Hypoglycemia 'Drug Crisis'

On October 26 President Trump declared opioid deaths a ‘National Public Health Emergency’ because improper use of opioids had caused 64,000 deaths last year. But given the generally accepted mortality rate of one in twenty from diabetic hypoglycemia among type 1 patients (one survey (1) found that between 4% and 10% of all patient deaths in this group were from hypoglycemia), there are about 48,000 deaths from insulin use in the United States a year (2). This is even more serious a problem than with recreational drug use, since the ‘addiction’ to insulin cannot be avoided among diabetics, and their doctors, instead of helping them to avoid hypoglycemic death, typically concentrate just on reducing hyperglycemia, which naturally increases the hypoglycemia mortality risk.

So why isn’t this considered a ‘National Public Health Emergency’ justifying intensified efforts to cure type 1 diabetes, which has many more problems than just hypoglycemia?

  1. P. E. Cryer, “Severe Hypoglycemia Predicts Mortality in Diabetes,” Diabetes Care, 35 (9) 1814-1816 (2012).
  2. I calculated this based on an estimated prevalence of type 1 diabetes in the United States at about 3 per 1000 (A. Menke, et al., “The Prevalence of Type 1 Diabetes in the United States,” Epidemiology, 24 (5) 773-774 (2013) and the current estimate of the U. S population as 323,000,000.

I take exception to that statement as being factual. I’ve had a number of doctors since 1978 and they all were (and currently) have been VERY concerned about my hypo history. So statistically, 100% of the 7 endos (and others such as ER docs) have repeatedly warned me about my lows, my aggressive bolousing.

Maybe in the rest of the world, those 7 endos are an incredible anomaly. /s

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This does not appear to be reasonably based on any sort of factual data and serves merely to perpetuate a perceived personal bias and fear of the use of insulin.

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It’s not like the only problematic outcome with the opioid crisis is death—I work with many people with opiate addictions who aren’t dying, at least not yet, but are in terrible situations and suffering, including homelessness, engaging in survival crime and prostitution, at higher risk of being the victims of assault and domestic violence, and unable to break these cycles because of personal and systemic lack of support for people to recover, as well as no treatment for underlying problems such as PTSD and other mental health issues. Opiate addiction is also a social contagion, so left unchecked, it’s likely to keep spreading and take whole communities of young adults down with it. Yeah, being at risk of hypoglycemia sucks, but it’s simply not a more serious problem than opiate addiction. It’s really not necessary to make that comparison to suggest that hypoglycemia is a serious issue worth attention—if anything, it makes your argument much less credible, IMO. (As does trying to make a parallel between actual addiction and the need for insulin—entirely different things.)

Also I agree with @Dave44 in that most doctors I know of are extremely concerned re: hypoglycemic episodes/unawareness, and tend to urge diabetes to be cautious of A1cs that are too low for that reason. I also think that your calculation is questionable, and my guess is the mortality stats are outdated—as more and more people are using CGMs, that risk is likely to keep dropping, especially for children. In my lifetime as a diabetic, I’ve been impressed with the headway that’s been made to help people protect themselves against hypos, between developing better insulins, pumps, and monitoring options, and it seems like we are on the cusp of getting even better tech.

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Or perhaps simply made up?

The OP has basically said that almost 4% of the ENTIRE Type 1 population drops dead EVERY YEAR from too much insulin.

I certainly hope nobody takes this nonsense seriously.

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It looks like the citation is legit, but I haven’t read the article myself, so I don’t know exactly what the stats actually were and how they were obtained. These things really do change quickly though—I think some of that data was from a big 1983-1993 study, which was so different from today in terms of diabetes management, so even if those stats were accurate then, they certainly wouldn’t be now.

This is an internet rumor that periodically resurfaces.

It is simply a falsehood that 5% of the Type 1 diabetic population dies every year from insulin or whatever crazy variant of this internet rumor happens to pop up again.

It is a disservice to people who are looking for advice based on reality as opposed to fear mongering.

You don’t have to believe me. Next time you are at your Endo, ask them if each year they lose 5% of their Type 1 population. It simply doesn’t happen.

But it is great for the shock value !!! Hence - something that will never die on the internet.

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Please don’t ask me to defend things I did not say. Unless you can point to where I said that these diabetic deaths from hypoglycemia were per year, then don’t complain about it. My point was merely that there are clearly many diabetic deaths from hypoglycemia, and my calculated number did not even include hypoglycemia deaths among type 2 patients, so it is a serious problem.

As for the accuracy of the scope of the problem to which I alluded, consider this passage from P. Cryer, “Glycemic Goals in Diabetes: Trade-Off Between Glycemic Control and Iatrogenic [doctor or treatment caused] Hypoglycemia,” Diabetes, 36 (7) 2188-2195 (2014): “Older estimates were that 2-4% of patients with type 1 diabetes die of iatrogenic hypoglycemia. More recent estimates are that 4%, 6%, 7%, or 10% of those with type 1 diabetes die of hypoglycemia.” (References to studies are provided after each percentage, but I have deleted those in the interests of space; anyone interested in reading them can consult the journal article.)

As for the medical profession’s responsibility for pursuing hyperglycemia control at the expense of avoiding serious hypoglycemia, consider R. Mc Coy, et al., “Increased Mortality of Patients with Diabetes Reporting Severe Hypoglycemia,” Diabetes Care 35 (9) 1897-1901 (2012): “Hypoglycemia is the most common significant treatment-limiting adverse effect in patients with diabetes. Yet current guidelines and quality accountability metrics focus almost exclusively on prevention of hyperglycemia, which is consistent with previously researched data.” This last statement is supported by two cited sources, which have been omitted here.

Also quite possibly misinterpreted—for instance, might be a 5% in there somewhere, but not necessarily something that translates to 5% of people with diabetes are going to die. For instance, if 5% of diabetes-related deaths are due to hypoglycemia, that is a much much much smaller number than 5% of diabetics, since most diabetics aren’t dying diabetes-related deaths.

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But hey - free country and all.

By all means please feel free to continue to spread internet rumors at the expense of people looking for truth and facts.

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[quote=“Seydlitz, post:1, topic:64577, full:true” This is even more serious a problem than with recreational drug use, since the ‘addiction’ to insulin cannot be avoided among diabetics. Insulin is not an addiction need to look up what addicton is. Every ER doctor and every Endo I have worked with are concern about A1C of 8, 9’ 10’ and 11 but also very concerned about insulin dependent patients having A1C < 7 because of hypos occurring. And in my 42 years of Emerency Nursing very few diabetic deaths have occurred from hypos but from continued hyper complications and DKA.

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so to clarify the article says that

“For example, recent reports indicate that 4% (9), 6% (10), 7% (11), and 10% (12) of deaths of patients with type 1 diabetes were caused by hypoglycemia. It is sobering to think that as many as 1 in 25—or even 1 in 10—patients with type 1 diabetes will die of iatrogenic hypoglycemia.”

The 4%, 6%, and 7% numbers come from different studies. The 7% number comes from Norway and the study examined 107 deaths of T1’s. Frankly, 7% of all T1 deaths in a year being attributed to hypoglycemia? I think this might be a lot about not much.

Assuming these studies are true, it sounds like this puts hypoglycemia in roughly the same class as: lower respiratory disease, accidents, and stroke as mortality risks for T1 populations. Still way behind heart disease and cancers. Obviously, those are significant risks, but most people aren’t dying of them every year.

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In my area, heroin addicts are having “Narcan parties”. They keep shooting heroin and their buddies bring them back with Narcan so they can get high again. They are getting tattoes indicating how many times they have been brought back with Narcan. Paramedics go to the same houses multiple times a night. They aren’t arrested if they don’t have paraphernalia on them when found. They choose if they go to the ER. It is absolutely a crisis here. I have an uncle that died of a heroin overdose while his brother held him in a cold shower trying to revive him. His brother is still a heroin addict. I have several addicts in my family. My grandma died a couple years ago from a hypo. She didn’t show up to Christmas at my parents. My dad went and checked on her and she was still in bed seizing. She never came back. Died that day. She was type 2. My dad is type 2, my son is Type 1. Heroin and Diabetes have both affected my family greatly. I don’t know anything about statistics or Trumps perspective…but given the chance to eliminate one or the other…I’d absolutely choose diabetes.

This all seems like a made up issue but even if it were true there is one big problem. So far there is no solution.
Other problems can be fixed with proper treatment. So far doctors don’t have a clue how to deal with “hypos” other than to talk people into raising their A1C’s and causing “hyper” problems more.

I have had issues with “hypos” since before I was on Insulin and the doctors were just confused or didn’t believe me.
I have had many hypo attacks that were easily explained as caused by exercise etc but others had no explanation I could locate.

Even getting a CGMS which helps I had to ask for. Very few diabetics seem to have docs that suggest them.

And we are still waiting after years for dual chamber pumps with a supply of Glucagon.

I’ve posted on this issue before. The claims made that we are in a crisis of deaths due to hypoglycemia is just not based on data. Philip Cryers work is fundamentally flawed and the risks are way, way overblown.

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I don’t trust sensors that much, and I SURE don’t trust any Medtronic branded sensors (been there). Ergo, I’m not “waiting” for a pump with Glucagon. I haven’t used Gluc since I got my first pump (1996). Better control, always carry carbs, Dexcom G5 (recently) and I’ve had to throw out Gluc kits after they are expired by about 3-5 years. LOL. I do not “believe” in “closed loop” or “artificial pancreas” at this point. The tech is NRFPT. I’ve heard about both for so many years it’s ridiculous.

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I have been a T1 for 35 years. I can think of at least a half dozen occasions where I could’ve wrapped the car I was driving around a tree while hypo, if I hadn’t appropriately caught and corrected the hypo.

I didn’t wreck the car and that was good.

But if I did, maybe I wouldn’t be the only one to die, maybe my family or some poor bystanders could die too.

I’ve also been to the ER a couple times with epic hypos requiring glucagon and/or IV’s. I’ve never been to the ER or even to a doctors appointment with a complication from high bg (well, not since the two weeks at diagnosis at least.)

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I’ve lived in both eras and things are indeed different. At the beginning of 1983, only a tiny fraction of T1’s were monitoring bg’s at home.

While the tools for monitoring bg and newer insulin treatment regimens incrementally help with the issue of hypos, I don’t think it puts the risks (or mortality rates) to zero.

I mean, I’ve had severe hypos requiring paramedics and trips to the ER so I hope this doesn’t come off thick-skinned. I survived those hypos and am not deathly afraid of the possibility of a hypo, that those are the exception and the vast majority I can handle myself. But it’s also super easy for me to see that if things had gone just slightly different in several situations, that I would’ve died many years ago from a hypo.

Seydlitz - aside from curing diabetes to lower hypoglycemia you need an insulin which mimics naturally secreted pancreatic insulin. What we all know is non-diabetics do not get hypoglycemia when their pancreas releases insulin and the pancreas does no carb counting. If you had an insulin as fast as natural pancreatic insulin you would not have hypoglycemia as the livers actions will counter insulin over dosing as it does with the pancreas.

That insulin is already on the market but few doctors are prescribing it. The biggest hurdle was the original label did not show the true speed of the insulin. The remaining hurdle seems to be getting insurance coverage.

Here is a video you may want to watch where Al Mann talks pros/cons of current insulins.
Al was one of the great minds in diabetes and developed the insulin pump. He starts talking diabetes
at 8:30m but it gets interesting at 11:00m, he explains hypoglycemia at 14:30m and then talks about stopping T2 progression at 15:00M “interesting this lowers insulin resistance… this is even likely to slow and even stop the progression of Type 2 diabetes” www.youtube.com/watch?v=SvZxYmYPXYQ