What Causes Dead In Bed Syndrome
A lack of detailed post-mortem notes has meant that the cause or causes of dead in bed syndrome have not been confirmed with certainty.
The evidence that has been available suggests that deaths could be caused by night time hypoglycemia triggering disturbances in heart rhythm or cardiac autonomic neuropathy .
Hypoglycemia-associated autonomic failure is also thought to play a part. HAAF means patients have a reduced counter-regulatory response to hypos and reduced hypo awareness
The reduced counter-regulatory response means that the body has reduced ability to produce the adrenaline or glucagon in response to a hypo. Glucagon is the bodys blood glucose raising hormone, and so a lack of glucagon response takes away a key life saving mechanism.
Claims Of 24000 ‘excess’ Deaths From Diabetes
As many as 24,000 people with diabetes are dying unnecessarily each year, many of the papers have reported today. This shock statistic was a conclusion from the National Diabetes Audit, the first ever report to look at deaths from the condition.
While this is a large number of deaths, it must be viewed in context millions of people live with this potentially life-threatening long-term illness, yet it can be managed safely.
The National Diabetes Audit suggests that in England there are about 24,000 excess deaths a year in people with diagnosed diabetes. This means that each year, around 24,000 more deaths occur among people with diabetes than would be expected to occur if their mortality risk was the same as that of the general population. A press release from the NHS Information Centre, which published the audit report, said these deaths could be avoided through better management of the condition.
What Is Diabetic Coma
Diabetic coma is a situation in which the patient suffers from unconsciousness due to very high or very low blood sugar and glucose levels. Diabetic coma is a dangerous condition as it might even lead to the death of the patient concerned. It is therefore important to understand the causes behind the same.
Causes of Diabetic Coma
Following are the causes of diabetic coma:
Hypoglycemia:
You can suffer from hypoglycemia or low blood sugar if you have too much of insulin in your body or due to lack of food.
Diabetic Hyperosmolar Syndrome:
This is the condition when the blood glucose levels are too high. The excess sugar makes its way to the urine through the blood and this process drains away a lot of useful fluids from the blood. This condition might lead to diabetic coma by causing excessive dehydration. This condition is most common in middle-aged people who usually suffer from type 2 diabetes.
Diabetes Ketoacidosis:
This is a condition when ketones get accumulated in the body. This happens when there is a lack of energy in the muscle cells of the body and the stored fat of the body may then be utilized.
This condition is most common in those who suffer from type 1 diabetes condition.
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High Insulin Costs Are Killing Americans
No one with diabetes should die because they cant afford their insulin. Its a medicine that can be produced for just a few dollars but manufacturers Eli Lilly, Sanofi, and Novo Nordisk mark up the price as much as 5,000 percent and there are seven million Americans with diabetes that have no choice but to pay.
The price is so high that people are doing desperate things to get by, like using expired insulin, relying on crowdfunding to pay their bills, or taking less insulin than they need in an effort to ration their supplies. Rationing is extremely dangerous and can lead to a deadly condition known as diabetic ketoacidosis. Four people died in 2017 while rationing their insulin. Four more died in 2018. Five died in 2019.
How Hospice Can Help With End
Hospice supports not just the patient, but the family and family caregiver, by providing a number of different services that help satisfy their physical, emotional, and spiritual needs.
The Crossroads team consists of doctors, nurses, aides, social workers, and volunteers ready to help. If you would like to learn more, please select one of the contact options from the blue Help Center bar to speak with someone 24/7.
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People Dying Of Diabetes Who Never Knew They Had It Study Finds
7 September 12
People who don’t know they have Type 1 diabetes may account for a surprising number of deaths from one complication of the condition, a new study says.
Nearly a third of people in Maryland who died over a six-year period from diabetic ketoacidosis, a condition of severe insulin deficiency, had no known history of diabetes, the study of autopsy results found.
While the researchers weren’t able to definitively tell whether those who died had Type 1 or Type 2 diabetes, their high blood sugar levels suggest they probably had Type 1, said study researcher Dr. Zabiullah Ali, the assistant medical examiner for the Office of Chief Medical Examiner in Maryland.
The finding highlights the need for regular physicals that include checking blood sugar levels, especially if warning signs of diabetes are present, the researchers said.
The study was published in the September issue of the American Journal of Forensic Medicine and Pathology.
What happens when the body runs out of sugar
Diabetic ketoacidosis is a complication of diabetes that occurs when body cells don’t have enough glucose to use for energy, so they switch to burning fat instead.
Breaking down fat for energy produces molecules called ketones, which are acids and can build up in the blood. If ketone levels climb too high, they can poison the body, causing chemical imbalances that can lead to coma, or death.
Adults can be diagnosed with Type 1 diabetes too
What Does It Mean If Test Results Show I Have Protein In My Urine
This means your kidneys are allowing protein to be filtered through and now appear in your urine. This condition is called proteinuria. The continued presence of protein in your urine is a sign of kidney damage.
A note from Cleveland Clinic
Theres much you can do to prevent the development of diabetes . However, if you or your child or adolescent develop symptoms of diabetes, see your healthcare provider. The earlier diabetes is diagnosed, the sooner steps can be taken to treat and control it. The better you are able to control your blood sugar level, the more likely you are to live a long, healthy life.
Last reviewed by a Cleveland Clinic medical professional on 03/28/2021.
References
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What Are The Different Types Of Diabetes
The types of diabetes are:
- Type 1 diabetes: This type is an autoimmune disease, meaning your body attacks itself. In this case, the insulin-producing cells in your pancreas are destroyed. Up to 10% of people who have diabetes have Type 1. Its usually diagnosed in children and young adults . It was once better known as juvenile diabetes. People with Type 1 diabetes need to take insulin every day. This is why it is also called insulin-dependent diabetes.
- Type 2 diabetes: With this type, your body either doesnt make enough insulin or your bodys cells dont respond normally to the insulin. This is the most common type of diabetes. Up to 95% of people with diabetes have Type 2. It usually occurs in middle-aged and older people. Other common names for Type 2 include adult-onset diabetes and insulin-resistant diabetes. Your parents or grandparents may have called it having a touch of sugar.
- Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose levels are higher than normal but not high enough to be officially diagnosed with Type 2 diabetes.
- Gestational diabetes: This type develops in some women during their pregnancy. Gestational diabetes usually goes away after pregnancy. However, if you have gestational diabetes you’re at higher risk of developing Type 2 diabetes later on in life.
Less common types of diabetes include:
Diabetes insipidus is a distinct rare condition that causes your kidneys to produce a large amount of urine.
Why Is My Blood Glucose Level High How Does This Happen
The process of digestion includes breaking down the food you eat into various different nutrient sources. When you eat carbohydrates , your body breaks this down into sugar . When glucose is in your bloodstream, it needs help a “key” to get into its final destination where it’s used, which is inside your body’s cells . This help or “key” is insulin.
Insulin is a hormone made by your pancreas, an organ located behind your stomach. Your pancreas releases insulin into your bloodstream. Insulin acts as the key that unlocks the cell wall door, which allows glucose to enter your bodys cells. Glucose provides the fuel or energy tissues and organs need to properly function.
If you have diabetes:
- Your pancreas doesnt make any insulin or enough insulin.
- Your pancreas makes insulin but your bodys cells dont respond to it and cant use it as it normally should.
If glucose cant get into your bodys cells, it stays in your bloodstream and your blood glucose level rises.
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End Of Life Care In Diabetes
The Diabetes UK End of Life Clinical Care Recommendation document was updated in 2018 . It was acknowledged in the initial guidance that there was a dearth of evidence supporting diabetes care at that time and this is still the same today. The 3rd edition of the original document was required because of changing developments in policy for end of life care and the need to address special populations of those with diabetes. Newer therapies to control blood glucose had been reviewed and approved by the UK National Institute for Clinical and healthcare Excellence including insulin and non-insulin preparations, and the authors wanted to respond to the many constructive comments and feedback from practising clinicians in the field about the earlier revisions.
The document was developed for all HCPs working in the health and social care setting caring for people with diabetes and families during the last year of life. The recommendations aimed to ensure a consistent quality approach to care accompanied by a set of standards, and emphasise the importance of workforce as well as encouraging partnership working within established palliative care planning.
How Is Diabetes Diagnosed
Diabetes is diagnosed and managed by checking your glucose level in a blood test. There are three tests that can measure your blood glucose level: fasting glucose test, random glucose test and A1c test.
- Fasting plasma glucose test: This test is best done in the morning after an eight hour fast .
- Random plasma glucose test: This test can be done any time without the need to fast.
- A1c test: This test, also called HbA1C or glycated hemoglobin test, provides your average blood glucose level over the past two to three months. This test measures the amount of glucose attached to hemoglobin, the protein in your red blood cells that carries oxygen. You dont need to fast before this test.
- Oral glucose tolerance test: In this test, blood glucose level is first measured after an overnight fast. Then you drink a sugary drink. Your blood glucose level is then checked at hours one, two and three.
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Why Is Alzheimers Disease Called Type 3 Diabetes
Type 3 diabetes is a term that has been proposed to describe the connection between Alzheimers and diabetes. A variant of a gene, APOE4, that has been associated with Alzheimers disease seems to interfere with brain cells ability to use insulin, which may eventually cause the cells to starve and die.
Most Common Causes Of Death In Diabetes
The risk of death from coronary heart disease was almost threefold higher in individuals with diabetes. This observation has traditionally lead to controversial interpretations pointing out that individuals with diabetes and no coronary heart disease should be managed with a cardiovascular secondary prevention strategy . However, more recent publications have shown that coronary risk in individuals with diabetes and no coronary heart disease was significantly lower than that observed in patients with a history of coronary heart disease . Although the magnitude of the association was lower, diabetes was also significantly related with higher mortality from stroke and heart failure .
Concurring with previous reports, our results showed a moderate association of diabetes with death from cancer, particularly in the liver and colon-rectum . A possible pathological mechanism that may explain this association with the digestive tract is the increased insulin resistance and the alteration of insulin-like growth factors . In addition, the risk of lung cancer was increased in individuals with diabetes in our study results. However, this association is not consistent in the literature, with studies showing both decreased and increased risks of this type of cancer in individuals with diabetes . Finally, we did not find a significant association between diabetes and pancreatic cancer, despite a suggested link between the two diseases .
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How Is Diabetes Usually Managed
Diabetes management aims to keep blood glucose levels as normal as possible. People with type 1 diabetes need to have daily injections of insulin.
In people with type 2 diabetes, management depends upon the severity of the condition. A healthier diet and lifestyle alone can sometimes control the condition in people with early stage disease, although most people with type 2 eventually need to take medication to control their blood sugar. Some people with type 2 diabetes may also eventually need to take insulin. Medication may also be needed to reduce other associated risk factors for cardiovascular disease. For example, medications to reduce high blood pressure or control cholesterol.
Self-management of this condition is also crucial. People with diabetes need to be aware of and monitor blood glucose levels, maintain a healthy weight, eat a balanced diet, avoid smoking and have regular health checks.
Planning For End Of Life
The overriding principle of any care offered is to first do no harm as described by Thomas Inman in 1860 . Each time an individual is treated there is a risk of causing harm and this is no less true in diabetes management. Acknowledging that some individuals may not wish to know that they are entering the last stages in life some who have capacity and wish to management their diabetes for as long as they are able should be enabled to discuss and decide on treatment options. These should include blood glucose monitoring, potential drug side effects and what treatments they would prefer to have or be discontinued should their health deteriorate. When individuals are nearing the end of their lives this capacity may be impaired or absent. The development of care planning documents such as Advance Directives can enable this discussion to take place much earlier. There are three types of advance planning documents in the UK :
It is important that individuals are able to consider using these tools while they still have capacity and that, families, carers and the general practitioner are aware of their existence.
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Are There Other Treatment Options For Diabetes
Yes. There are two types of transplantations that might be an option for a select number of patients who have Type 1 diabetes. A pancreas transplant is possible. However, getting an organ transplant requires taking immune-suppressing drugs for the rest of your life and dealing with the side effects of these drugs. However, if the transplant is successful, youll likely be able to stop taking insulin.
Another type of transplant is a pancreatic islet transplant. In this transplant, clusters of islet cells are transplanted from an organ donor into your pancreas to replace those that have been destroyed.
Another treatment under research for Type 1 diabetes is immunotherapy. Since Type 1 is an immune system disease, immunotherapy holds promise as a way to use medication to turn off the parts of the immune system that cause Type 1 disease.
Bariatric surgery is another treatment option thats an indirect treatment for diabetes. Bariatric surgery is an option if you have Type 2 diabetes, are obese and considered a good candidate for this type of surgery. Much improved blood glucose levels are seen in people who have lost a significant amount of weight.
Of course other medications are prescribed to treat any existing health problems that contribute to increasing your risk of developing diabetes. These conditions include high blood pressure, high cholesterol and other heart-related diseases.
The Damaging Effects Of Secondary Complications Of Diabetes
Though hyper- and hypoglycemia are indeed dangerous, they are not the primary causes of death among people with diabetes. Heart disease is the main cause of increased death rates among diabetics
Not only is it the greatest killer of diabetics, but it also develops much earlier in diabetics than people without diabetes.
Heart disease comes as a result of compromised blood vessels that are weakened by uncontrolled glucose levels.
Kidney disease is also a common complication that can lead to a premature death. Vision loss, serious nerve damage in the eyes and extremities, and ongoing infections are other common life-threatening complications.
The good news? With type 2 diabetes it can be pretty easy to avoid these serious complications. With an active lifestyle and a clean, whole foods diet, type 2 diabetes can reverse in many cases!
While we cant legally make any promises here, it is worth the effort to make small changes in your current lifestyle. Perhaps you wont reverse the disease, but you could at least postpone many of the complications for just a little while longer.
NY Times. URL Link. Retrieved October 16, 2017.
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