Tanenberg RJ, Newton CA, Drake AJ.
Objective: The "dead-in-bed" syndrome accounts for approximately 6% of the mortality in patients with type 1 diabetes under the age of forty. Although theories explaining the syndrome involve hypoglycemia, proof of its presence is lacking since immediate postmortem glucose measurements are rarely obtained.Methods: We describe a case of a 23 year old man with a history of type 1 diabetes treated with an insulin pump, who had recurrent severe hypoglycemia. To better understand and eliminate these episodes the patient was placed on a retrospective continuous glucose monitoring system (CGMS). He was found dead in his undisturbed bed 20 hours later. The insulin pump and CGMS were both downloaded postmortem.Results: Postmortem download of the data in the CGMS demonstrated glucose levels below 30 mg/dL around the time of his death with only a minimal counterregulatory response. This corresponded to a post mortem vitreous glucose of 25 mg/dL.Conclusions: To our knowledge, this is the first documentation of hypoglycemia at the time of death in the "dead-in-bed" syndrome. This report should raise the awareness of physicians to the potentially lethal effects of hypoglycemia and provide justification of efforts directed at avoiding nocturnal hypoglycemia.
PMID: 19833577
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