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I found this info out while looking things up about Hypoglycemia this morning. I was trying to find answers as to what exactly causes low blood sugar and came across this article and read it. I thought that this should be put out there cause I didn't even hear of this until this morning. I didn't know if anyone else had heard anything about it or if the rest of the world was left as clueless as I was. I hope this helps and I hopes this brings new light into the Diabetic Community.
Dead In Bed Syndrome
Publication Date: 1/26/2010
What is the "dead in bed syndrome"?
In 1991, a report was published concerning sudden death occurring in teens and young adults with type 1 diabetes (T1DM) (1). After excluding deaths due to circumstances such as diabetic ketoacidosis and suicide. Twenty-two cases were reported where the patient "had gone to bed in apparently good health and been found dead in the morning." Most of them had no known complications of diabetes, and they died while asleep and were found in an undisturbed bed. Autopsy findings were absent. The authors suggested that "the timing of death and other circumstantial evidence suggests that hypoglycaemia or a hypoglycaemia-associated event was responsible."
Since then, other authors have estimated that as many as 6% of deaths in people with T1DM who die before the age of 40 are due to the dead in bed syndrome (2).
The syndrome is always mentioned in patients with T1DM; whether it may occur in T2DM is not discussed.
What causes the "dead in bed syndrome"?
The original description of the syndrome reviewed alternative causes of death, and came to the conclusion that these deaths were in some way associated with hypoglycemia. However, proving that hypoglycemia was the triggering event for the death is difficult and this explanation of the syndrome remains tentative.
Since the original article, there has been a modification of the theory that hypoglycemia is the cause, in which it's suggested that night-time low sugar (nocturnal hypoglycemia) may provoke changes in heart electrical activity, leading to heart rhythm disturbances (cardiac arrhythmias) that in turn lead to death. It's been found that hypoglycemia can change the electrical activity of the heart (technically, hypoglycemia can cause prolongation of the QT interval) and it's thought that in susceptible individuals, the change in electrical activity might cause lethal arrhythmias. A recent study of 25 patients with T1DM, using continuous glucose monitoring, found nocturnal hypoglycemia and using electrocardiographic monitoring, found that cardiac rhythm disturbances were occurring while the blood sugar was low (3).
It's possible that patients who die unexpectedly with the "dead in bed" syndrome" have early neuropathy affecting the nerves to the heart (cardiac autonomic neuropathy). One author suggests that the most susceptible individuals for the dead in bed syndrome are those with another cardiac finding: mitral valve prolapse. The mitral valve of the heart occasionally is found to be abnormal in shape and floppy; this prolapse is fairly common in young women, and in rare cases, has been associated with sudden death (4).
Several authors have looked at the possibility that the kind of insulin (semisynthetic human vs. animal source) may play a role, but have concluded that this was not a factor. Diabetes UK (the British Diabetes Association) states that "there has been no increase in the number of deaths attributed to this cause since the introduction of human insulin" (5).
Sadly, the risk of "dead in bed syndrome" cannot be excluded for anyone with type 1 diabetes on tight-control insulin programs.
Is it possible to prevent the "dead in bed syndrome"?
As the usual explanation for the sudden death is related to hypoglycemia, most authors suggest that avoidance of nocturnal hypoglycemia is important. Checking blood glucose levels at night occasionally, or using continuous glucose monitoring, will give a sense of the risk of nocturnal hypoglycemia. Making sure that the bedtime dose of insulin isn't accidentally too large, or that the bedtime dose of a long-acting insulin isn't accidentally replaced by a dose of a short-acting insulin, is appropriate (6). Switching the patient from older insulin programs (such as using NPH at suppertime), and avoidance of injections of short-acting insulin at bedtime, are particularly important to consider. Changes in meal planning, encouraging eating appropriate bedtime snacks, may help to prevent nocturnal hypoglycemia (7). Cutting overnight insulin doses after unexpected strenuous exercise should be considered, as there may be delayed hypoglycemia after exercise.
http://www.diabetesmonitor.com/learning-center/other-complications/dead-in-bed-syndrome.htm
Dead In Bed Syndrome
Publication Date: 1/26/2010
What is the "dead in bed syndrome"?
In 1991, a report was published concerning sudden death occurring in teens and young adults with type 1 diabetes (T1DM) (1). After excluding deaths due to circumstances such as diabetic ketoacidosis and suicide. Twenty-two cases were reported where the patient "had gone to bed in apparently good health and been found dead in the morning." Most of them had no known complications of diabetes, and they died while asleep and were found in an undisturbed bed. Autopsy findings were absent. The authors suggested that "the timing of death and other circumstantial evidence suggests that hypoglycaemia or a hypoglycaemia-associated event was responsible."
Since then, other authors have estimated that as many as 6% of deaths in people with T1DM who die before the age of 40 are due to the dead in bed syndrome (2).
The syndrome is always mentioned in patients with T1DM; whether it may occur in T2DM is not discussed.
What causes the "dead in bed syndrome"?
The original description of the syndrome reviewed alternative causes of death, and came to the conclusion that these deaths were in some way associated with hypoglycemia. However, proving that hypoglycemia was the triggering event for the death is difficult and this explanation of the syndrome remains tentative.
Since the original article, there has been a modification of the theory that hypoglycemia is the cause, in which it's suggested that night-time low sugar (nocturnal hypoglycemia) may provoke changes in heart electrical activity, leading to heart rhythm disturbances (cardiac arrhythmias) that in turn lead to death. It's been found that hypoglycemia can change the electrical activity of the heart (technically, hypoglycemia can cause prolongation of the QT interval) and it's thought that in susceptible individuals, the change in electrical activity might cause lethal arrhythmias. A recent study of 25 patients with T1DM, using continuous glucose monitoring, found nocturnal hypoglycemia and using electrocardiographic monitoring, found that cardiac rhythm disturbances were occurring while the blood sugar was low (3).
It's possible that patients who die unexpectedly with the "dead in bed" syndrome" have early neuropathy affecting the nerves to the heart (cardiac autonomic neuropathy). One author suggests that the most susceptible individuals for the dead in bed syndrome are those with another cardiac finding: mitral valve prolapse. The mitral valve of the heart occasionally is found to be abnormal in shape and floppy; this prolapse is fairly common in young women, and in rare cases, has been associated with sudden death (4).
Several authors have looked at the possibility that the kind of insulin (semisynthetic human vs. animal source) may play a role, but have concluded that this was not a factor. Diabetes UK (the British Diabetes Association) states that "there has been no increase in the number of deaths attributed to this cause since the introduction of human insulin" (5).
Sadly, the risk of "dead in bed syndrome" cannot be excluded for anyone with type 1 diabetes on tight-control insulin programs.
Is it possible to prevent the "dead in bed syndrome"?
As the usual explanation for the sudden death is related to hypoglycemia, most authors suggest that avoidance of nocturnal hypoglycemia is important. Checking blood glucose levels at night occasionally, or using continuous glucose monitoring, will give a sense of the risk of nocturnal hypoglycemia. Making sure that the bedtime dose of insulin isn't accidentally too large, or that the bedtime dose of a long-acting insulin isn't accidentally replaced by a dose of a short-acting insulin, is appropriate (6). Switching the patient from older insulin programs (such as using NPH at suppertime), and avoidance of injections of short-acting insulin at bedtime, are particularly important to consider. Changes in meal planning, encouraging eating appropriate bedtime snacks, may help to prevent nocturnal hypoglycemia (7). Cutting overnight insulin doses after unexpected strenuous exercise should be considered, as there may be delayed hypoglycemia after exercise.
http://www.diabetesmonitor.com/learning-center/other-complications/dead-in-bed-syndrome.htm
