‘Dead in Bed Syndrome’
GM Vs animal insulin
Choices – The Evidence
Evidence from people with diabetes
A little bit of history
Action and duration times of animal and GM ‘human’ insulins
Hypoglycaemia and loss of warnings
‘Dead in Bed Syndrome’
The concerns of patients are justified
Availability of animal insulins in the UK
Changing your insulin
What to do if your consultant refuses to change your insulin
Availability of animal insulin if admitted to hospital
Frequently asked questions
Allergic reactions to insulin
‘Dead in Bed Syndrome’
Unfortunately IDDT has also received reports from the relatives of young people with diabetes who have died suddenly in their sleep. Some reports from the families show that some of the above symptoms were already occurring. These deaths have become known as ‘dead in bed syndrome’, and are thought to be caused by hypoglycaemia although this is difficult to confirm in a post mortem. While this appears to be a very small number of deaths, an estimated 6% of all deaths in people with diabetes under 40, there are particular circumstances that surround them:
- The person is found dead in an undisturbed bed.
- The person was observed to be in good health before going to bed.
- It seems to happen most commonly in young people, especially those living alone.
‘Dead in bed syndrome’ and the association with GM ‘human’ insulin
In 1989 Dr Patrick Toseland, then a senior and well-respected pathologist at Guy’s Hospital, London, was asked to investigate 19 deaths reported by doctors in the previous 18 months that had occurred in young people with diabetes. The deaths were unusual – they all happened suddenly, they all appeared to follow a rapid decline in blood sugar levels and the deceased were all using ‘human’ insulin. Dr Toseland believed that this sort of sudden death in young diabetics was something new.
Sadly IDDT still receives reports of such deaths in young people and in the cases we have received, all of the deceased had been using GM ‘human’ insulin. Very little research has been done in this area, despite the recommendations from those who have carried out studies. Much of the evidence may be circumstantial and there may be a combination of causes but hypoglycaemia is strongly linked with these deaths and ‘human’ insulin is linked to loss of warning symptoms and a subsequent increased risk of hypoglycaemia.
Research related to ‘dead in bed syndrome’
Prior to 1993, no records were kept for the category of death from hypoglycaemia, so it is impossible to make comparisons of before and after the introduction of ‘human’ insulin by this method. The following studies are interesting:
- Dead in Bed Syndrome in Young Diabetic Patients in Norway
Diabetic Medicine 1995 vol.12 H Thordensen et al
The authors collected data from 1981 to 1990 and the cause of death examined in people under the age of 40.
- 16 cases of dead in bed syndrome were found, 6 females and 10 males the age ranged from 7 to 35 years
- The duration of diabetes was from 2 months to 26 years. 9 were on multi-dose regimes.
- Frequent episodes of hypoglycaemia were mentioned in 12 cases, 10 of these having night hypos.
12 of the total 16 deaths occurred during the years 1988,1989 and 1990. These years coincide with the introduction of ‘human’ insulin. They also coincide with the introduction of tighter diabetic control when there is a threefold increased risk of severe hypos.
[Diabetes Control and Complications Trial Study Group N.Eng.J.Med 1993; 329, 977-86]
The authors suggest that hypoglycaemia may play a part in these deaths. However, it is possible that ‘human’ insulin was the cause as it is known to cause loss of hypo warning signs and more frequent hypos. It may also be a combination of tight control and ‘human’ insulin.
- Unexplained Deaths in Type 1 Diabetic Patients
Diabetic Medicine 1991 vol.8 R B Tattersall and G V Gill
This study looked at 50 deaths of young people with diabetes that were collected in an ad hoc way. 22 of the deaths fitted into the ‘dead in bed’ category and 14 of these cases reportedly had night hypos. All were using ‘human’ insulin.
- GM ‘human’ and animal insulin compared – A review carried out by Prof Rhys Williams et al, Nuffield Institute for Health, Leeds. Date of original Review 1998 presented to the British Doabetes Association Medical Conference in May 1999.
Page 5 of ‘Human and animal insulin compared’, 29 July 1998 says:
"The following observations can be made from this body of evidence:
- Increased frequency of hypoglycaemia and reduced awareness of impending hypoglycaemia do occur when people are transferred from animal to "human" insulin.
- In some cases (probably a small number) these phenomena may lead to death.
- It is not possible to determine, from the evidence available, how commonly these phenomena occur.
- From mortality data it is likely that any association with sudden death is uncommon.
- It is not possible to say whether these phenomena are specific to "human" insulin or an effect resulting from tighter glycaemic control perhaps compounded, in some cases, by neurological complications in long standing-diabetes."
- Is undetected autonomic dysfunction responsible for sudden death in Type1 diabetes? The ‘dead in bed’ syndrome revisited
Diab Med. Aug 1999 Vol 16, Simon Heller et al
The authors explored the details of all the papers recording the syndrome to formulate a possible cause and they also did a literature review of nocturnal hypoglycaemia and autonomic dysfunction. The results showed that nocturnal hypoglycaemia is strongly implicated in being present prior to death but the death is sudden and probably arrhythmic. [Arrhythmic means any variation of the normal regular heartbeat.] They point out that dysrhythmias can occur with early autonomic neuropathy, with relative sympathetic overactivity, in young people with diabetes. They conclude that the ventricular dysrhythmias will be compounded by nocturnal hypoglycaemia which may be associated with an increase in the electrocardiograph Q-T interval and Q-T dispersion. This could lead to sudden death in an undisturbed bed. They say that further research in this area is urgently needed but this never happened.