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Insulin Overdose

C

Chester

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Hi Guys can you help
Our son Passed away due to an insulin overdose in Aug of last year, as the inquest is imminent I would like some idea of any questions I should be asking?.
Just days before Brian passed away he was prescribed beta blockers. He was also using an insulin pump. I have been made aware that someone who starts taking beta blockers loses their usual signs i.e. Sweats / palpitations of hypo/hyper and was wondering if this may have had a significant effect. As Brian was on his own at the time he would have had no one to assist in any problems. He had been T1 for 26 years and would have relied upon usual signs .
Please except my apologies if this post is not suitable for this forum
My thanks
Chez
 
Sorry to hear of your sad loss.......

Unsure as to what Beta-Blocker/s he was on ? There are several references at the bottom of this Royal Society of Medicine page which may be of some help as they discuss the effects of various Beta Blockers and Hypoglycaemia. Click on the Pub Med links for a clearer read.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1542843/

This is the first one .........

http://www.ncbi.nlm.nih.gov/pubmed/8184

There is also this from the BNF61.....the prescribing bible.

Beta-blockers can affect carbohydrate metabolism, causing hypoglycaemia or hyperglycaemia in patients with or without diabetes; they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia. However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers (see above) may be preferred. Beta-blockers should be avoided altogether in those with frequent episodes of hypoglycaemia. Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.
Click to expand...

As to whether this is significant or not only a Specialist in this type of treatment would be able to answer that. I do hope you have proper legal representation regarding this as you will need 'expert' evidence if you believe that things may not have been done correctly and that that caused or contributed to your Son's death........
 
I'm very sorry for your loss.

I don't know a lot about beta blockers but I did quickly find this extract from wikipedia:

"c) Beta blocker drugs: These medicines are designed to blunt the β-effect of adrenalin and related substances. Hence, if hypoglycemia occurs in someone who is using this type of drug, he/she may not experience the typical adrenergic warning symptoms such as tremor and palpitations. Again, the result is hypoglycemic unawareness. As noted above, beta blockers will also prevent adrenalin from stimulating the liver to make glucose, and therefore may make the hypoglycemia more severe and/or more protracted.[8]"

http://en.wikipedia.org/wiki/Diabetic_hypoglycemia

As a parent if this had happened to my child I would want to know what his blood glucose control was like prior to being prescribed beta blockers. Was he having frequent hypos? Was his blood glucose unstable? Why was he prescribed the beta blockers? Was it vital that he took them, could an alternative not have been prescribed? Was the beta blocker prescribed as a preventative treatement? For someone who is on insulin I would not want my child to take beta blockers unless it was absolutely necessary and vital for their wellbeing. If he did experience unstable blood glucose with frequent hypos was he very carefully monitored by doctors. How did they monitor his health to make sure he was not at risk. Was he given any tools to assist him with alerting of low blood sugar (as he would have been unable to detect a hypo himself) e.g. given a CGM linked to his pump which alarms when his BG is low? A hypo alert dog? Anything? What advice and information was he given about the effects beta blockers would have on his diabetes? Was he warned of the danger it might place him in? How often was he seen in clinic for his diabetes, I would want to establish that they were keeping a close eye on him and the frequency and severity of hypos. Was he offered training on carbohydrate counting and accurately adjusting his insulin (I would expect he was as he had a pump but it would be good to make sure). If you look back on his pump history what was his last bolus, does it seem particularly high compared to other boluses he usually gives. Some pumps can be set up with a maximum amount of insulin per delivery so if you try to deliver more than that maximum it won't allow you to. Did his pump have this feature and what was it set to? i.e. was the pump set up with a reasonable max insulin dose to prevent accidental overdose.

I'm sorry, I have so many questions. I'm sure you must have a lot too. I wish you luck in establishing what happened and if it could have been prevented. I agree with cugila, make sure you have legal advice.
 
I'm so sorry for your loss.

I recommend an organisation called Inquest. http://www.inquest.org.uk Don't worry about the homepage emphasis on death in custody, they support anyone facing an inquest on their loved one, whatever the circumstances. I'm sure they'd advise you on legal support, expert witnesses etc.

I hope the inquest helps you and your family. My brother died in an accident and although the inquest didn't answer all our questions, it was a big help. I hope this is true for you too.
 
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