Confirmation of Hypoglycemia in the “Dead-In-Bed” Syndrome, as Captured by a Retrospective Continuous Glucose Monitoring System

Tanenberg, Robert J.; Newton, Christopher A.; Drake, Almond J.

doi:10.4158/ep09260.cr

Cited by 198 publications

(147 citation statements)

References 17 publications

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“…1 It has been demonstrated that seizures can occur after 2.25 h of nocturnal hypoglycemia (glucose levels of <60 mg/dL), 2 and in a case of the dead-in-bed syndrome over 3 h of sensor hypoglycemia was documented. 3 Unfortunately, even when using CGM, a hypoglycemia alarm overnight is not protective, as most of the time a sleeping child will not be awakened by the alarm. 4 The ideal system for preventing nocturnal hypoglycemia would work automatically without alarms and without a need for the patient to awaken by suspending or attenuating insulin delivery to prevent hypoglycemia and then returning to the usual basal insulin infusion rate when the risk of hypoglycemia abates.…”

Section: Introductionmentioning

confidence: 99%

Outpatient Safety Assessment of an In-Home Predictive Low-Glucose Suspend System with Type 1 Diabetes Subjects at Elevated Risk of Nocturnal Hypoglycemia

Buckingham

Cameron

Calhoun

et al. 2013

Diabetes Technology & Therapeutics

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Objective: Nocturnal hypoglycemia is a common problem with type 1 diabetes. In the home setting, we conducted a pilot study to evaluate the safety of a system consisting of an insulin pump and continuous glucose monitor communicating wirelessly with a bedside computer running an algorithm that temporarily suspends insulin delivery when hypoglycemia is predicted. Research Design and Methods: After the run-in phase, a 21-night randomized trial was conducted in which each night was randomly assigned 2:1 to have either the predictive low-glucose suspend (PLGS) system active (intervention night) or inactive (control night). Three predictive algorithm versions were studied sequentially during the study for a total of 252 intervention and 123 control nights. The trial included 19 participants 18-56 years old with type 1 diabetes (hemoglobin A1c level of 6.0-7.7%) who were current users of the MiniMed Paradigm Ò REAL-Time RevelÔ System and Sof-sensor Ò glucose sensor (Medtronic Diabetes, Northridge, CA). Results: With the final algorithm, pump suspension occurred on 53% of 77 intervention nights. Mean morning glucose level was 144 -48 mg/dL on the 77 intervention nights versus 133 -57 mg/dL on the 37 control nights, with morning blood ketones >0.6 mmol/L following one intervention night. Overnight hypoglycemia was lower on intervention than control nights, with at least one value £70 mg/dL occurring on 16% versus 30% of nights, respectively, with the final algorithm. Conclusions: This study demonstrated that the PLGS system in the home setting is safe and feasible. The preliminary efficacy data appear promising with the final algorithm reducing nocturnal hypoglycemia by almost 50%.

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Section: Introductionmentioning

confidence: 99%

Outpatient Safety Assessment of an In-Home Predictive Low-Glucose Suspend System with Type 1 Diabetes Subjects at Elevated Risk of Nocturnal Hypoglycemia

Buckingham

Cameron

Calhoun

et al. 2013

Diabetes Technology & Therapeutics

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“…Sudden death in known diabetic patients is often thought to be associated with hypoglycemia. In one 23-year-old diabetic man being managed with CSII who was found dead in bed having last been seen 20 h prior, hypoglycemia at the time of death was retrospectively confirmed by a continuous glucose monitoring system [41]. Hypoglycemia may also produce concomitant hypothermia or, rarely, hyperthermia [42].…”

Section: What Adverse Events Are Associated With Insulin Overdose?mentioning

confidence: 99%

Case Files of the Harvard Medical Toxicology Fellowship at Children’s Hospital Boston: An Insulin Overdose

Skolnik

Ewald

2010

J. Med. Toxicol.

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A 16-year-old boy with a history of type I diabetes mellitus being managed with an insulin pump presented to the emergency department in cardiac arrest. Per report from the patient's mother, the patient had noticed that his insulin cartridge, containing insulin lispro, was empty the night prior to admission so he had replaced it at approximately 7:00 PM. He had used his glucometer through the night with recorded values of 225-389 mg/dL and had administered a total of 14.5 units of insulin via his pump. At around 6:30 AM, the morning of admission, his mother attempted to wake him for school and found him cyanotic and motionless. She attempted to obtain a fingerstick glucose measurement but was unable to do so and administered glucagon, as well as activating Emergency Medical Services (EMS). When EMS arrived, the patient was pulseless. Cardiopulmonary resuscitation was initiated, and the patient was endotracheally intubated. Point-of-care glucose determination was 81 mg/dL. He received epinephrine, atropine, naloxone, and an ampule of 50% dextrose (25 g) during his prehospital care. He was defibrillated twice at 200 J for ventricular fibrillation. He was transferred to the emergency department with cardiopulmonary resuscitation in progress. EMS reported that an empty insulin syringe had been seen underneath the patient's bed. After approximately 1 h of resuscitative efforts, during which the patient received additional epinephrine, sodium bicarbonate, and hydrocortisone, he had return of spontaneous circulation. His initial arterial blood gas revealed a pH of 6.8, PaCO 2 of 70 mmHg, and PaO 2 of 335 mmHg. His serum glucose at that time was 377 mg/dL, and the anion gap was 39 mEq/L with urine negative for ketones. He underwent computed tomography scan of the head, chest, abdomen, and pelvis that demonstrated left upper lobe consolidation and gastric distention but was otherwise normal. He was transferred to a tertiary-care children's hospital where his serum glucose on arrival was 50 mg/dL. He received 25 g of intravenous dextrose, and an infusion of 10% dextrose in normal saline was started. A toxicology consult was obtained.

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“…21,24 One case report confirmed hypoglycemia as the cause of deadin-bed syndrome, and a recent report by Novodvorsky et al confirms that cardiac arrhythmias and repolarization occur during asymptomatic nocturnal hypoglycemia more commonly than daytime hypoglycemia. [25][26][27] Hypoglycemia is a well-described deterrent to the achievement of normal glycemia and impacts patients at all levels of glucose control. Mild hypoglycemia is common in patients with type 1 diabetes, occurring daily to weekly.…”

Section: Cgm In Type 1 Diabetes Treated With MDImentioning

confidence: 99%

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

McGill

Ahmann

2017

Diabetes Technology & Therapeutics

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Continuous glucose monitoring (CGM) is developing into an increasingly useful tool for glucose monitoring and therapeutic guidance in the treatment of diabetes. Multiple daily doses of insulin (MDI) is the most common method for intensive insulin treatment of type 1 diabetes and is also becoming more common in the treatment of type 2 diabetes as an increasing population with type 2 diabetes experiences progressive beta cell loss. The clinical evidence demonstrating the benefit of CGM in the outcomes of patients treated with MDI is becoming clearer, particularly with the recent completion of several randomized clinical trials addressing both type 1 and 2 diabetes. This evidence is reviewed.

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Confirmation of Hypoglycemia in the “Dead-In-Bed” Syndrome, as Captured by a Retrospective Continuous Glucose Monitoring System

Cited by 198 publications

References 17 publications

Outpatient Safety Assessment of an In-Home Predictive Low-Glucose Suspend System with Type 1 Diabetes Subjects at Elevated Risk of Nocturnal Hypoglycemia

Outpatient Safety Assessment of an In-Home Predictive Low-Glucose Suspend System with Type 1 Diabetes Subjects at Elevated Risk of Nocturnal Hypoglycemia

Case Files of the Harvard Medical Toxicology Fellowship at Children’s Hospital Boston: An Insulin Overdose

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

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