Actor and director Penny Marshall passed away yesterday at the age of 75. According to a statement from Marshall’s family, her death was caused by complications from diabetes.
Marshall spoke about other health problems over the years—including lung and brain cancer diagnoses in 2009—but not about diabetes. It’s unclear how long she lived with the condition, or whether she had type 1 or type 2.
Diabetes is a chronic condition that affects millions of people in the United States—many who live for years with the diagnosis. So the Hollywood legend’s death may have people wondering, how exactly does someone die from diabetes?
To find out, Health spoke with Donald Mcclain, MD, professor of endocrinology and metabolism at Wake Forest School of Medicine. Here are some of the most common complications of diabetes (both type 1 and type 2) that can lead to fatal consequences, and how patients can protect themselves.
Too-high blood sugar
When diabetes is well managed, patients can live long and healthy lives. But one of the biggest threats to people who have this condition is uncontrolled blood glucose levels. If glucose levels get too high, for example, it can lead to sudden death.
This complication, known as diabetic ketoacidosis, is more common in type 1 diabetes, a condition in which the body cannot make its own insulin. However, it’s not unheard of in people with uncontrolled type 2 diabetes (in which insulin production is present but impaired), as well.
Most people with type 1 diabetes are able to keep their blood glucose at normal levels by using an insulin pump or by manually injecting themselves with insulin several times a day. But ketoacidosis can still happen—and without immediate treatment with insulin, it can be fatal. This can happen when people skip doses of insulin, but it can also be caused by illnesses or certain drugs.
Damaged organs over time
Another way diabetes can lead to death is by damage done to organs and tissues in the body over a long period of time. “For example, the blood vessels in the kidneys can be damaged by high blood sugar,” says Dr. Mcclain—a complication that can lead to kidney failure and require dialysis.
This same type of organ and blood-vessel damage can also lead to blindness and to amputation of feet or legs, he adds, which can reduce quality of life and raise the risk of infection, injuries, or additional illnesses. “We know that keeping blood sugar under control, for both type 1 and type 2 diabetes, is one of the best ways to reduce the risk of these complications,” says Dr. Mcclain.
An increased risk of heart and vascular problems
About two-thirds of people with diabetes actually die from cardiovascular conditions like heart attacks or strokes, says Dr. Mcclain. That’s because diabetes can occur alongside other conditions like obesity, high cholesterol, or high blood pressure, and the combination of these diseases can make each of them more dangerous. People with diabetes are also more likely to develop Alzheimer’s disease.
Maintaining a healthy weight, eating a balanced diet, and getting regular physical activity are all ways that people with diabetes can help protect their heart and their brain as they age. But it’s also important they work with their doctors to keep their blood glucose—as well as their blood pressure and cholesterol—in the healthy range.
Too-low blood sugar
Overtreatment of diabetes is also a concern, says Dr. Mcclain. “If you take too much insulin and your blood sugar goes way down, that can cause seizure, coma, and death,” he says. Low blood sugar can literally starve the brain of oxygen, he adds, and it can also trigger dangerous heart arrhythmias.
Improvements in medical technology have made overtreatment much less likely than it once was, says Dr. Mcclain, but it’s still a risk—especially as patients get older. “The warning system that lets your brain know that your blood sugar is getting too low becomes blunted as you age,” he says. “Elderly people also may not be eating meals on a regular schedule, which can affect insulin levels.”
Doctors are seeing fewer complications, but more diabetes cases overall
Dr. Mcclain says that doctors are getting better at treating diabetes—and at preventing complications so patients can live longer, healthier lives. “Just yesterday I had several diabetes patients in their 80s who are doing quite well,” he says. “It’s not easy, and it’s a lot of work on the part of the patient, but we have good tools that are getting better all the time, and we can do this.”
But at the same time, more and more people are being diagnosed with type 2 diabetes—which means that there are still plenty of people suffering from complications and dying from those complications, as well. “We’re doing better on a population level at managing it,” says Dr. Mcclain, “but we’re still fighting a rising tide of disease.”
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