Is T2 really fatal???

[MrsA2]

Readers of my other posts will know that a close relative died at Christmas

I have today received their death certificate which shows
1 brain tumour
2 Type 2 and hypothyroidism

I know the person had at least 3 other serious conditions, blood cancer (for over 30 years) , very high blood pressure, heart failure (had a pacemaker) and had been on a right cocktail of medications for years. The fatal brain tumour was only diagnosed a couple of weeks before death.
They had only been diagnosed as T2 in December 2019, and had never really bought into the low carb lifestyle.

However I was really shocked to see T2 cited as a cause of death. There had been no vision or neuropathy symptoms, no major diabetes medication (metformin only).

Does anyone know why Type 2 was listed, when any of the other conditions were potentially more dangerous?
Is there something I'm not understanding about T2? Or about death certificates?

Note, I'm not looking to question or complain to authorities. I just want to understand why T2 was listed

 

[lovinglife]

Once again so sorry for your loss. Can’t really answer your question but I can share a couple of things with you.

My friends mum died 10 years ago, she was T2 with a Hba1c of 38, she was 76 with no other health problems. She just dropped down dead one evening from a massive heart attack and all that was on the death certificate was Type 2 diabetes (my friend had the same questions as you) she asked the GP and he said anyone with T2 no matter how well controlled they are it contributes to their death (which I personally think is rubbish)

My dad had T2 for 35 years low carb diet from the start, really looked after himself, skinny etc but ended up on insulin quite suddenly which made me suspect LADA rather than T2. He developed dementia and Louis body dementia in his 80s and went down hill very quickly. When he died I fully expected his death certificate to say T2 somewhere but it wasn’t mentioned, only the dementia

It seems things are not consistent and maybe depends on the doctor who is signing the certificate and what they saw them last for

 

[AndBreathe]

Readers of my other posts will know that a close relative died at Christmas

I have today received their death certificate which shows
1 brain tumour
2 Type 2 and hypothyroidism

I know the person had at least 3 other serious conditions, blood cancer (for over 30 years) , very high blood pressure, heart failure (had a pacemaker) and had been on a right cocktail of medications for years. The fatal brain tumour was only diagnosed a couple of weeks before death.
They had only been diagnosed as T2 in December 2019, and had never really bought into the low carb lifestyle.

However I was really shocked to see T2 cited as a cause of death. There had been no vision or neuropathy symptoms, no major diabetes medication (metformin only).

Does anyone know why Type 2 was listed, when any of the other conditions were potentially more dangerous?
Is there something I'm not understanding about T2? Or about death certificates?

Note, I'm not looking to question or complain to authorities. I just want to understand why T2 was listed

MrsA2, we can only speculate, obviously. It could be their diabetes wasn’t at all well controlled, and if the deceased was on a lot of medications, or in pain, it could be the numbers could be right out of kilter. At the other end of things, it could have been the most recent diagnosis on their list.

It would be easy to quip that life is 100% fatal. It’s just a matter of how long it take, but we all know that.

If your relation had a terminal tumour, please try not to torture yourself over extraneous details. It will only add to your stress and grief, and that is hard enough to bear.

 

[HSSS]

Readers of my other posts will know that a close relative died at Christmas

I have today received their death certificate which shows
1 brain tumour
2 Type 2 and hypothyroidism

I know the person had at least 3 other serious conditions, blood cancer (for over 30 years) , very high blood pressure, heart failure (had a pacemaker) and had been on a right cocktail of medications for years. The fatal brain tumour was only diagnosed a couple of weeks before death.
They had only been diagnosed as T2 in December 2019, and had never really bought into the low carb lifestyle.

However I was really shocked to see T2 cited as a cause of death. There had been no vision or neuropathy symptoms, no major diabetes medication (metformin only).

Does anyone know why Type 2 was listed, when any of the other conditions were potentially more dangerous?
Is there something I'm not understanding about T2? Or about death certificates?

Note, I'm not looking to question or complain to authorities. I just want to understand why T2 was listed

I’ve never needed to question a death certificate either. Do you know who signed it and are you able to contact them to ask in the way you have here (for understanding rather than dispute)? Presumably much easier if it’s a gp than a hospital dr. I find unanswered questions play on my mind more than almost any answer that might be given.

 

[AndBreathe]

I’ve never needed to question a death certificate either. Do you know who signed it and are you able to contact them to ask in the way you have here (for understanding rather than dispute)? Presumably much easier if it’s a gp than a hospital dr. I find unanswered questions play on my mind more than almost any answer that might be given.

Unless MrsA2 had been given permission, by the deceased, to speak with medics about them, I doubt any Doc would discuss it. Even those who have passed on have the right to medical confidentiality.

Even if the certifying medic just thought it was a decent idea, nothing will change the sad situation in play.

 

[Antje77]

Just guessing here, but HCP's are rather quick to blame or include diabetes as a (partial) cause for any ailment in the living, regardless of BG, and I expect it won't be any different for the dead.

I have experience with various GP's, a rheumatologist, and a diabetes nurse who as a casual aside mentioned something like "oh, and the diabetes won't help either of course".
None of them had an answer to my return question: "I thought high BG was the problem, not diabetes in itself. How does my diabetes worsen my issues if my numbers are non diabetic?"

Sending some more hugs in hope they'll help a little bit in getting to grips with losing someone close to your heart.

 

[EllieM]

It seems things are not consistent and maybe depends on the doctor who is signing the certificate and what they saw them last for

I suspect this. It looks to me that you need a reason to put on the death certificate so as to avoid a coroner's report, and maybe "old age" isn't acceptable? My (UK) parents in law died in their late 80s and early 90s and by then both had dementia, T2 and a host of other things, so the death was not at all surprising. I'm pretty sure T2 was on at least one certificate, even though I wouldn't have thought it was really relevant to either of them.

 

[HSSS]

Unless MrsA2 had been given permission, by the deceased, to speak with medics about them, I doubt any Doc would discuss it. Even those who have passed on have the right to medical confidentiality.

Even if the certifying medic just thought it was a decent idea, nothing will change the sad situation in play.

I’m not suggesting it would change anything, other than some understanding

 

[BigAlan]

Readers of my other posts will know that a close relative died at Christmas

I have today received their death certificate which shows
1 brain tumour
2 Type 2 and hypothyroidism

I know the person had at least 3 other serious conditions, blood cancer (for over 30 years) , very high blood pressure, heart failure (had a pacemaker) and had been on a right cocktail of medications for years. The fatal brain tumour was only diagnosed a couple of weeks before death.
They had only been diagnosed as T2 in December 2019, and had never really bought into the low carb lifestyle.

However I was really shocked to see T2 cited as a cause of death. There had been no vision or neuropathy symptoms, no major diabetes medication (metformin only).

Does anyone know why Type 2 was listed, when any of the other conditions were potentially more dangerous?
Is there something I'm not understanding about T2? Or about death certificates?

Note, I'm not looking to question or complain to authorities. I just want to understand why T2 was listed

As a cynic, I have wondered for years if diabetes and obesity are the modern forms of catch all like smoking was in the 70's.

Dr, Dr I've broken a fingernail. That's because you smoke!
But Dr, I don't smoke.
Well you would break a finger nail if you smoked.

Currently, you are at a much higher risk of dementia if you are morbidly obese, diabetic and have high blood pressure.... oh and you are in your 65 - 90 age range.

It could also be that more funding can be released, or media interest greater if diabetes is mentioned on the death certificate.

Another example is in London a small child died from pollution on the death certificate. This is brought out by both sides arguing about ULEZ in London.

As I say, I'm a cynic, but if it was a death from gangrene brought on by diabetes then that could be on the death certificate but I've never done any research into this so it's just a cynics hypothesis.

 

[KennyA]

Used to be responsible for some of this, back in the day.

The local coroner will often have a preference for how doctors fill out death certificates, and that can have a bearing and lead to differences between coroner patches.

Doctors frequently put things on the death certificate that may not be the direct causes of death, but which they feel might have contributed or had some part to play. The doctor certifying is unlikely to be 100% certain about many deaths: if it's the deceased's GP there might be more background knowledge. A hospital doctor is typically likely to know much less about a patient's background, and often patients in hospitals die before a firm diagnosis is made.

In other words: death certficates sometimes aren't all that accurate and they are understood not to be - they're completed before any autopsy (a coroner decision) is done and represent the certifying doc's "best guess" about what might have caused or contributed to the death. If the coroner isn't happy about the information on the certificate (eg maybe because the deceased's family has queried some or all of it) then the coroner can require an autopsy and a full examination as far as possible of the cause(s) of death.

 

[MrsA2]

please try not to torture yourself over extraneous details. It will only add to your stress and grief, and that is hard enough to bear.

Don't worry, I'm not. I'm quite accepting of the cause, just mildly curious about the sudden appearance of T2 which was the least of their problems.
It also happens to be the only one I share, so sparked my interest, that's all.
And thank you for your kind concern

 

[MrsA2]

It could also be that more funding can be released

That could well be it.

 

[JoKalsbeek]

Readers of my other posts will know that a close relative died at Christmas

I have today received their death certificate which shows
1 brain tumour
2 Type 2 and hypothyroidism

I know the person had at least 3 other serious conditions, blood cancer (for over 30 years) , very high blood pressure, heart failure (had a pacemaker) and had been on a right cocktail of medications for years. The fatal brain tumour was only diagnosed a couple of weeks before death.
They had only been diagnosed as T2 in December 2019, and had never really bought into the low carb lifestyle.

However I was really shocked to see T2 cited as a cause of death. There had been no vision or neuropathy symptoms, no major diabetes medication (metformin only).

Does anyone know why Type 2 was listed, when any of the other conditions were potentially more dangerous?
Is there something I'm not understanding about T2? Or about death certificates?

Note, I'm not looking to question or complain to authorities. I just want to understand why T2 was listed

Nothing usefull to add, just wanted to say I'm sorry for your loss...
Hugs,
Jo

 

[AndBreathe]

I’m not suggesting it would change anything, other than some understanding

Sadly, the harsh reality is it won't change the outcome.

 

[KennyA]

That could well be it.

It's not. Death Certification is a Home Office (rather than Health) concern - it certifies formally that someone has died. Once the death is registered, due legal process can commence.

The recorded cause(s) on the certificate is (as mentioned above) an informed professional guess in many cases. It can be a problem because a lot of research uses death certfication as an accurate account of the cause of death, without an appreciation of the many complexities involved.

I also had a close family member die recently - he was in hospital for pneumonia when he suffered a fatal heart attack. The certificate said Pneumonia; Myocardial Infarction. I had trouble registering the death because the (inexperienced) deputy registrar at the council maintained that pneumonia did not cause heart attacks, and referred the death to the coroner. Of course pneumonia of itself does not cause heart attacks, but the strain of a severe infection requiring hospitalisation, plus advanced age, adds additional strain on the heart, and therefore...

The coroner left it at that, in part because we as next of kin had no concerns.

 

[HSSS]

Sadly, the harsh reality is it won't change the outcome.

Err exactly what I said no?

 

[KennyA]

I thought it might be useful, given the exchanges earlier, to add some reference info here about death certification in England and Wales. I've attached a copy of a (blank) death certficate, which is formally known as the Medical Certificate of Cause of Death (MCCD). The process is set out in full in the gov.uk link below, but I've attached a shorter and simpler TLDR version. The gov.uk info is authoritative.

https://www.gov.uk/government/publi...death-in-england-and-wales-accessible-version

It gets a bit more complex because new regulations are to come into force in 2024 (link below), and these will alter the current arrangements - they introduce a new role of "medical examiner". I've not looked at them properly, but if you're interested it's best to read the Explanatory Note at the back of the Regulations first.

https://assets.publishing.service.gov.uk/media/6578905a095987000d95df37/draft-medical-certificate-of-cause-of-death-regulations-2024.pdf?utm_source=substack&utm_medium=email

The idea is that Part 1 covers the immediate, direct cause of death and is reported on the certificate.

The medical practitioner should go back through the sequence of events or conditions that led to death on subsequent lines until reaching the condition or event that started the fatal sequence. The condition on the lowest completed line of part I should therefore have caused all of the conditions on the lines above it.

This will usually be selected as the underlying cause of death, following the International Classification of Diseases (ICD) coding rules. The WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain. Incidentally, Coroners can complete what is called a "Prevention of Future Deaths" report, after an inquest, which is intended to avoid or remove a potential cause of other deaths.

Part 2 of the certficate deals with anything else that might have indirectly affected or contributed to the death. This means that other diseases, conditions, or events that contributed to the death, but were not part of the direct sequence, are recorded in part two of the certificate. The certfication advice to doctors says that conditions mentioned in part two must be known or suspected to have contributed to the death, not merely be other conditions that were present at the time.

Once the certificate is issued, trained coders (who are not medical practitioners), working on the basis of the content of the death certificate, assign an ICD code or codes. However, the coding process and the decisions made on which codes to use, are carried out in the absence of medical notes, post mortem reports or any other evidence.

So, what the doctor writes on the certificate is what gets coded. What gets coded is what gets counted and reported.

Those of us who have to register a death will need a death certificate to do so. The registration process is set out here.

Register a death

Find out how to register a death in the UK or abroad

www.gov.uk

 

[MrsA2]

I thought it might be useful, given the exchanges earlier, to add some reference info here about death certification in England and Wales. I've attached a copy of a (blank) death certficate, which is formally known as the Medical Certificate of Cause of Death (MCCD). The process is set out in full in the gov.uk link below, but I've attached a shorter and simpler TLDR version. The gov.uk info is authoritative.

https://www.gov.uk/government/publi...death-in-england-and-wales-accessible-version

It gets a bit more complex because new regulations are to come into force in 2024 (link below), and these will alter the current arrangements - they introduce a new role of "medical examiner". I've not looked at them properly, but if you're interested it's best to read the Explanatory Note at the back of the Regulations first.

https://assets.publishing.service.gov.uk/media/6578905a095987000d95df37/draft-medical-certificate-of-cause-of-death-regulations-2024.pdf?utm_source=substack&utm_medium=email

The idea is that Part 1 covers the immediate, direct cause of death and is reported on the certificate.

The medical practitioner should go back through the sequence of events or conditions that led to death on subsequent lines until reaching the condition or event that started the fatal sequence. The condition on the lowest completed line of part I should therefore have caused all of the conditions on the lines above it.

This will usually be selected as the underlying cause of death, following the International Classification of Diseases (ICD) coding rules. The WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain. Incidentally, Coroners can complete what is called a "Prevention of Future Deaths" report, after an inquest, which is intended to avoid or remove a potential cause of other deaths.

Part 2 of the certficate deals with anything else that might have indirectly affected or contributed to the death. This means that other diseases, conditions, or events that contributed to the death, but were not part of the direct sequence, are recorded in part two of the certificate. The certfication advice to doctors says that conditions mentioned in part two must be known or suspected to have contributed to the death, not merely be other conditions that were present at the time.

Once the certificate is issued, trained coders (who are not medical practitioners), working on the basis of the content of the death certificate, assign an ICD code or codes. However, the coding process and the decisions made on which codes to use, are carried out in the absence of medical notes, post mortem reports or any other evidence.

So, what the doctor writes on the certificate is what gets coded. What gets coded is what gets counted and reported.

Those of us who have to register a death will need a death certificate to do so. The registration process is set out here.

Register a death

Find out how to register a death in the UK or abroad

www.gov.uk

So, supposing my relative had died under the new regulation, where would T2 have appeared on the death certificate?
And would the other serious ailments (cancer, heart failure, high blood pressure, among others) have appeared at all?
(Knowing this is supposition and guess work)

 

[KennyA]

So, supposing my relative had died under the new regulation, where would T2 have appeared on the death certificate?
And would the other serious ailments (cancer, heart failure, high blood pressure, among others) have appeared at all?
(Knowing this is supposition and guess work)

That would be a complete guess on my part, because the answer would depend on the thinking of whatever doctor completed the certficate. I'd expect that to depend on the condition, recent medical history, all sorts of things. Was T2 the immediate cause of death or directly led to it? - if so then part 1. Did it contribute to the death, although it didn't cause it? - if so, then part 2.

So the immediate cause of death appears in part 1 of the certificate, along with any condition that directly led to it: and anything else that might have contributed would be in part 2. The guidance does make clear that just having the condition doesn't mean it goes in part 2 - it must be thought or suspected to have contributed to the death.

I know of people who have spoken to the (hospital) doctor who completed a death certificate for a relative, and asked for it to be explained to them. In those cases the doctor was helpful - obviously this isn't in any way an indication of what might happen in every case.

 

[Lainie71]

I have always wondered also about this. Although my dad didn't have type 2 on paper, I suspect he did. Dad did have lung cancer but on his death cert it stated pneumonia. I would have thought it would have been lung cancer, but I know that pneumonia can be an off shoot of lung cancer so perhaps that's why the death cert out come. Awful either way.