Cited by 225Diabetes Management and ResearchAutopsy Techniques and OutcomesPatient Safety and Medication Errors

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Confirmation of Hypoglycemia in the “Dead-In-Bed” Syndrome, as Captured by a Retrospective Continuous Glucose Monitoring System

Tanenberg, Robert J., Newton, Christopher A., Drake, Almond J.·2010·Endocrine Practice

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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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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)
DOI: 10.4158/ep09260.cr
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Endocrine Practice (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Pathology and Forensic Medicine › Autopsy Techniques and Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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Confirmation of Hypoglycemia in the “Dead-In-Bed” Syndrome, as Captured by a Retrospective Continuous Glucose Monitoring System

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