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Cited by 50Adrenal Hormones and DisordersDiabetes Management and ResearchPancreatic function and diabetes

Nocturnal hypoglycemia identified by a continuous glucose monitoring system in patients with primary adrenal insufficiency (addison’s disease)

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Meyer, Gesine, Hackemann, Annika, Reusch, Juergen, Badenhoop, Klaus·2012·Diabetes Technology & Therapeutics
DOI 10.1089/dia.2011.0158PMC PMC3338953
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Abstract

Background Hypoglycemia can be a symptom in patients with Addison's disease. The common regimen of replacement therapy with oral glucocorticoids results in unphysiological low cortisol levels in the early morning, the time of highest insulin sensitivity. Therefore patients with Addison's disease are at risk for unrecognized and potentially severe nocturnal hypoglycemia also because of a disturbed counterregulatory function. Use of a continuous glucose monitoring system (CGMS) could help to adjust hydrocortisone treatment and to avoid nocturnal hypoglycemia in these patients. Methods Thirteen patients with Addison's disease were screened for hypoglycemia wearing a CGMS for 3-5 days. Results In one patient we identified a hypoglycemic episode at 3:45 a.m. with a blood glucose level of 46 mg/dL, clearly beneath the 95% tolerance interval of minimal glucose levels between 2 and 4 a.m. (53.84 mg/dL). After the hydrocortisone replacement scheme was changed, the minimum blood glucose level between 2 and 4 a.m. normalized to 87 mg/dL. Conclusions Continuous glucose monitoring can detect nocturnal hypoglycemia in patients with primary adrenal insufficiency and hence prevent in these patients an impaired quality of life and even serious adverse effects.

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Crossref · 10.1089/dia.2011.0158

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  • Several studies using continuous glucose monitoring in adults with adrenal insufficiency have shown benefits by providing useful information on blood sugar trends.

    “Several studies conducted using CGM in adults with AI have shown benefits as they provided useful information on blood sugar trends.”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [52]

  • In a separate case study, a patient with Addison's disease reported better sleep when the evening dose of hydrocortisone was delayed due to detected hypoglycaemia from continuous glucose monitoring.

    “In a separate case study, a patient with Addison’s disease reported better sleep when the evening dose of hydrocortisone was delayed due to detected hypoglycaemia from CGM (52).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [52]

  • Insulin sensitivity is highest between 0200 and 0400, causing patients with adrenal insufficiency to be at risk of nocturnal hypoglycaemia.

    “Insulin sensitivity is also the highest between 0200 and 0400, causing patients with AI to be at risk of nocturnal hypoglycaemia (52).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [52]

  • Lack of cortisol may augment insulin sensitivity, leading to increased glucose uptake, and nocturnal fasting hypoglycemia may occur because insulin sensitivity tends to be highest between 2-4 a.m.

    “Second, the lack of cortisol may augment insulin sensitivity, leading to increased glucose uptake. As a result, nocturnal fasting hypoglycemia may occur, as insulin sensitivity tends to be highest between the hours of 2-4 a.m. [33].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [33]

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Authors
Meyer, G., Hackemann, A., Reusch, J., & Badenhoop, K.
Affiliations
  • University Hospital Frankfurt (DE)
  • Medical Clinic 2, Hospital Frankfurt-Hoechst, Frankfurt, Germany.
Corresponding author
Meyer, Gesine
ORCID
Meyer, Gesine
Venue
Diabetes Technology & Therapeutics
Publisher
SAGE Publications
Published
2012-05
Volume
14
Issue
5
Pages
386-388
ISSN
  • 1520-9156 (ISSN-L)
  • 1557-8593
DOI
10.1089/dia.2011.0158
PMC
PMC3338953
OpenAlex
W2042292327
Cited by
50
References
14
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 3 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 8 · 2015: 1 · 2014: 5 · 2013: 3 · 2012: 2
FWCI
2.82
Type
journal article
Language
en
Open access
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Diabetes Technology & Therapeutics (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Keywords
nocturnal hypoglycemia, Addison's disease, continuous glucose monitoring, hydrocortisone replacement, glucocorticoid replacement therapy, cortisol deficiency, insulin sensitivity, hypoglycemia screening
MeSH terms
Addison Disease, Adult, Aged, Blood Glucose, Circadian Rhythm, Female, Humans, Hydrocortisone, Hypoglycemia, Male, Middle Aged, Monitoring, Physiologic, Patient Compliance, Patient Education as Topic, Retrospective Studies, Blood Glucose Self-Monitoring, Monitoring, Ambulatory, Young Adult

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