[mellavora]

> that would kill you if the resulting low blood sugar is not dealt with.

My wife is type I, so I have a sense of what you live with.

She bought a book, "The Insulin Murders", which looked at a number of cases where insulin was the weapon of choice. The good news is that it is actually really hard to die from low blood sugar, assuming good medical care is available.

Coma to death is > 12 hours, more like 24 or 48. Assuming other people are around, there is plenty of time for medical response. And treatment is easy, glucogon turns it around in minutes.

And I'm not sure a 20% insulin overdose would trigger coma. Definitely hypoglycemia, but blood sugar has to be pretty low for coma.

Look, I'm not saying it is easy, and risk of harm from getting it wrong is high (as you wrote), but risk of death is much lower than you might think

[coldpie]

> The good news is that it is actually really hard to die from low blood sugar, assuming good medical care is available.

Yes, but the bad news is it only takes one mistake to do you in, and the battle never stops for your entire life. I had a fellow T1D friend die last summer from hypoglycemia. Wikipedia says (with a citation, available at link):

> In terms of mortality, hypoglycemia causes death in 6-10% of type 1 diabetics.

It's the kind of thing that hangs over you. Every time you go to sleep, you wonder if maybe you took too much at dinner and this will be your last night. (I'm sure you know this from your wife--there's a reason she was interested in that book--but the reading audience may appreciate the context.)

[1] https://en.wikipedia.org/wiki/Hypoglycemia

[Trasmatta]

> The good news is that it is actually really hard to die from low blood sugar, assuming good medical care is available.

Except it's extremely hard to get medical care when your mind and body shuts down because of a severe case of hypoglycemia. There isn't always somebody around to call an ambulance.

If you haven't experienced a severe episode of hypoglycemia yourself, you really don't understand fully how it can effect both the mind and body, even if you've seen it in your wife.

And like the other poster mentioned, 6-10% of T1D's die of hypoglycemia. It's a lot easier to die of than you're giving it credit for.

If COVID had a 6-10% death rate, I don't think anyone would be saying "it's actually really hard to die from COVID".

> And I'm not sure a 20% insulin overdose would trigger coma

You can experience hypoglycemia without any insulin overdose. There are many other factors that impact your BG, and sometimes a combination of those will hit a T1D with a severe hypo, even if they took what should have been the correct insulin:carb ratio.

[sgmoore]

> You can experience hypoglycemia without any insulin overdose.

One of the worst hypos that I have had (Fingerprick said 1.9mmol/l which is about 34 mg/dl) was a 'Lantus low' which is not really an overdose.

[pimeys]

It adds a bit to the risk that going down to hypoglycemia is not very good for your brain cells. And staying in hyper is not good for your cells in general, for your eyes or for your internal organs.

You might not die, but might develop some nasty problems later on in your life...

[sweston4]

I 100% agree with what you're saying.

Assume a 1:10 insulin to carb ratio (though I don't think insulin dosages have a strictly linear effect) and a meal of 100 carbs. If the meal, in reality, has 80 carbs, you've injected two extra units of insulin. We might expect a unit of insulin to reduce blood glucose by 30-50 mg/dl, so we've reduced our expected blood glucose by 60-80 mg/dl. If you target a blood glucose of 80 mg/dl, this would mean your expected future glucose is 0-20 mg/dl. In that case, you would die.

Now, the problem with this example is that I would 100% take action to avoid dying, so my actual risk of death is still minute despite having a lethal dose of insulin in my body at the time I inject myself. However, it's still a bit strange to know that, conditional on me taking no independent action, I'm hours away from death in certain situations.

[sgmoore]

> The good news is that it is actually really hard to die from low blood sugar, assuming good medical care is available.

And yet, have there not been a number of cases where medical professionals have been convicted of the murders of several patients by injecting them with insulin? I would expect that these patients should have had 'good medical care' available to them.

I have not read the book, but perhaps it is ignoring the fact that extreme hypos may trigger other problems such as heart attacks. When a condition becomes common enough to be given a non-medical name, as in the 'dead in bed' syndrome, then I you can't *assume* you will survive for 24 hours.

The risk of death might be lower than I think, but I'm not to be ignoring any alarms I get.

(Type 2 but insulin dependent)

[idealmedtech]

Insulin overdose is very hard to die from, but it can easily cause permanent brain damage. And that's just in healthy adults. In terms of immediate risk, hypoglycemia is far more dangerous than hyperglycemia (though this is not to discount the severity of DKA).