But knowledge is power, right?
What is the deal with otherwise healthy type I's dying in their sleep from hypos? I had kind of assumed (or maybe convinced myself) that there had to be more to the story, like drugs or drinking, but I'm losing my resolve. Is it really just a crap shoot to go to sleep every night? Is it a Q of glycogen stores in the liver -- and if so, how does one make sure they're stocked up?
And your liver only has to ignore the trigger just once. I am truly thankful for my CGM. I've been keeping myself a bit more steady and I'm finding I'm getting hypo symptoms at a much safer level. I never thought I'd be so happy to find myself having a Noah's Flood level body sweat at 46. I really do appreciate the smaller victories.
I just used a medtronic ipro cgms and I had woken up with a wet t-shirt and a bg of 234 which is high for me. I just figured I had gone low during the night, but when I got the report back I had stayed fairly steady all night long with no significant lows. So now I have to turn to maybe hot flashes screwing with my blood sugar, oh the joys of aging.
That's interesting about waking up with a bs of 380. Mine is always right around 380 after an overnight low.
Maybe it is time to get a CGM.
Based on what I've read, it has to do with lows causing disruptions in heart rhythm, and for some people this disruption turns into a fatal heart rhythm if the low continues long enough. I don't know if there is any way to tell who is at risk and who isn't, but it's definitely scary.
I'm working from memory but I remember reading that most of these episodes involve long sustained multi-hour lows. They've happened to me more than once and I'm sure glad my liver responded well.
I live alone and sleep with two Dexcom receivers (stereo alarms) and a low blood sugar alert dog. Sometimes I think he cheats and just listens for the Dex to alarm and then wakes me up when I've been sleeping through it! He gets his treat just the same.
This is a frightening phenomena but you can't protect yourself from everything. Take reasonable precautions. As far as protecting yourself from this, the best practice is to have as few lows as possible so that you don't lose the awareness and symptoms that help alert you to your falling blood sugar. Not making too many demands on the emergency liver sugar should help preserve it for when you need it.
Do people around you know how and when to give a glucagon shot? Do you even own one?
I'm not sure, honestly. But I have always seemed to wake up from my hypos. I'm usually not on TuD at 4am.. but I just got woken with a 55 bloodsugar. For me, it seems strange that someone could sleep through a low. I guess that as long as I keep my hypo awareness (14 years and counting!) Then I feel pretty confident that if I go low at night, I WILL wake up. So I won't lose any sleep worrying about lows...
(the lows themselves, yes I'll lose some sleep there, but not the worrying)
The "dead in bed" story is relatively new. If it was going to happen with any frequency, it would have happened a lot more with those of us raised on NPH. And we were never scared to go to sleep. I'm sure there is a grain (very small) of truth to this story, but I believe that these sorts of things are incredibly rare.
The "dead in bed" syndrome is not new (though our collective awareness of this phenomena is new) and educated estimates as to its incidence are significant. Here's an abstract of the findings of an Irish study published in 2010:
""Dead in bed" is a tragic description of a particular type of sudden death in type 1 diabetes mellitus (DM). Patients are typically found dead in the early morning, lying in an undisturbed bed, having been well the previous evening. The incidence of "dead in bed" syndrome is not known but studies suggest figures of between 4.7 and 27.3% of all unexplained deaths in type 1 DM. The pathogenesis is unclear but patients typically have a preceding history of recurrent severe hypoglycaemia. We describe two cases of "dead in bed" syndrome which occurred at our institution within a 12-month period."
I was able to look through the paper. The two cases displayed are perhaps extreme. The first case, the woman had a long history of severe hypos and unawareness and was described as requiring 3-4 injections of glucagon every month. The second was poorly controlled with an A1c 9-11% and "significant complications" including a history of severe hypos and excess alcohol intake.
The 27.3% figure is actually misrepresented from an earlier study of 3228 type 1 patients (children), of whom 10 died. 5 deaths were due to accidents and the other 5 were attributed to "diabetes." There are not many "unexplained" deaths and the mortality found in the study (only 0.75/1000 patient years) was not high to begin with.
Thanks for these details, bsc. It looks like you have good access to the medical literature.
What did you think of the JDRF claim in a full page ad in The New York Times last year that claimed that 1 in 20 Type 1 diabetics dies from hypoglycemia?
I would urge you to actually read the literature on this matter. This advertisement is a serious distortion relying on a single paper which probably should never have gotten past the editors. The paper by Philip Cryer as I believe an editorial in Diabetes Care, it was probably not reviewed and is full of errors. For instance, Cryer claims that 6% of patients in the DCCT/EDIC study (15) died of hypos, but only 3 of the 1400 patients died (0.2%) hardly 6%. He cites a Norway study (16) and claims 10% of patients died, but my reading of the paper suggests 10 out of more than 2000 died of hypos, a paltry 0.5%.
I just don't beleive that 1 in 20 type 1s dies from hypos.
I just don't beleive that 1 in 20 type 1s dies from hypos.
I look at my personal history. In 30 years, two extremely serious hypos that I was definitely not getting over on my own, required glucagon and or glucose IV. I also look at the risks the author of the original paper outlined, the vicious cycle of repeated hypos from hypo unawareness that feeds back on itself, and I know that I've fallen into that trap as well, it is not a mythical trap, it's very easy to fall into. In hindsight the pattern was clear but it was not clear to me while I was stuck in that cycle.
If I hadn't had good medical help, I think it's very very likely that either one of those events would've killed me.
So just by my personal accounting, without ER's and 911 calls and paramedics, I'd be dead long ago.
That's not to count a very very small number of times when I was driving while hypo and could've died by wrapping the car around a tree.
Was I lucky to have folks around who could help me with glucagon and professional medical help? Would I have died for sure in either of those events? How about those potential car wrecks, would I have died for sure in any of those? Maybe, maybe not. But I don't have any problem believing that the rate is way higher than 1 in 20.
Now, if the coroner got to my dead body in any of those cases, could he have PROVED to his satisfaction, or your satisfaction, that I had died from a hypo? In one case, yeah, he might have found chemstrips (old bg test strips) he could run through the meter, because I knew I was hypo from my own bg tests but despite all my efforts my bg was still plummeting. But the other cases, he would've found a mangled body wrapped in sheet metal wrapped around a tree, or a diabetic dead from who knows what causes. I think only very very rarely are coroners able to read bg at time of death, from a body that might have been dead for many hours to days. So probably the number of folks who die from hypos, if you look at death certificates, is extremely underreported.