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January 30, 2001

Hypoglycemia

Question from Toronto, Ontario, Canada:

I have had type 1 diabetes for 15 years. I have heard recently that it is possible for someone who has a hypoglycemic reaction, and does not treat it, to die from it. I guess an example would be if you have a reaction during the night while you are sleeping and you do not wake up to treat it. I know that during a hypoglycemic reaction that your brain is deprived of sugar and oxygen, fuels to feed the brain, so in one sense this seems possible to me. Is this true?

Answer:

The short answer is that it is true. People with diabetes who have experienced severe hypoglycemic reactions have died. However, this is a complicated question and worthy of a much longer explanation.

When the blood sugar becomes so low as to inhibit normal brain function because of loss of its obligate fuel, the brain can seize. As the least, you could pass out or lose consciousness. It is what is happening around the time of the low blood sugar that may be dangerous, in addition to the loss of consciousness. For instance, alcohol intake is associated with hypoglycemia. If you pass out with a low blood sugar after drinking, it is possible to vomit, aspirate, or any number of other possibilities. It is possible to have a reaction while driving or using machinery. There are reports of patients with diabetes being found dead and attempts to recreate the cause of death have shown that they were hypoglycemic prior to death. Whether this is associated with a fatal heartbeat problem or not is not clear. I think it is important to try to avoid hypoglycemia. Frequent monitoring and education are our allies in trying to improve blood sugars as much as possible without having severe hypoglycemia. Remember that long-term exposure to high sugars (even moderately high sugars) is associated with complications which are also life threatening and decrease the quality of life for those who experience them.

JTL