In memory of Margaret Pitt

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Tragic, a woman (with Insulinitis, old
name: type 1 diabetes, for 30 years)
slightly younger than me, died due to
negligence, in the UK.

The causality, a severe hypoglycemic
event which transpired in a hospital
after Margaret was admitted due to a
serious low glucose event, and was
unmonitored after being moved out
of intensive care.

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June 25, 2012
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Excerpts [with inserts, not part of original
article, included in brackets]:

A ... mother-of-three died after doctors
forgot to check her blood sugar levels
- days after she went to hospital with
dangerously low glucose levels.

Margaret Pitt, 55, who had lived with ...
[Insulinitis] for 30 years, admitted herself
to hospital when she realised her blood
sugar [glucose] levels were too low.

But after she was moved off the intensive
care ward at Alexandra Hospital, Worces-
tershire, medics neglected to continue to
monitor her blood levels - and she collapsed
and suffered irreversible brain damage in
November 2010.

Now, a coronor has criticised medics who
carried out her treatment - describing the
actions of a nurse who failed to check the
teaching assistant's blood levels as 'a gross
failure to provide basic medical treatment'.

Margaret's devastated widower, David, said:
'Maggie and I had been happily married for
35 years and for her life to be tragically cut
short so needlessly is almost too much to

'I am absolutely distraught by Margaret's
death and very angry that she was let down
so badly by the nurses that she put her
complete trust in.

'My wife deserved far better. She was on
a ward which was supposed to have exper-
ience of caring for ... patients [who have
one of the High Glucose Conditions] and
supposedly had the expertise to treat her
condition, yet it appears she was just left
to deteriorate without anyone checking her
blood sugar [glucose] levels.

'Over the years there were a number of
occasions when I had to pull Maggie out
of hypoglycaemic shock. I would check the
back of her neck and if she was perspiring,
I would give her warm water and a glucose
tablet. It's not rocket science and so I still
don't understand how trained medical staff
got it so wrong.'

Margaret had lived with ... [Insulinitis] for
more than 30 years, having been diagnosed
when she was 20 years old, and over the
years had become used to the daily routine
of injections and checking her blood glucose

However, on 4 November 2010 Margaret
began to feel unwell and she recognised
the tell-tale signs that her blood glucose
levels had risen to a point where she needed
medical help. She was admitted to the
Alexandra Hospital and after being treated
in intensive care she was moved to a ward
for ongoing glucose tests and treatment.

In the early hours of 13 November, Margaret
was found collapsed and unconscious and
she was rushed back to intensive care where
doctors discovered that she had suffered
severe brain damage as a result of dan-
gerously low blood glucose levels.

Her family were told that the damage was
irreversible and there was nothing more that
could be done. She remained in intensive
care until she was transferred to Primrose
Hospice on 19 November where two days
later, she died.


During a five-day inquest, HM Deputy Coroner
for Worcestershire, Marguerite Elcock, heard
how an experienced nurse failed to carry out
blood tests which would have shown that
Margaret's glucose levels were not being
.... [maintained at acceptable levels] after
she was admitted.

Medical law expert Sara Burns, from solicitors
Irwin Mitchell, representing the family, said:
'The inquest has been incredibly harrowing
for Margaret's family as they have heard that
she was woefully let down by a number of
clinicians on this ward.

'Repeated opportunities to intervene and
stabilise Margaret were missed and guide-
lines for blood glucose level testing were
not followed ...

'NHS policies and guides are in place for a
reason - to save lives, and staff across the
NHS must follow these to prevent unneces-
sary deaths.

'We will continue to help Margaret's family
in their battle for justice and we are now
considering whether, given the evidence
heard during this inquest, it is appropriate
for us to refer the case to the Nursing and
Midwifery Council.'

David added: 'I believe Margaret would still
be alive today if she had received the cor-
rect treatment and, although nothing will
turn back the clock for us, I hope improve-
ments have since been made to protect
any other family from suffering the heart-
break we have had to endure.'

Margaret's daughter, Samantha, added:
'Margaret or 'Maggie' as she was affection-
ately known, was a loving mother, grand-
mother, sister and daughter. Her unex-
pected death has left a very large void in
all our lives.

'Due to a series of failures she is now un-
able to watch her children and grandchil-
dren grow up and have been stripped of
the chance to happily live out her retire-
ment in her beloved chosen location of
Somerset for which she had so many

'We are grateful that the inquest has pro-
vided us with some important answers
regarding the circumstances of my Mum's
death, so that we as a family can have
some closure after 19 long and very hard


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Pro-Humanist FREELOVER
C.ure I.nsulinitis A.ssociation
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