are reducing your Insulin to the minimum possible doses, which minimises any mistakes and makes serious problems much less likely. (The "law of small numbers", according to Richard K. Bernstein.) I totally accept that the Keto diet is not for everybody. Depending on circumstances it may be difficult to stick to. But if you are a T1 living alone then it may help to alleviate anxiety about Hypos.

As Indiana91 said, this is extremely rare for anybody to die from a Hypo, whatever is their strategy for managing Diabetes. Usually bad Hypos are a thoroughly unpleasant experience, but rarely cause physical harm.

The following Post/Thread may be of interest to you . . .
http://www.diabetes.co.uk/forum/threads/lchf-hypo-danger.56717/page-2#post-527324

Regards,
Antony

I think its cos I don't fully understand whether people can randomly have hypos in the night, or what causes them, that's possibly making me freak out more...x

Insulin-Dependent Diabetics that experience Hypos have them because they have injected an inappropriate amount of Insulin. Diabetes sends blood-sugar levels HIGH; only a problem with your Insulin injection will send your blood-sugars too LOW. (I realise there are exceptions, but I speak about 99.9% of cases.)

 

[simonkit]

It's obviously a little worrying when you hear of sad events like this but it is very rare. Bear in mind that at night your body is really only on "tick over" so your glucose levels should stay quite stable.. there are things that can affect this which are mainly:

Long acting insulin dosage - too strong and it could mean you drop during the night
Exercise during the day/evening - you still burn glucose some time afterwards which could drop your levels at night
Alcohol intake

I've probably missed something so please feel free to add.

Regarding exercise and alcohol then taking a small amount of Carb before sleep is a good idea, if you're not sure about long acting insulin dosage it's best to seek professional advice

 

[-Artemis-]

Thanks @simonkit & @Kathryn321 - I do know it's probably a slightly 'how long is a piece of string' question re the risks, but I so really appreciate your reassurances nonetheless x

@diamondnostril - that's really interesting....I have read a bit about ketogenic diets and in fact kept myself in the honeymoon period for a while following one.... but I'm vegan - so found it *very* challneging to stick to - basicaly just salads and nuts, day in, day out.... I'm trying to stay low-ish carb though as just makes sense to me to overall - but I'm not sure if you need to be very low carb to be ketogenic...? I'm probably having about 80g carbs a day since starting insulin - which I guess woudl knock me out of ketosis?
...I'm going to read your link to the thread that you posted now.... thank you x

 

[Hooked]

Blood test before bed and have a small snack.
Alcohol prevents the liver producing glucose if blood glucose levels drop too low and can lower the levels itself. So be careful if you're drinking.

 

[Indiana91]

Hi Artemis,

I am a T1 that lives alone.

In the last 2 years I have discovered the Ketogenic diet, and this has been a complete revelation to me. In addition to preventing high blood-sugar levels it also protects against the unpleasant effects of low blood-sugar levels (because the metabolism switches to feed the brain primarily with Ketones rather than with Glucose).

I know the idea is a bit controversial and when I've stated this idea on previous threads I've received some negative responses; if the same happens here I won't respond, so that this thread doesn't get pulled off track.

There are several published medical studies that confirm the idea that a Keto-adapted brain does not experience a loss of function even when blood-sugar levels are extremely low.

Even if you don't buy into the above idea, the very fact of eating Ketogenic (LCHF) means that you are reducing your Insulin to the minimum possible doses, which minimises any mistakes and makes serious problems much less likely. (The "law of small numbers", according to Richard K. Bernstein.) I totally accept that the Keto diet is not for everybody. Depending on circumstances it may be difficult to stick to. But if you are a T1 living alone then it may help to alleviate anxiety about Hypos.

As Indiana91 said, this is extremely rare for anybody to die from a Hypo, whatever is their strategy for managing Diabetes. Usually bad Hypos are a thoroughly unpleasant experience, but rarely cause physical harm.

The following Post/Thread may be of interest to you . . .
http://www.diabetes.co.uk/forum/threads/lchf-hypo-danger.56717/page-2#post-527324

Regards,
Antony



Insulin-Dependent Diabetics that experience Hypos have them because they have injected an inappropriate amount of Insulin. Diabetes sends blood-sugar levels HIGH; only a problem with your Insulin injection will send your blood-sugars too LOW. (I realise there are exceptions, but I speak about 99.9% of cases.)

Activity levels and exercise also cause hypos as do other things such as heat, stress, illness etc. everyone is different. Too much insulin may be the main cause, but it is certainly not the only cause.

Indiana x


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[jack412]

I would want to see the medical report rather than a newspaper saying what they think was hypo
I would think it is more likely the person died at home from dka

 

[diamondnostril]

Activity levels and exercise also cause hypos as do other things such as heat, stress, illness etc. everyone is different. Too much insulin may be the main cause, but it is certainly not the only cause.

Indiana x


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I don't agree with this.

People who do not inject Insulin do not go Hypoglycemic**, regardless of how much exercise they do, or how hot it is, or how stressed they are, or if they are ill.

Too much injected Insulin is always the cause of a Hypo . . . the problem for a T1 Diabetic is that exercise, temperature, stress, illness etc all constantly affect the amount that one should be injecting, and all this is extremely difficult to accurately keep up with on a day-to-day basis. Mistakes are almost inevitable.

Apologies if you think I am just being picky and arguing over semantics.

** again, I know there are exceptions, people with Reactive Hypoglycemia for example; I speak of 99.9% of cases.

 

[noblehead]

It's understandable that you have these concerns Artemis and I don't expect anyone on insulin hasn't thought about it at some time.

However you've been given some good advice on testing before bed and making sure to keep fast-acting carbs besides your bed, provided you get your basal insulin dose right night hypo's can be kept to a minimum and those that do occur will normally wake you in good time so that you can treat it, it's a good idea to test your bg during the night if you wake just to make sure your bg levels are fine.

Simon, makes a good point about exercising and alcohol in an evening effecting bg levels many hours later, but these can all be compensated by reducing your insulin or taking on board a few more carbs, once you do get established taking insulin you can do a carb counting course such as DAFNE that will teach all about insulin management and how stress, illness, hormones, exercise and alcohol effect bg control.

Try not to worry and any concerns speak with your diabetes team or come back on here.

 

[Robinredbreast]

Activity levels and exercise also cause hypos as do other things such as heat, stress, illness etc. everyone is different. Too much insulin may be the main cause, but it is certainly not the only cause.

Indiana x


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Would that be with Insulin already taken. ie taking insulin with a meal with a sedentary morning ahead, but then, all of a sudden, having to rush about and be more active, thus setting off a possible hypo.? That's what I'm interpreting, but maybe it's not? ( as that happened a few times to me earlier on in the year.)
With best wishes

 

[Robinredbreast]

Activity levels and exercise also cause hypos as do other things such as heat, stress, illness etc. everyone is different. Too much insulin may be the main cause, but it is certainly not the only cause.

Indiana x


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Thanks Kathryn - yea, that's exactly where I'm at right now - I haven't slept properly since starting (it's super early days though - not even a week yet) and am waking up and testing two times a night at least... which is silly cos I know worrying won't help! Even more ironically, cos I've been high for a while, my liver is actually going nuts overnight and chucking out loads of glucose cos of the insulin (I think my benchmark is high, so my body thinks I'm dropping when i'm not) - so right now I'm waking high anyway!

I did know the risks before starting the insulin, but it's cos this girl was the same age as me, and in the same town that's really bothered me I think.... Plus as I said above, I think its cos I don't fully understand whether people can randomly have hypos in the night, or what causes them, that's possibly making me freak out more...x

Please try and not to worry too much, I know it's hard but as members have said, these things are rare and unfortunately it's the sad or bad things that hit the headlines and not a headline with 'a newly diagnosed type 1 diabetic woke up to a 5.6 this morning and she is so happy with her control' !
Do you have any more news on the poor girl who died so suddenly, was it a hypo ?

Take good care and always check your blood sugars.
With best wishes RRB

 

[noblehead]

Would that be with Insulin already taken. ie taking insulin with a meal with a sedentary morning ahead, but then, all of a sudden, having to rush about and be more active, thus setting off a possible hypo.? That's what I'm interpreting, but maybe it's not? ( as that happened a few times to me earlier on in the year.)
With best wishes

Yeah i would guess that's what Indiana means as unplanned exercise (or any other activity) can result in postprandial hypo's.

There's also other reasons for postprandial hypo's, such as slow gastric emptying and poor insulin absorption from injection site problems.

 

[Jaylee]

I would tend to agree with Jack412's comment on the news article causing your worry Artemis.
Facebook news quite often sensationalises Inappropriately.. Most of it more often than not circulated urban myth style poison letters...?

38 years I've been on insulin. Without fail I've dealt with night hypos while the other occupants slept...

 

[Robinredbreast]

Yeah i would guess that's what Indiana means as unplanned exercise (or any other activity) can result in postprandial hypo's.

There's also other reasons for postprandial hypo's, such as slow gastric emptying and poor insulin absorption from injection site problems.

I will need to add Coeliac disease too, because before I was actually diagnosed, I had some hypo's which plummeted 10 to 15 minutes after eating with Insulin! so a worrying time on occasions.

 

[ealingr]

I think you've had some good advice here.

One of the things I didn't really grasp for a long time was the fact that a diabetic person's liver will normally release emergency glucose if the blood sugar level drops really low. I believe that is one of the reasons diabetics rarely die from low blood sugar.

While preventing a situation where your blood sugar gets really low is obviously the best plan (and you're already trying to do that by coming on here, getting tips and actively managing your diabetes), it might be reassuring to keep the liver's response in mind.