Relationship of Nocturnal Hypoglycemia to Daytime Glycemia in IDDM

Lerman, Israel; Wolfsdorf, Joseph I.

doi:10.2337/diacare.11.8.636

Cited by 20 publications

(16 citation statements)

References 22 publications

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“…As noted earlier, there is substantial numerical agreement concerning the minimal impact of nocturnal hypoglycemia on fasting glycemia in IDDM patients (6)(7)(8)(9)(10)12,21,22). These data add to this, and further support the conclusion that nocturnal hypoglycemia does not appear to cause clinically important fasting hyperglycemia in IDDM patients (12).…”

Section: Table 4 Potential Determinants Of Plasma Glucose Concentratisupporting

confidence: 71%

“…Although not supported by several clinical studies (6,8,9), this aspect of the Somogyi hypothesis is supported by the study by Perriello et al (21). Their data indicate that the pathophysiology of posthypoglycemic insulin resistance may be translated into excessive postprandial hyperglycemia under a specific clinical condition: patients with IDDM willing and able to achieve very tight glycemic control with a continuous subcutaneous insulin infusion.…”

Section: Table 4 Potential Determinants Of Plasma Glucose Concentratimentioning

confidence: 74%

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Failure of Nocturnal Hypoglycemia to Cause Daytime Hyperglycemia in Patients With IDDM

et al. 1990

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To test the hypothesis that nocturnal hypoglycemia causes postprandial hyperglycemia the next day (the Somogyi phenomenon) in patients with insulin-dependent diabetes mellitus (IDDM), we studied 10 moderately well controlled patients, who were on their usual therapeutic regimens, from 2000 to 2000 on three occasions. On a control day, samples were obtained without intervention. On another day, nocturnal hypoglycemia was prevented (by intravenous infusion of glucose, if necessary, from 2200 to 0400 to keep plasma glucose levels at greater than 5.6 mM). On another day, nocturnal hypoglycemia was induced (by stepped intravenous insulin infusions between 2200 and 0200 to reduce plasma glucose levels to less than 2.8 mM). After nocturnal hypoglycemia (1.9 +/- 0.2 mM), fasting (0800), morning (0800-1100), afternoon (1200-1500), evening (1600-2000), and entire-day (0800-2000) plasma glucose concentrations were no higher than those after prevention of nocturnal hypoglycemia or sampling only. On the control day, fasting and daytime plasma glucose levels were directly related to the preceding 2200 (r = 0.723, P less than 0.02, and r = 0.762, P = 0.01, respectively) and nocturnal nadir (r = 0.714, P less than 0.02, and r = 0.728, P less than 0.02) plasma glucose concentrations. Daytime plasma glucose levels were unrelated to peak nocturnal plasma glucagon, epinephrine, norepinephrine, growth hormone, or cortisol concentrations. We conclude that nocturnal hypoglycemia does not appear to cause clinically important daytime hyperglycemia in patients representative of most patients with IDDM.

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Section: Table 4 Potential Determinants Of Plasma Glucose Concentratisupporting

confidence: 71%

Section: Table 4 Potential Determinants Of Plasma Glucose Concentratimentioning

confidence: 74%

Failure of Nocturnal Hypoglycemia to Cause Daytime Hyperglycemia in Patients With IDDM

et al. 1990

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“…injection of soluble insulin into the thigh than after s. c. injection into the thigh [2] An important finding in the present study was the marked decrease in blood glucose concentrations from bedtime to 03.00 hours in the SCT group The lower noc turnal blood glucose concentration in the SCT group was due to a higher incidence of blood glucose values below 4 mmol/1. Nocturnal hypoglycaemia is a major problem in the treatment of the diabetic patient [19][20][21][22][23][24][25]; several risk factors have been identified [23][24][25]. The present study indicates a formerly unknown risk factor.…”

Section: Discussionmentioning

confidence: 64%

“…Another risk factor for nocturnal hypoglycaemia is blood glucose concentration at bedtime, thus the lower the blood glucose concentration the higher the risk for developing nocturnal hypoglycaemia [23][24][25]. However, blood glucose concentration at bedtime was similar in the three groups.…”

Section: Discussionmentioning

confidence: 90%

Impact of injection sites for soluble insulin on glycaemic control in Type 1 (insulin-dependent) diabetic patients treated with a multiple insulin injection regimen

et al. 1993

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Summary.The absorption rate of rapid acting (soluble) insulin is slow from the subcutaneous tissue of the thigh compared to intramuscular injection into the thigh and s. c. injection into the abdominal wall. The aim of the study was to evaluate the impact of soluble insulin injected either intramuscularly into the thigh (IMT), s. c. into the abdominal wall (SCA) or s.c. into the thigh (SCT) on glycaemic control in Type 1 (insulin-dependent) diabetic outpatients treated with the basal bolus insulin delivery regimen. Fifty-five, C-peptide negative Type 1 diabetic outpatients were included in a randomised 3-month intervention study. The insulin doses were adjusted frequently by blinded observers based on the patients' self-monitored blood glucose values and reported hypoglycaemic episodes. The serum fructosamine value was within normal limits in three patients in the IMT group, in six patients in the SCA group and in none of the patients in the SCT group following the intervention period (p < 0.01). However, the difference in mean serum fructosamine values did not reach statistical significance (IMT: 1.24 retool/1 (95 % confidence interval; 1.17 to 1.31), SCA: 1.25 mmol/1 (1.18 to 1.32), SCT: 1.34 mmol/1 (1.26 to 1.41), (p = 0.09)). Blood glucose excursions were larger in the SCT group than in the SCA and IMT group from post-lunch to pre-dinner measurements and from pre-to post-dinner measurements. A higher number of measured low nocturnal blood glucose values (less than 4 mmol/1) was observed in the SCT group (34 of 85) than in the IMT (14 of 64) and SCA (21 of 81) group (p < 0.05). Three patients in the IMT group, two in the SCA group, and seven in the SCT group experienced severe hypoglycaemic episodes (p = 0.14). In conclusion s. c. injection of soluble insulin into the abdominal wall is preferable compared to s. c. injection into the thigh in the basal bolus insulin delivery regimen. Furthermore, soluble insulin injection s. c. into the thigh during daytime has important clinical implications for the development of nocturnal hypoglycaemia independently of the NPH insulin injection at bedtime. Key words: Insulin pharmacokinetics, intramuscular insulininjection, subcutaneous insulin injection, blood glucose control, nocturnal hypoglycaemia.The multiple insulin injection regimen (basal bolus insulin delivery regimen) is based on injections of soluble (rapid acting) insulin at mealtimes and injections of NPH (intermediate acting) insulin at bedtime. The purpose of this insulin regimen is to mimic the normal diurnal plasma insulin profile [1]. Thus, the purpose of the bolus component is to provide insulin delivery adequately timed to the absorption of the meal, whereas the purpose of the basal component is to provide adequate insulinisation during the night time and between meals. Obviously, insulin delivery depends on the absorption rate of the injected insulin and this has been demonstrated to vary considerably between different anatomical regions [2][3][4][5][6][7][8][9][10][11][12].It has been shown, that the p...

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“…A few studies in which glucose profiles after hypoglycaemia were monitored beyond fasting values have been presented [7,8].These observational studies were unable to convincingly detect significant hyperglycaemic effects of nocturnal hypoglycaemia during the following daytime period. These observational studies, which were conducted over 15 years ago, were unable to detect significant hyperglycaemic effects during the day after nocturnal hypoglycaemia.…”

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confidence: 99%

Comment to: Hoi-Hansen T, Pedersen-Bjergaard U, Thorsteinsson B (2005) The Somogyi phenomenon revisited using continuous glucose monitoring in daily life. Diabetologia 48:2437–2438

et al. 2006

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Relationship of Nocturnal Hypoglycemia to Daytime Glycemia in IDDM

Cited by 20 publications

References 22 publications

Failure of Nocturnal Hypoglycemia to Cause Daytime Hyperglycemia in Patients With IDDM

Failure of Nocturnal Hypoglycemia to Cause Daytime Hyperglycemia in Patients With IDDM

Impact of injection sites for soluble insulin on glycaemic control in Type 1 (insulin-dependent) diabetic patients treated with a multiple insulin injection regimen

Comment to: Hoi-Hansen T, Pedersen-Bjergaard U, Thorsteinsson B (2005) The Somogyi phenomenon revisited using continuous glucose monitoring in daily life. Diabetologia 48:2437–2438

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