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It depends on what the true blood sugar value was: if someone were already at the high end of normal and a 'brittle diabetic', you can end up in 'diabetic ketoa

It depends on what the true blood sugar value was: if someone were already at the high end of normal and a 'brittle diabetic', you can end up in 'diabetic ketoacidosis' for T1DM individuals or—less likely—'hyperosmolar hyperglycemic state' generally. See https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 https://www.mayoclinic.org/diseases-conditions/hyperglycemia... for a discussion of both (in Emergency conditions)

SkyPuncher 10mo ago
[flagged]
- slowking2 10mo ago
  You can die on the order of hours to days not of high blood sugar per se, but of the low insulin causing diabetic ketoacidosis parent comment mentions. It would be odd for a faulty sensor to cause an otherwise bad day into dka and death though. The sensor would need to be wildly off for hours and the user to not notice. Insulin delivery would need to be paused or greatly reduced for many hours. There are additional therapies like SGLT-2 that could make this more likely but they usually aren’t used with T1D precisely because they break the normally very strong correlation between inadequate insulin levels (leading to dka) and high blood glucose. Even though I can’t think of an easy way for a false low(s) to turn into lethal DKA, that doesn’t mean it didn’t happen. Abbott sells a lot of CGMs. It could have been a contributing factor to several deaths even if the fault would almost always not be a significant issue.
- bonsai_spool 10mo ago
  > Sorry to be crass, but this type of argument is exactly why non-experts shouldn't be talking about topics > I myself am not a doctor. I love to learn from my wife. I suggest that you speak to your wife before correcting my unimpeachable explanation of why someone might die from being told, incorrectly by their CGM, that their blood glucose is low. I say this as someone doesn't need to rely on a spouse but have actually received my own medical education. And I've had my own HHS patients—it's not even clear if your wife (!!) works in this area. As the sibling commentator shares, we don't really expect these patients to show up after a day of bad data, but we also have no idea how many days of bad data occurred.
  - pixl97 10mo ago
    As someone that experienced DKA when I was young I'm still not sure how that happens unless there were a lot of other confounding factors. Having hypoglycemia that high for a while will make everything start smelling like varnish. Also you start physically hurting especially your kidneys which is not something you can ignore. If there were other confounding factors then I'm wondering what their endo told them, unless this is one of those countries you could buy it without a prescription? Any endo with any training would have a fragile diabetic using more than one monitoring method and have them doing regular blood tests.
    - bonsai_spool 10mo ago
      I responded to your sibling post: https://news.ycombinator.com/item?id=46395603 https://news.ycombinator.com/item?id=46395603 DKA is a common presenting symptom for new T1DM patients but that's definitely not the only time it occurs. And we also have HHS which can occur in T1DM and T2DM.
  - SkyPuncher 10mo ago
    Thank you for offering your credentials. By nature of this being an internet, tech-focused forum there just aren't many doctors here. Without a reference to credentials, I made a (poor) assumption about your authority on the matter. I was very clear that I probably know more than the average person, but I'm certainly not an authority. I do think my underlying point is generally, correct, though. And, implicitly supported by your retort. Low and high blood sugar are emergencies of different acuity. To be clear, by the time either of them turns into an emergency, they are both emergencies. However, the time frame for going from "my blood sugar is managed" to "I need emergency intervention" is generally different (and longer for high blood sugar emergencies).
    - bonsai_spool 10mo ago
      I'll respond to the sibling poster with the same content—yes, DKA won't cause coma as quickly as insulin overdose but it can indeed come on acutely and it absolutely does kill people. I'm a bit frustrated by the number of people on this page who are saying that high BG readings aren't an emergency; the timeline to death isn't weeks or months or 'next time I get to urgent care' but instead 'later today' or 'early tomorrow'. DKA may be precipitated by infection (like the seasonal flu), and in that setting, worsened further by an unreliable CGM. Here are some case reports that relate to this: - https://sci-hub.box/10.2337/diacare.6.6.622b https://sci-hub.box/10.2337/diacare.6.6.622b (note two patients who were 'intelligent' presented with DKA despite multiple normal readings) - https://pubmed.ncbi.nlm.nih.gov/40811481/ https://pubmed.ncbi.nlm.nih.gov/40811481/ (pregnant women can have DKA irrespective of blood glucose readings due to changes in normal range attributable to pregnancy) You can read many more of these kinds of cases: https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidosis%5BTIAB%5D%20OR%20DKA%5BTIAB%5D%20OR%20%22Diabetic%20Ketoacidosis%22%5BMESH%5D)%20AND%20Case%20Reports%5BPTYP%5D%20AND%20(adult*%5BTIAB%5D%20OR%20Adult%5BMESH%5D)%20NOT%20(pediatric%5BTIAB%5D%20OR%20child*%5BTIAB%5D%20OR%20infant%5BTIAB%5D%20OR%20adolescent%5BTIAB%5D)%20AND%20blood%20glucose%20monitor&sort=pubdate https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidos...
- mlyle 10mo ago
  Don’t be the guy who lectures the MD/PhD— who gave an outside source— about being not an expert, by citing conversations with your spouse.
  - SkyPuncher 10mo ago
    The MD/PhD did not offer any credentials. Citing an outside source does not make one more correct. My point still remains. Low and High blood sugar are different acuity of emergencies.
    - bonsai_spool 10mo ago
      I have to say that I don't talk about credentials because they really are an inappropriate source of authority on the internet. I instead link to authoritative references.
    - mlyle 10mo ago
      It seems like you're missing the distinction being drawn between high blood sugar (but adequate levels of insulin to prevent ketosis) and very very lowlevels of insulin. The former is bad over longer time scales; the latter can become ketosis/acidosis/an emergency quickly. But neither that, nor is whether he should offer credentials the point. The point is you said this: > > > Sorry to be crass, but this type of argument is exactly why non-experts shouldn't be talking about topics they aren't experts on. I think there's a little recalibration necessary if the person you said this to turns out to be pretty well educated and capable in the subject.

SkyPuncher 10mo ago

[flagged]

slowking2 10mo ago
You can die on the order of hours to days not of high blood sugar per se, but of the low insulin causing diabetic ketoacidosis parent comment mentions. It would be odd for a faulty sensor to cause an otherwise bad day into dka and death though. The sensor would need to be wildly off for hours and the user to not notice. Insulin delivery would need to be paused or greatly reduced for many hours. There are additional therapies like SGLT-2 that could make this more likely but they usually aren’t used with T1D precisely because they break the normally very strong correlation between inadequate insulin levels (leading to dka) and high blood glucose. Even though I can’t think of an easy way for a false low(s) to turn into lethal DKA, that doesn’t mean it didn’t happen. Abbott sells a lot of CGMs. It could have been a contributing factor to several deaths even if the fault would almost always not be a significant issue.
bonsai_spool 10mo ago
> Sorry to be crass, but this type of argument is exactly why non-experts shouldn't be talking about topics > I myself am not a doctor. I love to learn from my wife. I suggest that you speak to your wife before correcting my unimpeachable explanation of why someone might die from being told, incorrectly by their CGM, that their blood glucose is low. I say this as someone doesn't need to rely on a spouse but have actually received my own medical education. And I've had my own HHS patients—it's not even clear if your wife (!!) works in this area. As the sibling commentator shares, we don't really expect these patients to show up after a day of bad data, but we also have no idea how many days of bad data occurred.
- pixl97 10mo ago
  As someone that experienced DKA when I was young I'm still not sure how that happens unless there were a lot of other confounding factors. Having hypoglycemia that high for a while will make everything start smelling like varnish. Also you start physically hurting especially your kidneys which is not something you can ignore. If there were other confounding factors then I'm wondering what their endo told them, unless this is one of those countries you could buy it without a prescription? Any endo with any training would have a fragile diabetic using more than one monitoring method and have them doing regular blood tests.
  - bonsai_spool 10mo ago
    I responded to your sibling post: https://news.ycombinator.com/item?id=46395603 https://news.ycombinator.com/item?id=46395603 DKA is a common presenting symptom for new T1DM patients but that's definitely not the only time it occurs. And we also have HHS which can occur in T1DM and T2DM.
- SkyPuncher 10mo ago
  Thank you for offering your credentials. By nature of this being an internet, tech-focused forum there just aren't many doctors here. Without a reference to credentials, I made a (poor) assumption about your authority on the matter. I was very clear that I probably know more than the average person, but I'm certainly not an authority. I do think my underlying point is generally, correct, though. And, implicitly supported by your retort. Low and high blood sugar are emergencies of different acuity. To be clear, by the time either of them turns into an emergency, they are both emergencies. However, the time frame for going from "my blood sugar is managed" to "I need emergency intervention" is generally different (and longer for high blood sugar emergencies).
  - bonsai_spool 10mo ago
    I'll respond to the sibling poster with the same content—yes, DKA won't cause coma as quickly as insulin overdose but it can indeed come on acutely and it absolutely does kill people. I'm a bit frustrated by the number of people on this page who are saying that high BG readings aren't an emergency; the timeline to death isn't weeks or months or 'next time I get to urgent care' but instead 'later today' or 'early tomorrow'. DKA may be precipitated by infection (like the seasonal flu), and in that setting, worsened further by an unreliable CGM. Here are some case reports that relate to this: - https://sci-hub.box/10.2337/diacare.6.6.622b https://sci-hub.box/10.2337/diacare.6.6.622b (note two patients who were 'intelligent' presented with DKA despite multiple normal readings) - https://pubmed.ncbi.nlm.nih.gov/40811481/ https://pubmed.ncbi.nlm.nih.gov/40811481/ (pregnant women can have DKA irrespective of blood glucose readings due to changes in normal range attributable to pregnancy) You can read many more of these kinds of cases: https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidosis%5BTIAB%5D%20OR%20DKA%5BTIAB%5D%20OR%20%22Diabetic%20Ketoacidosis%22%5BMESH%5D)%20AND%20Case%20Reports%5BPTYP%5D%20AND%20(adult*%5BTIAB%5D%20OR%20Adult%5BMESH%5D)%20NOT%20(pediatric%5BTIAB%5D%20OR%20child*%5BTIAB%5D%20OR%20infant%5BTIAB%5D%20OR%20adolescent%5BTIAB%5D)%20AND%20blood%20glucose%20monitor&sort=pubdate https://pubmed.ncbi.nlm.nih.gov/?term=(diabetic%20ketoacidos...
mlyle 10mo ago
Don’t be the guy who lectures the MD/PhD— who gave an outside source— about being not an expert, by citing conversations with your spouse.
- SkyPuncher 10mo ago
  The MD/PhD did not offer any credentials. Citing an outside source does not make one more correct. My point still remains. Low and High blood sugar are different acuity of emergencies.
  - bonsai_spool 10mo ago
    I have to say that I don't talk about credentials because they really are an inappropriate source of authority on the internet. I instead link to authoritative references.
  - mlyle 10mo ago
    It seems like you're missing the distinction being drawn between high blood sugar (but adequate levels of insulin to prevent ketosis) and very very lowlevels of insulin. The former is bad over longer time scales; the latter can become ketosis/acidosis/an emergency quickly. But neither that, nor is whether he should offer credentials the point. The point is you said this: > > > Sorry to be crass, but this type of argument is exactly why non-experts shouldn't be talking about topics they aren't experts on. I think there's a little recalibration necessary if the person you said this to turns out to be pretty well educated and capable in the subject.