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• W4289532080 abstract "In 2020, 5224 people died by suicide in England and Wales.1 Each person's death is a potentially preventable tragedy. ‘My dear, 24-year-old son killed himself with a massive bolus of insulin from his pump in March of 2011. He had struggled with T1 diabetes since…he was only 1-and-a-half years old…Let's fast forward 23 years…Past him being taunted and bullied by classmates because he had diabetes; past his significant adjustment to an insulin pump when he was 12…Fast forward to his being accepted into a highly selective college and his parents going into debt to keep him there. And we arrive, finally at a handful of suicide attempts while in college??? Where did this come from, we wondered? He doesn't deserve this!! We don't deserve this!! What happened to our fantastic, skillful, passionate, talented and self-reliant son? Haven't we ALL suffered enough? …No matter how many times we implored him to take care of himself for us and his siblings – if not for himself, he chose to end his life using his pump – the major thing that we had gotten him to improve his life with diabetes. Ironic. Tragic.’2 Aged 17, Jiggy lost everything in a fire. Then, at college, he was diagnosed with type 1 diabetes. ‘The stress and sadness of life and diabetes stacked up pretty quickly. With my depression and the sensitivity of my triggers, suicidal thoughts are my first initial reaction to situations… I couldn't understand…what I was doing wrong…The sting of fingerpricks and injections, the frustration of seeing a number I didn't want to see, the lows in the middle of a workout or the middle of the night – it all really annoyed me…With the life I was living and the challenges I've faced, my thoughts at the time became, “Clearly, somebody doesn't want me to live and gave me this disease…Clearly, these supplies in front of me can help me end it all.” What happened next – I don't know. I wasn't really thinking. I blacked out and everything was autopilot. I was alone in my dorm room, and I injected plenty of insulin and went to bed – or tried. The shaking, the sweating, and the heavy breathing – I couldn't go through with it. I had to wake up. I hated my diabetes. It was a constant reminder that I hated my life. But if I couldn't even go through with the attempt of ending everything, it looked like I had to stay.’3 Jiggy survived. Others don't. Mental health problems are common in diabetes and vice versa. One meta-analysis of people with diabetes found that the adjusted risk for depression was 1.25 (1.10–1.44) compared with people without diabetes.4 A meta-analysis including 54 studies found that having diabetes increased the risk of suicide (RR 1.56 [1.29–1.89]); among people with type 1 diabetes RR 2.25 (1.50–3.38).5 A Finnish study of people who died from suicide compared those with type 1 diabetes or type 2 diabetes with people without diabetes. Depression occurred in 44.4% with type 1 diabetes, 23.5% type 2, and 19.9% without diabetes. Many were under the influence of alcohol (44.4% type 1, 24.0% type 2, and 46.6% without diabetes). Unsurprisingly, insulin was much more likely to be used for suicide by people with type 1 diabetes than those with type 2.6 People may overdose on other glucose-lowering treatments. A 47-year-old woman with type 2 diabetes and renal impairment attempted suicide with metformin. She developed hypoglycaemia and lactic acidosis but recovered after haemofiltration and ventilatory support.7 Sulphonylureas potentiate pancreatic insulin release. In overdose, glucose infusion for hypoglycaemia may be followed by rebound hypoglycaemia. Octreotide has been used to treat this.8 One cohort study following people prescribed DPP-4 inhibitors or GLP-1 receptor agonists did not show an increased risk of new depression or self-harm.9 Life with diabetes is often a struggle. Self-harm in diabetes was discussed in a past leader.10 Even if death is not intended, self-harm may be fatal. A 47-year-old woman had long-standing type 1 diabetes. She attended A&E over 100 times with hypoglycaemia and had multiple home ambulance call-outs.11 I recall a man with similarly frequent hypoglycaemia. In one year, ambulance crews were called to his house 99 times, each time having to evade his fiercely devoted guard dogs. Extensive care for both patients, including psychological help, failed to reduce the hypos. Jasper was 10. His parents managed his type 1 diabetes very carefully. ‘His blood sugar readings had been perfect all day…[w]hen he came in from playing hard at soccer and asked “can I have some of this Sprite?” I said: “no, wait till you go low”.’… Hours later Jasper had a hypoglycaemic seizure. His terrified mother injected glucagon. In hospital ‘He kept going low and none of us could understand why. The doctors and I came to the conclusion that his pump must have malfunctioned…He told me, after I had decided that I was going to rip off the “defective” insulin pump (burn it) and sue the company, that it was actually him who had given himself almost 16 units of insulin… “I wanted the Sprite, Mum, so I gave myself insulin when you told me not to. And when I still wasn't low by bedtime, I gave myself more insulin”.’12 Using hypoglycaemia to win sugary food or drink is not uncommon. Education about safe enjoyment of treats is part of diabetes education – for example in the DAFNE course (Diabetes Adjustment For Normal Eating).13 Some people omit insulin to induce hyperglycaemia and weight loss – diabulimia, often associated with other features of eating disorder. Fatal diabetic ketoacidosis (DKA) may ensue.14 Among people with type 1 diabetes in France, 1539 were admitted for DKA of whom 7.2% were hospitalised for a suicide attempt over the next nine years, compared with 2.5% of the 14,892 without DKA. Suicide risk was highest in the first year after admission. Assess people with DKA psychologically, especially for depression and suicide risk.15, 16 Ask people with diabetes how they're getting on. Discuss emotions. Ask about depressive symptoms, including thoughts of self-harm or suicide. Listen non-judgementally. Act. Urgently refer suicidal patients to mental health services. If you're not the GP, liaise with the GP to ensure treatment of the depression and follow up. Notify other relevant health care professionals in community or hospital services. Tell the patient about local and national helplines/websites (Box 1). In the UK there are 24/7 urgent local mental health helplines.17 Keep the patient under frequent supportive review. Getting help for suicidal thoughts21 Support right now UK-wide Other free helplines21 Message a text line22 If you do not want to talk to someone over the phone, these text lines are open 24 hours a day, every day The RESCUE collaborative community is working ‘to reduce rates of intended self-injury and suicidal acts by people with diabetes through improved understanding of the risk factors and implementing strategies to address them.’18, 19 Being bereaved by suicide has been described as ‘grief with the volume turned up’. Bereaved relatives and friends need support, as may health care professionals. ‘Help is at Hand’ is a supportive and practical booklet by Support after Suicide – a collaboration hosted by the Samaritans.20" @default.
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• W4289532080 title "Suicide and diabetes" @default.
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