My Numerous Escapes from Death by Sulfonylureas

But never will Allah delay a soul when its time has come. And Allah is Acquainted with what you do.

(Holy Quran 63: 11)

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Introduction

This is an account of my numerous escapes from death/near death by sulfonylureas, a group of anti-diabetic drugs, that cause hypoglycemia (low blood glucose levels).

Everyone would probably agree that it is a miracle that I am living today to narrate these events before you, but the fact remains: time and place of death are fixed.

1st Episode: Blurred Vision

Date February 2008

Venue Samanabad, Lahore

I had recently been diagnosed with type 2 diabetes and started on a sulfonylurea (glibenclamide/glyburide). My family was shifting to Rawalpindi and I was supervising the loading of the luggage on to a truck.

I told my wife of my vision becoming a bit blurred as if my visual acuity had decreased. I knew I had my glasses on and I certainly didn’t believe my eyesight had further deteriorated after so many years.

It was only after we finished loading the truck and I took something to eat that my vision became normal again all of a sudden. That was when I just realized I had experienced my first episode of hypoglycemia!

2nd Episode: Disoriented, Confused

Date March 2008

Venue: LMDC (Lahore Medical & Dental College), Lahore Pakistan.

I had felt a bit confused ever since I hopped on to the college bus. When I reached college I felt a bit more confused and somewhat disoriented. I felt like I had taken a narcotic or something (although in reality I had never taken one).  I even questioned our peon if he had mixed some cocktail in my cup of tea.

I somehow delivered a whole lecture in this confused, disoriented state (probably due to confidence/mastery of the topic).

By the end of the lecture, I was extremely disoriented and obviously too confused to understand what was happening to me. My peon comprehending my condition gave me few pieces of sandwich after which I quickly revived and suddenly came out of my uncomfortable condition.

After coming back to my senses, I realized that I just had experienced my second attack of hypoglycemia!

3rd Episode: Missing the Morning (Fajr) Prayer

Date February 2008

Venue Samanabad, Lahore

It was just by chance that my wife thought of phoning me up from Rawalpindi that fateful day to check upon me after praying the morning prayers. My phone was not responding.

Worried, she then phoned up our landlord who lived downstairs. They came and banged my door with no response. They somehow squeezed their younger son through a small window pane in the kitchen and got the door open.

They found me ‘sleeping’ and unresponsive to vocal and motor commands. They immediately gave me something to eat and I ‘woke’ up all of a sudden, surprised to see my landlord and his family all surrounding me with anxious looks on their faces!

I wondered afterwards what would have happened if God-forbid my wife hadn’t checked on me that morning and awoke me from my 3rd episode of hypoglycemia.

4th Episode: The Escape from Death

Date:  February 2011.

Venue: LMDC (Lahore Medical & Dental College) Faculty Hostel, Lahore Pakistan.

It is probably a great advantage of being very punctual as was proved that fateful day.

It was night time after dinner in the LMDC faculty hostel. I was welcomed by a knock on my door by a group of students who came to give some ‘mithai’ (sweets) for passing their exams.  I reluctantly took some pieces.

Although I already had taken a full meal, I did eat a piece of the sweets but took an extra dose of the sulfonylurea to compensate for the extra amount of glucose that had gone into my body.

I had a BDS lecture the next morning at 10:00 am. Being very punctual, I did not turn up for the lecture and my department colleagues started looking for me.

My phone was not responding. They came looking for me in the faculty hostel and looking at the window pane, saw me ‘sleeping’.

They immediately got the duplicate keys to my room and opened it to find me lying unconscious. They immediately gave me, as I was told afterwards, some more pieces of remaining sweets and juices, but I still did not come to.

I was then taken to the teaching hospital, around ten minute drive away, still unresponsive.  There I was immediately given dextrose infusion and I remember waking up in the hospital, all of a sudden wondering how in the world how I had ended up there!

The blood glucose level shown to me at that time in the hospital was only 26 mg/dl!  Probably only half an hour more or so, I would have gone or suffered from seizures or renal shut down etc but Alhamdulillah I survived, yet again.

To this day I wonder what would have happened if I did not have a lecture that day.  I also remain thankful to this day to my colleagues in the department, especially Prof Shah Murad, Dr. Fatima & Mr. Jan Muhammad, for saving my life.

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5th Episode: Breaking the Fast

Date: August/Ramadhan 2011.

Venue:

Many would think I would have stopped experimenting/taking any more risks after the recent episode. Nope.

It was in Ramadhan, holy month of fasting for Muslims, in August 2011, I think. Alhamdulillah I was fasting as usual, having took my anti-diabetic medication at sehri (meal taken before dawn prayers). Around Zuhr prayers I had that now very familiar feeling of being hypoglycemic. I checked my blood glucose with a glucometer and found it to be 76 mg/dl.

I just prayed and hoped upon hope that I had enough fuel (glucose) for my flight to land safely at time of Aftar (time of breaking of fast), only to wake up and find myself being force-fed by my family with food sometime around Asr (an hour or so before Aftari). I was told I had become unresponsive after falling ‘asleep’.

The Reasons for the Bizarre Idiopathic Behavior

There are many other minor episodes but of a less severe intensity.

One would think one would be crazy taking these risks but research has found benefits of tight control of diabetes.

Benefits of Tight Glycemic Control

‘The consensus of the American Diabetes Association is that intensive glycemic control and targeting normal or near-normal glucose control associated with comprehensive self-management training should become standard therapy in diabetic patients.’

Studies have shown that “near normalization” of blood glucose resulted in a delay in onset and a major slowing of progression of microvascular and neuropathic complications of diabetes during follow-up periods of up to 10 years.

In a study, a reduction of approximately 60% in risk of diabetic retinopathy, nephropathy, and neuropathy was noted in the tight control group compared with the standard control group.

Tight control of diabetes, with reduction of HbA1c from 9.1% to 7%, was shown to reduce the risk of microvascular complications overall compared with that achieved with conventional therapy.

(All References: Basic & Clinical Pharmacology, by Dr. Bertram Katzung, 13th Edition)

An Effort to Emulate my Father

 My father Ma sha Allah has always been my ideal for many aspects of life, including keeping blood sugar levels well in check. Alhamdulillah he has kept his blood sugar levels well in check on oral anti-diabetics for over 35 years, only recently being shifted to insulin.

Alhamdulillah, he has not developed as yet, neuropathy, nephropathy, retinopathy or any other microvascular complications of diabetes.

Probably he has the advantage of being a PhD in mathematics, thus enabling to calculate on his own, daily doses with accurate precision Ma sha Allah (including daily insulin doses these days), due to which he has never suffered from a hypoglycemic attack in his life Alhamdulillah

Conclusion

Currently the hypoglycemic episodes have decreased, partly due to less risks taken, better understanding of the disease and calculations of dose, change of medications, living with my family and partly due to my regular humorous threats to my family ‘Jaan, meri sugar low ho rahi hai’ (honey, my sugar level is decreasing).

Maybe God had greater plans for me, for I have lived to write 3 books in Pharmacology and around 100 articles on Islam and political Islam read by 300-400 viewers/day (averages increasing by the month) from over 180 countries. Alhamdulillah!

Despite the effort for tight control precautions should be taken including:

1.  Patient awareness

2. Keeping sweets in pockets

3. Relatives/colleagues should be aware/close easy to contact in case of emergency

4. Should not be living alone

5. Most importantly, regularly consult your diabetologist (diabetes specialist) about medications, change in dosing etc)

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For more details and other useful information on Pharmacology

Read ‘Nauman’s Textbook of Pharmacology’ (3rd Edition)

https://drnaumanshad.wordpress.com/2016/07/22/naumans-textbook-of-pharmacology/

For many more MCQs (4500 MCQs) divided into units, chapters, and topics read:

‘Learning Pharmacology from Nauman’s MCQS’

https://drnaumanshad.wordpress.com/2016/11/26/learning-pharmacology-from-naumans-mcqs/

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