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July 23, 2001

Complications

Question from Vancouver, British Columbia, Canada:

My 40 year old sister, who had type 1 diabetes diagnosed at age one, died a few days ago. I would like to know if there is reason to suspect that she died prematurely. I've read many of your responses, and it seems you do not feel that people with diabetes should have a lower than average life expectancy. I think 40 is too young to die, too, but she did die. My sister went to a gaggle of doctors regularly and throughout her life, yet when she died, she was facing amputation of both legs, had had triple bypass surgery three years previously and had had two recent heart attacks. In addition, she'd been on peritoneal dialysis for seven years and was recently told she was not a candidate for kidney transplant. She did smoke for a few years during her 20s, and had not been able to do physical work in the past decade. She lived alone, having split with her partner of 15 years within a year of beginning dialysis. I really want to know if we might have expected her to die at 40.

Answer:

My sincerest sympathies to you on the loss of your sister. It sounds like she had a large burden of vascular disease. When that occurs, there can be premature death. It seems that chronic renal failure and dialysis is the major indicator for premature death. It seems to accelerate vascular disease.

JTL

[Editor’s comment: It appears from your question that your sister’s diabetes was diagnosed long before “tight control” of blood sugar was proven to be important in preventing complications (which was in 1993, when the DCCT study was published). I would wonder if her blood sugar control back during her childhood, teens, and young adult years was out-of-control, as it was for most patients in those days, and that the diabetes control then was at least partially the reason for her complications and premature death.

WWQ]