While death in people undergoing a prolonged fasting period is rare, when it did occur, it was in several cases associated with insulin use. A few patients have died by combining fasting with an insulin injection, probably because insulin normally works poorly in diabetes patients, and fasting partially reverses this effect. The same insulin injection that normally decreases glucose to healthy levels in a diabetic patient can cause a much more precipitous drop in a diabetic patient who is fasting—resulting in hypoglycemic shock and, in some cases, death. Similar albeit reduced dangers apply to
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