Someone I know died recently. She was 58, she had Type II diabetes and high cholesterol, and the assumption was that one of them killed her. But since no autopsy was performed, we don’t really know.
There was no indications that anything was particularly wrong, and she was found lying very peacefully in her bed, hands folded on her chest. Dead.
So I have a couple of questions. Her son was murdered 3 months to the day before she was found, it is not inconceivable that it was suicide. But is it possible to suicide by OD’ing on pills and have no evidence of it? I was always sort of under the impression that there would be vomit, death throes, something. I always remember the story of the actress in the 30’s or 40’s who was going to go out looking so fabulous and was found covered in vomit.
If it was suicide, could it have been from the diabetes pills she was taking? They were those new ones, forget the name…
Secondly, if she died of natural causes… wow, is it really possible to just lie down to go to sleep and have no convulsion, twitch, twist, nuthin? Heart just stops beating without pain or anything? Just drift away in perfect peace and obliviousness?
And finally, the official cause of death listed on her death certificate was “hardening of the arteries”. This strikes me as some kind of bullshit catchall for unesplained but natural death. And how does one die from hardened arteries? Don’t you actually die from a heart attack brought on by aterial problems?
There are several types of quick ways to die which would leave no symptoms and be totally undiagnosable without autopsy: pulmonary embolus, massive cerebral vascular accident (stroke, ruptured aneurysm, etc.), massive heart attack, sudden cardiac death, fatal arrhythmias, thromboembolus from the carotids, the list goes on. Chances of having most of these go up with diabetes and hypercholesterolemia. With most of them, you pretty much go
“peacefully.” Also, hands folded on chest can also be interpreted as “clutching the chest because of sudden massive chest pain.”
Also, drug overdoses. Opiates come to mind – they depress respiration in overdose, and you literally suffocate. There are dozens of diabetes medications, but a likely side effect from some of them (insulins and sulfonylureas IIRC) is hypoglycemia. She may have seized (and thus vomited) from hypoglycemia but not necessarily.
Hardening of the arteries, or arteriosclerosis, can be caused by any number of things, but is most often caused by fat deposits in the arteries (atherosclerosis) or high blood pressure (hypertensive arteriosclerosis). Diabetes predisposes to both. This can lead again to any of the vascular causes listed above – stroke, heart attack, pulmonary embolus, etc – so it is a pretty good guess (without an autopsy).
Depends on what you OD on. Any kind of depressant will put you to sleep and then your heart stops. Should look peaceful. For example, alcohol, sleeping pills. Most sleeping pills have inert ingredients in them, that if you take too much make you vomit. Mix sleeping pills with alcohol and you don’t need as many sleeping pills to OD on, and you are less prone to vomiting. The other problem with sleeping pills is the gelatin capsule. Take to many and you can pull a Hendrix by drowning in your own gelatin vomit.
She may also have had a relatively pain free heart attack, something that is a well-known and documented phenomenom in diabetes mellitis.
Diabetics are prone to degeneration of nerve tissue, thought to be caused by a disruption to the cells that produce myelin, the substance that acts as both insulation and conduction enhancer in nerve fibres. When the myelin sheath breaks down, conduction is severely impaired. Peripheral nerves (which include those that transmit pain stimuli) seem to be particularly vulnerable to this damage.
Hence, tha lady in question could well have laid down feeling quite unwell, but not thrashing around in great pain, like most people with severe cardiac pain do.
I’ve known at least one type II diabetes sufferer who died exactly like your friend. They feel a bit unwell beforehand, but nothing definite–achiness, tiredness, the blahs. Heart attacks can kill you pretty quickly and, Hollywoodisms aside, somewhat painlessly.
As to the hardening of the arteries question, think of your arteries as being like a water hose. Ever tried to bend a really stiff, old hose? SNAP, it’s broken, and water gushes out. Something similar happens to people with hardened arteries. The great SF magazine editor John W. Campbell died of HAs; he was sitting in his chair napping when one of his major arteries gave way. No one noticed until they tried to wake him up.
There is a rare condition in diabetic patients known as dead-in-bed syndrome, where an otherwise healthy diabetic is found dead, usually in an undisturbed bed. IIRC, this condition applies mainly to juvenile-onset, or Type I diabetics, and is thought to be due to severe hypoglycemia experienced during sleep.
IANAMD, but I believe it would take a fast acting insulin, such as Humalog, to drop glucose levels that quickly.
Guy - the term “hardened arteries” has more to do with atherosclerotic degeneration, where because of repeated scarring and plaque buildup, the arteries gradually lose their ability to dilate and constrict in order to regulate blood pressure.
What you have referred to is known as an aneurysm, where an artery (or vein) blows out. This is usually due to hypertension and an inherent weakness or defect in the vessel wall.
Cynic - it would be highly unusual for a diabetic to self administer insulin, let alone fast-acting insulin, just prior to going to bed, precisely because of the risk of hypoglycaemia.
However, someone with type I diabetes can often go through upheavals in an otherwise settled routine of balancing diet, exercise and medication. There are 2 or 3 patients I attend regularly who go through episodes of hypoglycaemia in the dead of the night. They are fortunate that their partners are alert enough to the impending signs to call for some help, otherwise they could easily end up “dead in bed”.
A guy I know died in bed right next to his wife, who didn’t realize he had passed until she went to wake him up for his turn in the shower. Rude shock, to say the least. To this day, no one is sure what killed him, although he was diabetic (Type II), and everyone’s pretty sure that had something to do with it.
It happens, and sometimes, it’s just gonna stay a mystery.
I’m still working on the “no autopsy” part. It’s my understanding that, in Illinois, at least, if you die outside of a hospital they are going to find out why and an autopsy is required.
Usually not the case in most US jurisdictions, as long as there are no suspicious circumstances (a stake thru the heart, signs of a struggle) and they can get a physician who knew the patient and is willing to assign a probable cause of death. I knew my patient Joe Blow had coronary artery disease, took his meds irregularly, kept smoking, kept drinking, and refused further intervention. So when they told me he was seen climbing 3 flights of stairs, and was found dead at the top, I was comfortable saying he infarcted and died. Thus no autopsy.