David Kerr: The dark side of insulin

David KerrIt has been a strange few weeks for insulin. This year is the 90th anniversary of its discovery and in everyday clinical practice, insulin still remains “a force of magical activity” as described in a letter to the Times shortly after it was first used in humans. Nowadays, despite a bewildering array of therapies for diabetes in general, the immediate consequences of starting insulin in new onset type 1 diabetes still remains a medical marvel. However, over the past few weeks, insulin has received a rather negative press.

The very dark side of insulin has again resurfaced, this time in a hospital in the North of England. Apparently insulin was surreptitiously added to bags of normal saline, resulting in a catalogue of severe hypoglycaemia. Although police investigations are ongoing, a nurse has been charged in relation to the suspicious deaths of at least 5 people.

Meanwhile in the US, insulin has become a discussion topic for computer hackers in the past few days. Computer hacking has been in the news for a number of weeks and certainly the effects of being hacked can range from mild inconvenience (eg spamming) to the catastrophic personal financial consequences of identity theft. Last week at the Black Hat Technical Security Conference in Las Vegas, a computer security expert with type 1 diabetes described how he was able to interfere remotely with the wireless connection between his continuous glucose monitoring system and insulin pump. Hacking involved interfering with the wireless sensors that collect blood sugar information and transmit it to the insulin pump allowing him to “suspend” the insulin infusion. Fortunately the specific manufacturer of the hacked devices remains unknown – as the security expert responsible pointed out “I am not disclosing all the technical details. I won’t give out details on how to kill me in the middle of a hacker conference. Lives are at stake here.”

On Twitter and in the blogosphere, the diabetic community received this particular news item with a sense of sang-froid – rather than worrying that people with diabetes might become the next targets for technological terrorism, people living with diabetes were upset because “this kind of security breach potential could perhaps cause the already slow Food and Drug Administration to cease new diabetes device approvals in their tracks.”

Closer to home, maladministration of insulin in hospital will soon become a “never event” in NHS hospitals. This puts this particular prescription error at the same level as amputating the wrong limb or leaving a swab in the abdomen after an operation. If a never event occurs this will result in significant financial penalties for the institution – given that 37% of inpatients with diabetes were reported to have “experienced” at least one insulin prescription error in 2010, it is likely that insulin will continue to be of interest way beyond its impact on blood glucose levels.

David Kerr wears many hats, sometimes at the same time – Diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes. He has received consultancy fees and honoraria for participating in advisory boards for Medtronic, Roche, Lifescan, and Abbott Diabetes Care. He also holds a small amount of stock in CellNovo (a new insulin pump company) and Axon Telehealth.