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[IP] RE: Hypoglycemia and Dr. Joe's e-news for 10/19/00

> A patient a Yale University was recently told that you cannot die from
> hypoglycemia while treating for diabetes.  This seems to be true.  I have
> seen people in hypoglycemic coma for 12 to 24 hours and awaken without
> difficulty.

20+ years ago I was brought by ambulance, at 2:30 a.m., to the local
hospital.  I was severely hypo.  After 4 hours I had not regained
consciousness so my wife asked that I be moved 35 miles to the hospital
where my internist was on staff.  She was told I would not survive the trip.
After another hour she insisted and I was finally transported.  This
incident prompted my internist to suggest that an endo manage my diabetes.
I was told that I was very fortunate to have survived.  My blood
electrolytes were very low but especially potassium, and they didn't
understand how my heart continued to function. My wife was understandably
shaken because a few weeks before, a neighbor of her parents called her
husband at work because he was late getting home.  Since he did not answer
the phone she went to the office to find him on the floor in severe
hypoglycemia.  He did not survive.  Three years ago a doctor friend of mine
had a young woman patient who was Type 1 who also died in a severe hypo
>From Diabetes Care:

The so-called dead-in-bed syndrome refers to sudden death in young diabetic
patients without any history of long-term complications. Autopsy is
typically negative. The present report summarizes frequency data on this
condition from studies in the U.K. and the Scandinavian countries. It
appears that such deaths occur in 6% of all deaths in diabetic patients
below age 40 years. The frequency may also be expressed as 26 events per
100,000 patient-years. The causes are by definition unknown, but a plausible
theory is a death in hypoglycemia, since a history of nocturnal hypoglycemia
is noted in most cases. While waiting for the clarification of the
underlying pathophysiology, one should attempt to identify patients who are
at particular risk of hypoglycemia and advocate caution in efforts to
normalize blood glucose and HbA1c in these cases.
Diabetes Care 22 (Suppl. 2):B40B42, 1999

John Kinsley
Type 1 - 1956
MM 507 - 1998

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