Nav: Home

Death by insulin -- management of self-harm and suicide in diabetes management

April 06, 2017

Diabetes affects roughly 30 million Americans, and is one of the leading causes of disability and mortality. As a result, organizations such as the American Diabetes Association (ADA), Endocrine Society and American Association of Clinical Endocrinologists (AACE) have made efforts to move away from the one size fits all management of diabetes. Instead, diabetes management is now customized based on patient variables such as age, life expectancy, co-morbid conditions, finances, and patient goals.

As a result this special issue of Current Diabetes Reviews, guest edited by Dr. Alyson Myers, explores the management of diabetes in medically complex patients. The ADA has recently released a statement in November 2016 in regards to the importance of assessing the psychosocial issues that impact persons with diabetes. Psychosocial stresses like co-morbid mood disorders, food insecurities or lack of social support can impede diabetes management.

One of the articles of this special issue addresses the role of diabetes medications in self-harm behavior. Drs. Madhuker Trivedi and Alyson Myers discuss the management of the self-harming or suicidal patient with diabetes. This review is a follow-up to a study that they published in 2013 in which 9.7% of patients with newly diagnosed diabetes (less than 24 months) endorsed a history of suicide attempt. Half of those patients tested positive for depression at the time of the study, thus persons with diabetes need to be screened for both depression and suicidality, as rates of both may be higher than in the general population.

Insulin is considered a high risk medication, thus it can be manipulated to cause severe hyper or hypoglycemia, both of which can both potentially lead to death. Oral agents such as sulfonylureas or metformin have also been used in overdoses with or without insulin. Suicide is the tenth leading cause of death in the United States. Suicide is typically associated with mood disorders like depression or impulsivity disorders. Persons with both type 1 and type 2 diabetes have been known to have higher rates of depressive disorders; as a result suicidal ideation should be assessed in such patients. Unfortunately death by insulin may be misclassified as an accident, when it was in fact a suicide attempt. Then manner in which to distinguish between the two, as well as how to manage these high-risk patients is described in this article.

In addition, the review compiles cases in the literature involving overdoses by continuous subcutaneous insulin infusion, also known as insulin pump therapy. The acuity of medical therapy in such overdoses great as some of the agents used can have hypoglycemic effects for up to 72 hours. Over-treating patients with high infusion rates of intravenous dextrose can make hypoglycemia even worse it as it stimulates further release of insulin. Frequent glycemic monitoring and a multi-disciplinary approach to patient care with a behavioral health and medical team is warranted.

Overall, there is little in the literature in regards to the link between diabetes in suicide. In this article the authors highlight the link between diabetes and depression as a likely cause for the increased self-harm rates seen in those with both type 1 and type 2 diabetes. They also address the management goals of such patients and the need for further research in this area.
Reference: Myers, A.; (2017). Death by Insulin: Management of Self-Harm and Suicide in Diabetes Management. Current Diabetes Reviews., DOI: 10.2174/1573399812666161005163618

Bentham Science Publishers

Related Diabetes Articles:

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).
Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.
People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.
Diabetes, but not diabetes drug, linked to poor pregnancy outcomes
New research indicates that pregnant women with pre-gestational diabetes who take metformin are at a higher risk for adverse pregnancy outcomes -- such as major birth defects and pregnancy loss -- than the general population, but their increased risk is not due to metformin but diabetes.
New oral diabetes drug shows promise in phase 3 trial for patients with type 1 diabetes
A University of Colorado Anschutz Medical Campus study finds sotagliflozin helps control glucose and reduces the need for insulin in patients with type 1 diabetes.
Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin
Two studies in the Jan. 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.
Complications of type 2 diabetes affect quality of life, care can lead to diabetes burnout
T2D Lifestyle, a national survey by Health Union of more than 400 individuals experiencing type 2 diabetes (T2D), reveals that patients not only struggle with commonly understood complications, but also numerous lesser known ones that people do not associate with diabetes.
A better way to predict diabetes
An international team of researchers has discovered a simple, accurate new way to predict which women with gestational diabetes will develop type 2 diabetes after delivery.
The Lancet Diabetes & Endocrinology: Older Americans with diabetes living longer without disability, US study shows
Older Americans with diabetes born in the 1940s are living longer and with less disability performing day to day tasks than those born 10 years earlier, according to new research published in The Lancet Diabetes & Endocrinology journal.
Reverse your diabetes -- and you can stay diabetes-free long-term
A new study from Newcastle University, UK, has shown that people who reverse their diabetes and then keep their weight down remain free of diabetes.
More Diabetes News and Diabetes Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.