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IDDT United States

Hypoglycaemia and loss of warnings

For more information about hypos and loss of warnings CLICK HERE.

Hypoglycaemia and loss or reduced warning symptoms of an impending hypoglycaemic attack are the most common reported adverse reactions to synthetic ‘human’ insulin. As an organisation we have to wonder if physicians and healthcare professionals do not understand the effects of hypos and loss of warnings on the daily life of those of us who live with diabetes. Perhaps this lack of understanding offers one explanation of the refusal to change people to pork or beef insulin when they experience loss of warnings and so more episodes of severe hypoglycaemia.

Hypoglycaemia itself, or the avoidance of it, is an acute daily problem for people with diabetes but when accompanied by loss or partial loss of warnings, it can have a dramatic effect on the lives of the person with diabetes and their families. There can be a marked reduction in the quality of life for all concerned.

Understanding the effects of hypos and loss of warnings

Information gathered in 1997 by IDDT from the experiences of people with diabetes and their caregivers says that loss of warnings may result in the following:

· A feeling of insecurity and loss of independence.

· Embarrassment.

· Being a danger to oneself and others.

· Aggressive or violent behaviour.

· Family conflict, breakdown of relationships.

· Loss of driving licence – it is illegal to drive with loss of warnings.

· Loss of job

· A deliberate raising of blood glucose levels to avoid such situations.

Even more worrying is the condition of hypoglycaemia automatism when in a hypo the person is unaware of their actions, often described as ‘functioning on auto-pilot’. Research into the relationship between hypoglycaemia and crime that has shown that hypoglycaemia has resulted in the following crimes:

Person

· Disorderly conduct

· Resisting arrest

· Assault

· Murder

Property

· Wilful destruction

· Shoplifting

· Petty larceny

· Embezzlement

· Driving violations

Behaviour

· Exhibitionism

· Blasphemy

· Slander

· Sexual perversion

· Sadism

[David Kerr and Joan Everett, Journal of Nursing Vol 1: N0 4 1997]

Repeated hypoglycaemia in children has been shown to cause a slight reduction in their IQ and cognitive functioning and so avoidance of hypos and loss of warnings is very important in children. It is for these reasons, and many more, that IDDT believes that every possible option should be tried to reduce the risk of hypos and loss of warnings. Therefore if a person/child has unaccountable hypos, reduced or loss of warnings of hypoglycaemia, they should be offered a change to pork or beef insulin for a trial period of at least 6 months.

Note: In a book written by Charles Fox and Anthony Pickering for GPs, Diabetes in the Real World, the advice is "If a patient is showing signs of unhappiness over problems with hypos, it is always worth offering a change to the porcine equivalent of the insulin being used."

As ‘human’ insulin has never been demonstrated to have any advantages over animal insulin, this advice is welcomed but unfortunately GPs often will not change the species of insulin without approval of the hospital consultant and it is usually here that the refusal to prescribe animal insulin occur.