When many people think about insulin, the blood-sugar-lowering hormone’s ability to save the lives of people living with diabetes is one of the first things that come to mind. But a review published in Current Diabetes Reviews warns that insulin can be deadly when used to inflict self-harm, and urges doctors to watch for people who attempt suicide by misusing this medication, CBS News reports

Insulin is a natural hormone produced by the body that helps convert the sugar in foods into fuel for our cells. Individuals with type 1 or type 2 diabetes often use insulin meds to help regulate their blood sugar on a day-to-day basis. But doctors caution that taking too much or too little insulin can also cause life-threatening reactions in people with these illnesses. In addition, these findings warn that some individuals may purposely misuse the drug in an attempt to commit suicide.

This review is a follow-up to a study that authors Madhuker Trivedi, MD, and Alyson Myers, MD, published in 2013 in which 9.7 percent of patients with newly diagnosed diabetes (less than 24 months) endorsed a history of suicide attempt. According to the researchers, people living with diabetes tend to suffer much higher rates of depression than the general population, and suicide, or attempted suicide, by using insulin isn’t easy to spot.

“If someone comes in with hypoglycemia [extremely low blood sugar levels], you think ‘Oh, they overdid it.’ And sometimes when people come in with hyperglycemia [very high blood sugar levels] or DKA [diabetic ketoacidosis, a complication of hyperglycemia] the intention to self-harm can be missed,” said Myers, director of inpatient diabetes at North Shore University Hospital in Manhasset, New York, and lead author of the study.

The report recommended that doctors not assume that insulin overdoses or underdoses are simple mistakes and urged that patients be screened for psychosocial concerns after such events.

If doctors identify a potential concern, Myers said, they should refer patients to a mental health care provider. In addition, health care practitioners advised that anyone concerned that a loved one might be misusing his or her medications for self-harm should call that person’s doctor, bring them to the hospital or call 911 if the person is in immediate trouble.

Click here to learn more about how to help others through a diabetes crisis.