Confirmation of hypoglycemia in the “dead-in-bed” syndrome, as captured by a retrospective continuous glucose monitoring system
Abstract
Objective To report a case that substantiates the presence of hypoglycemia at the time of death of a young man with type 1 diabetes, who was found unresponsive in his undisturbed bed in the morning.Methods We describe a 23-year-old man with a history of type 1 diabetes treated with an insulin pump, who had recurrent severe hypoglycemia. In an effort to understand these episodes better and attempt to eliminate them, a retrospective (non-real-time) continuous subcutaneous glucose monitoring system (CGMS) was attached to the patient. He was found dead in his undisturbed bed 20 hours later. The insulin pump and CGMS were both downloaded for postmortem study.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 counter-regulatory response. This finding corresponded to a postmortem vitreous humor glucose of 25 mg/dL. An autopsy showed no major anatomic abnormalities that could have contributed to his death.Conclusion To our knowledge, this is the first documentation of hypoglycemia at the time of death in a patient with the "dead-in-bed" syndrome. This report should raise the awareness of physicians to the potentially lethal effects of hypoglycemia and provide justification for efforts directed at avoiding nocturnal hypoglycemia.
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A temporal relationship between extremely low subcutaneous glucose concentrations and death in a patient with type 1 diabetes wearing a CGM device and found dead in bed has been reported.
“A temporal relationship between extremely low subcutaneous glucose concentrations and death in a patient with type 1 diabetes who was wearing a CGM device and was found dead in bed has been reported (31).”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [31]
A temporal relationship between extremely low subcutaneous glucose concentrations and death in a patient with type 1 diabetes who was wearing a CGM device and was found dead in bed has been reported.
“A temporal relationship between extremely low subcutaneous glucose concentrations and death in a patient with type 1 diabetes who was wearing a CGM device and was found dead in bed has been reported (31).”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [31]
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- Authors
- Tanenberg, R. J., Newton, C. A., & Drake, A. J.
- Affiliations
- East Carolina University (US)
- Emory University (US)
- Corresponding author
- Tanenberg, Robert J.
- ORCID
- Tanenberg, Robert J.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 16
- Issue
- 2
- Pages
- 244-248
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W1994810473
- Cited by
- 225
- References
- 21
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 8 · 2023: 15 · 2022: 13 · 2021: 9 · 2020: 11 · 2019: 13 · 2018: 18 · 2017: 21 · 2016: 10 · 2015: 21 · 2014: 16 · 2013: 29 · 2012: 11
- FWCI
- 6.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Autopsy Techniques and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- type 1 diabetes, continuous glucose monitoring, insulin pump therapy, nocturnal hypoglycemia, counterregulatory response
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemia, Insulin Infusion Systems, Male, Fatal Outcome, Young Adult
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