Insulin induced hypoglycemia and suicidal ideation

by dm gillis

How does one ask this question of a psychiatrist who’s so prepared to put a patient into the hospital: How do I manage suicidal ideation, that accompanies bouts of hypoglycemia, while mildly depressed?

The question is obviously one outside of the experience of most psychiatrists, since very few patients with bipolar disorder also have type 1 diabetes, for which injecting insulin is absolutely necessary, and can lead to occasional episodes of serious hypoglycemia. I’ve discovered that this is murky territory psychiatrists don’t want to visit.

In fact, in my experience, it’s a forbidden question because asking will almost certainly place me in danger of being incarcerated on a psych ward. I know because the last time I asked, the police were called and waiting for me when I arrived home from the appointment. All because I mentioned the suicide word, while asking what I thought was a perfectly reasonable question.

The point is that there are times when I have low levels of depression made worse by seriously low blood glucose levels. During these episodes, when my brain lacks the fuel required to function properly, any irrational thoughts I have safely stored away, may be let loose and run free.

FYI: The day the cops scooped me my glucose levels got lower and lower as the events unfolded, because the cops didn’t believe I was diabetic and wouldn’t let me eat. They justified this by pointing out that I wasn’t wearing my bracelet—my choice, my mistake. So, by the time I arrived at the hospital in the back of a police car, my sugars were so low that even the emergency ward nurse raised an eyebrow. When my glucose level was normalised, however, I was actually able to talk my way out of being admitted to the psych ward, a testament to my ability to think and communicate rationally when all is well.

The result is that now I don’t ask the question.

Am I capable of following through with an attempt at suicide, as a result of thoughts that come during a bout of hypoglycemia? So far I haven’t, obviously. All I need is a few seconds of clarity to know that I need some quick sugar. The problem is that the clarity doesn’t always arrive.

Is it smugness on the part of a psychiatrist, or a need to inspire confidence by presenting him or herself as all-knowing, that leads to an inability to calmly discuss this challenge? I’ve experienced both of these attitudes in doctors, much to my disappointment. So, what’s the strategy? Time will tell.