Last Updated: 12/05/05 02:36 PM
Discuss it at Diabetics World EMAIL LISTS(click here)
01-Sep-96 07:12:28
Sb: Dangers of Hypo's
Fm: Bruce Beale 100345,3667
To: allI am greatly indebted to the Editor of Interactive Wall Street Journal for authority to republish this very important article. If you have the free Microsoft Explorer 3. 00 you will be given free access to the Wall Street Journal until November. It comes with a quite exceptional search engine. I commend both the WSJ and MSIE 3. 00 to members. I am prepared to put a copy of MSIE in our library for download should I get any requests.
The DCCT ended very suddenly and a couple of years early. some of us never accepted the reasons given. "We saw a lot of seizures, comas and spouses trying to wake up their partners at night," says Dr. Boyle, who was a researcher in the study. The reasons are starting to emerge had the study been allowed to continue it would, in my opinion have shown that tight control was a killer.
For parents of Type 1 children I want to make it absolutely clear that Type 1 and Type 2 are totally separate conditions. The onset of Type 2 is often very slow and gradual and a great deal of damage is done before the patient seeks help. This is not as so of the type 1 patient where the onset is often very sudden and life threatening leaving parents with an irrational fear of hyper's and a curious acceptance of lows which are much more life threatening and dangerous.
It is not simply the effects of tight control that has led to an increase in deaths. It is the lack of a suitable basal insulin on the market that is the final killer together with the assumption that tinkering around with the dose before a meal is sensible. A change in short term ill have an impact on the basal dose and it will take a couple of days for you to see the full effect of this. A change in medication needs to be carefully considered.
"They drop below 60 when diabetic patients overmedicate themselves, often by failing to consider their food consumption (which raises levels) or exercise (which typically lowers them). "
I am sorry but one of the reasons for my being unable to read the parents and Parenting Section is that I daily read examples of the most dreadful overmedication.
Patients Who Carefully Manage Diabetes May Face Hidden Risks Saturday 29 8 96
By JAMES S. HIRSCH Staff Reporter of THE WALL STREET JOURNAL
Melinda Lindsey tested her blood sugar up to six times a day to keep her diabetes under tight control. But on a quiet two-lane road in Jeffersonville, Ind. , she lost control completely. Last November, Ms. Lindsey's white Oldsmobile barreled off the road and crashed into a tree. Ms. Lindsey, who was two months pregnant, was killed. Authorities estimate she was traveling 73 miles an hour. There were no skid marks. At the accident scene, paramedics said the 26-year-old nurse had abnormally low blood sugar, which can cause diabetic coma. "She evidently just passed out, and her foot hit the accelerator," says her father, Clifford Lindsey.
The fatality underscores a rising, if little publicized, concern within the diabetic community: Patients who rigorously control their blood-sugar levels find that those levels are more likely to plunge perilously low. "It's an enormous problem, and it's becoming more common across the world as people push harder to control their diabetes," says Patrick Boyle, a diabetes specialist at the University of New Mexico Health Science Center in Albuquerque.
Diabetes occurs when the pancreas stops making insulin-producing cells, which moderate blood-sugar swings. High blood sugar typically results. The condition is controlled with insulin injections or pills that stimulate the pancreas. About eight million Americans have been diagnosed with the disease, and another eight million are believed to have it but haven't been diagnosed.
Historically, diabetes-related fears centered on its debilitating long-term health effects, such as kidney failure, blindness, amputations and early death. Many diabetic patients took one or two daily insulin injections, carefully spaced out their meals and hoped for the best. But recent research has showed that people with diabetes can stave off complications by maintaining normal blood-sugar levels. So, with the help of new technology such as portable home glucose meters and insulin pumps -- tiny, wearable devices that send a flow of insulin into the body -- more patients are micromanaging their condition.
Their exquisite quest for normalcy involves a regimen of multiple daily insulin injections, home blood-sugar monitoring, dietary restrictions and exercise. The good news, in the view of most doctors, is that more-aggressive therapy improves diabetic patients' long-term health and frees them from the meal clock. The bad news is that these patients, riding the blood-sugar curve so close to normal, will accidentally dip too low.
"The whole spectrum of [blood sugars] is shifting downward, but the dark side is that it increases the rate of hypoglycemia," or low blood sugar, says David Nathan of Massachusetts General Hospital in Boston.
People who aggressively manage their diabetes are three times more likely than other diabetics to suffer severe low-blood-sugar episodes, defined as a patient being temporarily disabled, according to the Diabetes Control and Complications Trial, a landmark study completed in 1993.
"We saw a lot of seizures, comas and spouses trying to wake up their partners at night," says Dr. Boyle, who was a researcher in the study.
Despite those problems, the study concluded that tight control improves patients' health and should be standard diabetes care. Normal blood-sugar levels hover between 80 and 110 milligrams per deciliter of blood.
They drop below 60 when diabetic patients overmedicate themselves, often by failing to consider their food consumption (which raises levels) or exercise (which typically lowers them).
Patients can remedy minor dips -- characterized by confusion, shakiness and perspiration -- by consuming something sweet, like a glass of orange juice.
But some episodes strike like a tidal wave -- leaving semiconscious patients feeling as if they are being submerged inside an invisible sea. They have only dazed moments to pull themselves out. Most do, but others need help -- and some don't make it at all.
Research studies estimate between 4% and 13% of the insulin-dependent diabetic patients who die each year perish in hypoglycemic-related accidents.
"What's worrisome about these deaths is that they are due to the treatment," notes Philip Cryer, president of the American Diabetes Association and a member of the Washington University School of Medicine in St. Louis. Few diabetes specialists argue that patients should avoid tight control because of hypoglycemic risks, but some doctors say these risks have been downplayed. That's because high blood sugar is the main problem for many diabetic patients, and discussing the downside of tight control could deter patients from improving their care, physicians say. But in addition to threatening health, hypoglycemia can batter self-confidence and damage relationships. Last year, Kimberly Chase had a low-blood-sugar seizure after relying on a faulty home-glucose meter; her husband revived her by giving her orange juice. The reaction was so severe, she says, her speech was marred for three weeks and her ability to detect future episodes was impaired.
The 35-year-old Ms. Chase, who teaches English at a college in Seattle, says the stress caused her marriage to break up. "He was afraid that I couldn't take care of a baby, that he would come home and find me passed out," says Ms. Chase, who still maintains tight control. "I'm afraid of the long-term effects" of high blood sugar, she says. Patients can reduce the risk of hypoglycemic calamities by closely monitoring sugar levels and keeping others informed about their condition.
Chris Crenshaw runs a landscaping company in Nashville, Tenn. , and if he feels shaky while working high in a tree, a glucose meter is sent up to him on a rope.
The 31-year-old Mr. Crenshaw once had a close call on a duck-hunting trip, when he confused the signs of low blood sugar with the excitement of the hunt. "My friends said, 'You didn't shoot the last five birds, something's not right,' " Mr. Crenshaw says. "They gave me a glucose tablet. "Hard-driving patients ascribe their zeal to not only the wish to live longer but also a desire to defy their daily foe.
Michael Zarrick, a 35-year-old manufacturers' representative in Kansas City, decided to go on the insulin pump last year when he feared his kidneys were going bad. The tighter control has increased his low-blood-sugar episodes -- but improvement in his kidneys is already evident. "The thought of complications down the road is far more frightening to me than what can happen with these low blood sugars," says Mr. Zarrick, who has had diabetes since he was 10 years old. "I won't let it beat me."
My reply:
Gentlemen:
As a long-term diabetic having been on insulin therapy for over 43 years and as a devoted reader of the Journal, I feel compelled to respond to your recent article concerning the dangers of intensive therapy and of the undisclosed dangers of "human" insulin.
For the past 6. 5 years, I have owned and operated the Diabetes & Hypoglycemia Forum on Compuserve Information Service.
Having been maligned, cursed, ridiculed and libeled for my position that the DCCT was a tremendous waste of taxpayer dollars that was destined to kill a great many diabetics and innocent non-diabetics, it is almost unpleasant to finally read the admission that I was correct.
The 340% risk of severe hypoglycemia was known BEFORE the main study was run. The patients in the study were deliberately selected to be those LEAST prone to hypoglycemia and most of the tremendous FREE medical care they got was devoted to avoiding hypoglycemia. The study's fallacious conclusion that the risk of near instant death from hypoglycemia or resultant trauma and the risk of killing others while in shock is outweighed by avoiding the risks of potentially blinding retinopathy, potential kidney failure and possible nerve damage in the distant future is simply silly on its face.
In 1989, you ran an article indicating that "human insulin" might be part of the problem which diabetics are experiencing and once we are able to properly read the results of the DCCT, this too will be made apparent as the preponderance of scientific evidence already shows that there is absolutely NO benefit to human insulin and that properly measured, there is an extreme risk of going into severe hypoglycemic shock as a direct result of using human insulin. The combination of using human insulin and attempting "intensive therapy" at the same time is clearly not in the interests of any diabetic.
It is time for Lilly, Novo and the entire medical community to wake up and smell the coffee.
Listen to the diabetics and give us back our badly needed animal source insulins. Admit the mistake and waste of $176,000,000 to $300,000,000 in the silliness of the DCCT and lets work to make living with diabetes a possibility and refresh the search for promised cures.
WE the diabetics of the US, in whose name American Diabetes Association and Juvenile Diabetes Foundation collect funds for research and care, must, like the students of Galludet, be heard. Precious research money must NEVER be wasted like this again, and the truth about human insulin must be told.
I have enclosed a copy of cites on the risks of human insulin for your perusal.
Sincerely,
/s
One of the 16 million diabetics whose disease eats $1 in every $7 US healthcare dollars spent.