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Hypoglycemia Death Rate

Severe And Multiple Hypoglycemic Episodes Are Associated With Increased Risk Of Death In Icu Patients

Severe And Multiple Hypoglycemic Episodes Are Associated With Increased Risk Of Death In Icu Patients

Abstract In a randomized controlled trial comparing tight glucose control with a computerized decision support system and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity. Methods We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) hypoglycemia, multiple hypoglycemic events (n ≥3) and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary endpoint was 90-day mortality. We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10−5 digit with no replacement). A total of 2,601 patients were analyzed and divided into three groups: no hypoglycemia (n =1,474), moderate hypoglycemia (n =874, 34%) and severe hypoglycemia (n =253, 10%). Patients with moderate or severe hypoglycemia had a poorer prognosis, as shown by a higher mortality rate (36% and 54%, respectively, vs. 28%) and decreased number of treatment-free days. In the multivariable analysis, severe (odds ratio (OR), 1.50; 95% CI, 1.36 to 1.56; P =0.043) and multiple hypoglycemic events (OR, 1.76, 95% CI, 1.31 to 3.37; P <0.001) were significantly associated with mortality, whereas blood glucose CV was not. Using multivariable matching, patients with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality. In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality. Introduction Stress hyperglycemia and insulin resistance Continue reading >>

Severe Hypoglycemia And Risks Of Vascular Events And Death

Severe Hypoglycemia And Risks Of Vascular Events And Death

Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention. We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse clinical outcomes. We examined the associations between severe hypoglycemia and the risks of macrovascular or microvascular events and death among 11,140 patients with type 2 diabetes, using Cox proportional-hazards models with adjustment for covariates measured at baseline and after randomization. During a median follow-up period of 5 years, 231 patients (2.1%) had at least one severe hypoglycemic episode; 150 had been assigned to intensive glucose control (2.7% of the 5571 patients in that group), and 81 had been assigned to standard glucose control (1.5% of the 5569 patients in that group). The median times from the onset of severe hypoglycemia to the first major macrovascular event, the first major microvascular event, and death were 1.56 years (interquartile range, 0.84 to 2.41), 0.99 years (interquartile range, 0.40 to 2.17), and 1.05 years (interquartile range, 0.34 to 2.41), respectively. During follow-up, severe hypoglycemia was associated with a significant increase in the adjusted risks of major macrovascular events (hazard ratio, 2.88; 95% confidence interval [CI], 2.01 to 4.12), major microvascular events (hazard ratio, 1.81; 95% CI, 1.19 to 2.74), death from a cardiovascular cause (hazard ratio, 2.68; 95% CI, 1.72 to 4.19), and death from any cause (hazard ratio, 2.69; 95% CI, 1.97 to 3.67) (P<0.001 for all comparisons). Similar associations were apparent for a range of nonvascular outcomes, including respiratory, digestive, and skin conditions (P<0.01 for all comparisons). No r Continue reading >>

Type 1 Diabetes Hypoglycemia Deaths Per Year

Type 1 Diabetes Hypoglycemia Deaths Per Year

Hi, thanks for the article. I am a Type 1 diabetic. I use the Mini Med Paradigm Revel pump also. I have been using an insulin pump for the past 26 years. I started out with MiniMed, and I’ve used their pumps ever since. My question for those that are reading this blog is: Has anybody experienced paralysis when their blood sugars are extremely low? Two years ago, I awoke and I was completely paralyzed on my right side. I could turn my head, and my speech was normal. I woke my husband up, and said “Somethings not right!” He then asked if my blood sugar was low, and at the time I had no symptoms of low blood sugar. He rushed and brought me orange juice anyway. I drank two 8 oz glasses of juice, and slowly my right side began functioning again. Why, it didn’t alarm me more as to being paralyzed with a possible stroke, I don’t know. I called my physician and he immediately wanted me to come in. He then hospitalized me, and they ran a lot of test. All test came back normal. Thankfully. The only conclusion was that my blood sugar had dropped dangerously low, which caused the hemi paralysis. Jump now to this week, and I have had two mornings of waking up with hallucinations. This morning was the worst. I was screaming and crying at the top of my lungs. My husband was holding me and saying “it’s ok, it’s ok” , I was convinced that there were small babies drowning right beside me and I couldn’t move to help them. My right side was slightly paralyzed this morning also. This really scares me. I have some CGM sensors, but don’t always wear one, mainly because they are so expensive, and they only last 4 – 5 days per sensor. I will put one one this afternoon however. Just curious as to has anybody else experienced paralysis with low blood sugars? Continue reading >>

A Silent Danger: When Blood Sugar Goes Down While You Were Sleeping

A Silent Danger: When Blood Sugar Goes Down While You Were Sleeping

You've heard it before—how taking a snack at nighttime after dinner may not be such a good idea, what with the weight gain that may come with it. But if you're a diabetic, that nighttime snack may spell the difference between life and death—literally. “The absence of a nighttime snack when one is usually taken is one cause of nocturnal hypoglycemia,” said Dr. Richard Elwyn Fernando, president of Diabetes Philippines and consultant at St. Luke's Medical Center and Capitol Medical Center. Nocturnal hypoglycemia, as the name implies, happens at night. “It occurs when blood glucose levels fall below 4 millimoles per liter (mmol/l) or 72 milligrams per deciliter (mg/dl). At 40 mg/dl or below, a person can be comatose... In rare cases, it may lead to death,” Fernando said during a media briefing organized by pharmaceutical company Novo Nordisk last May 27. What makes it dangerous is that the person, being asleep, is not aware of what is happening and is not able to seek help. This poses a real concern for diabetics and their families, said Fernando. In a previous interview, former Health Secretary Esperanza Cabral said the body needs glucose to function well. “Kailangan ng katawan ang sugar for energy, metabolism,” she told GMA News. When the blood sugar drops to low levels, a person may experience dizziness, weakness and even fainting, Cabral said. There may also be confusion and disorientation. Fernando said hypoglycemia may lead to complications affecting the heart (decreased heart rate, decreased cardiac output, myocardial contractility), blood vessels (stroke, myocardial infarction, acute cardiac failure, ventricular arrythmia), and brain (seizures, convulsions, coma). While hypoglycemia may occur in both diabetics and non-diabetics alike—“kapag gutom Continue reading >>

The Dead In Bed Syndrome

The Dead In Bed Syndrome

Someone with type 1 diabetes is found dead in the morning in an undisturbed bed after having been observed in apparently good health the day before. No cause of death can be established. This is the typical situation of the "dead in bed" syndrome, a very tragic outcome which leaves the family with many unanswered questions: Why, when, how, could it have been avoided? After the first report from UK1 the observations have been confirmed from other countries.2,3 A number of young people with type 1 diabetes have been found dead in the morning without previous symptoms of illness, hyper- or hypoglycemia. The number of deaths of this kind per 10,000 patient years has been estimated to 2-6.4 For a population of 100,000 persons with diabetes, this represents 20-60 deaths per year or approximately 6% of all deaths in persons with diabetes aged less than 40 years.4 A relationship to human insulin1 or intensive insulin treatment2 has been postulated but does not seem likely.4 Autopsies have not revealed the cause of death. The diagnosis of hypoglycemia is difficult to confirm after death.5 There is however one case report where the person who died was wearing a retrospective (non-real-time) sensor, and the sensor reading demonstrated levels below 30 mg/dl (1.7 mmol/l) around the time of death (restrictions on reading glucose levels <40 mg/dl, 2.2 mmol/l, were removed by sensor manufacturer after the event), with at least 3 hours of severe hypoglycemia below <40 mg/dl, 2.2 mmol/l, before death.6 Another report using sensor tracings has shown a lag time of 2-4 hours before the onset of seizures when having severe hypoglycemia.7 In a recent review, clinical reports strongly suggest that nighttime hypoglycemia is a likely prerequisite of the event, but that the death is sudden and pr Continue reading >>

Hospitalization Rates For Hypoglycemia On The Rise

Hospitalization Rates For Hypoglycemia On The Rise

But those hospitalized are receiving better care than in the past, according to a longterm study. Hospitalization rates for hypoglycemia are increasing, according to a nine-year study published in The Lancet. The increased rate of hospitalization is most likely due to the increasing number of people with diabetes in the hospital system, researchers believe. Hypoglycemia, also known as low blood sugar, starves the brain of glucose energy, which can result in symptoms ranging from headache and confusion to loss of consciousness, seizure, coma, and death. While mild bouts of hypoglycemia can be treated at home, severe cases require hospitalization. For the study, researchers used the Hospital Episode Statistics database to collect data for all hospital visits in the UK that listed hypoglycemia as the primary reason of admission between January 1st, 2005 and December 31, 2014. In total, researchers examined 101,000 such hospital visits for about 80,000 people across England. By 2014, the rate of admissions for hypoglycemia increased by 39 percent from 2005 levels. However, when researchers factored in the increased number of total hospital admissions during that time period, they were able to decipher that the rate of admissions for hypoglycemia grew by just 14 percent. The good news is that those hospitalized received, on average, more effective care than in the past. Researchers found that length of stay, and rate of rapid readmissions and mortality all decreased throughout the study. Such studies point to the need for hospitals to be adequately prepared to assess and treat blood sugar-related problems, especially as rates of diabetes – and by extension, of hypoglycemia – rise. You can read more about how to lower your risk of a hospital stay from hypoglycemia by clic Continue reading >>

Effect Of Repetitive Glucose Spike And Hypoglycaemia On Atherosclerosis And Death Rate In Apo E-deficient Mice

Effect Of Repetitive Glucose Spike And Hypoglycaemia On Atherosclerosis And Death Rate In Apo E-deficient Mice

International Journal of Endocrinology Volume 2015 (2015), Article ID 406394, 9 pages 1Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan 2Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan 3Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan 4Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan 5Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan Academic Editor: Marco Bugliani Copyright © 2015 Kenichi Nakajima et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Epidemiological data suggest that postprandial hyperglycaemia and hypoglycaemia are potential risk factors for cardiovascular disease. However, the effects of repetitive postprandial glucose spikes, repetitive hypoglycaemia, and their combination on the progression of atherosclerosis remain largely unknown. The present study investigated the effects of rapid rises and falls in glucose, and their combination, on the progression of atherosclerosis in apolipoprotein (apo) E-deficient mice. In this study, apo E-deficient mice with forced oral administration of glucose twice daily for 15 weeks were used as a model of repetitive postprandial glucose spikes, and apo E-deficient mice given an intraperitoneal injection of insulin once a week for 15 weeks were used as a model of repetitive hyp Continue reading >>

Severe Hypoglycemia Predicts Mortality In Diabetes

Severe Hypoglycemia Predicts Mortality In Diabetes

In this issue of Diabetes Care, McCoy et al. (1) report 3.4-fold higher mortality in patients with diabetes who self-reported severe hypoglycemia (that which required the assistance of another person) 5 years earlier. They suggest that patient-related outcomes such as hypoglycemia would augment risk stratification and management of patients with diabetes. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes (2). It causes recurrent morbidity in most people with type 1 diabetes and many with advanced type 2 diabetes and is sometimes fatal. It impairs defenses against subsequent hypoglycemia and, thus, causes a vicious cycle of recurrent hypoglycemia. The barrier of hypoglycemia generally precludes maintenance of euglycemia over a lifetime of diabetes and, therefore, full realization of the benefits of glycemic control. Although it can be caused by an episode of marked absolute therapeutic hyperinsulinemia, iatrogenic hypoglycemia is typically the result of the interplay of mild-to-moderate absolute or even relative therapeutic hyperinsulinemia and compromised physiological and behavioral defenses against falling plasma glucose concentrations (2). The compromised physiological defenses include attenuated adrenomedullary epinephrine responses that, in the setting of absent insulin and glucagon responses, cause the clinical syndrome of defective glucose counterregulation with its 25-fold or greater increased risk of severe hypoglycemia during aggressive glycemic therapy. The compromised behavioral defense is the failure to ingest carbohydrates, which results from attenuated sympathoadrenal (largely sympathetic neural) responses that cause the clinical syndrome of hypoglycemia unawareness with its sixfold or greater increased risk of severe h Continue reading >>

High Mortality Risk In Hypoglycemic And Dysglycemic Children Admitted At A Referral Hospital In A Non Malaria Tropical Setting Of A Low Income Country

High Mortality Risk In Hypoglycemic And Dysglycemic Children Admitted At A Referral Hospital In A Non Malaria Tropical Setting Of A Low Income Country

Abstract Hypoglycemia is a recognized feature of severe malaria but its diagnosis and management remain problematic in resource-limited settings. There is limited data on the burden and prognosis associated with glycemia dysregulation in non-neonate children in non-malaria areas. We prospectively assessed the abnormal blood glucose prevalence and the outcome and risk factors of deaths in critically ill children admitted to a national referral hospital in Laos. Consecutive children (1 month-15 years) admitted to the pediatric ward of Mahosot hospital, were categorized using the integrated management of childhood illness (IMCI). Blood glucose was assessed once on admission through a finger prick using a bedside glucometer. Glycemia levels: hypoglycemia: < 2.2 mmol/L (< 40 mg⁄ dl), low glycemia: 2.2–4.4 mmol/L (40–79 mg⁄ dl), euglycemia: 4.4–8.3 mmol/L (80–149 mg⁄ dl), and hyperglycemia: > 8.3 mmol/L (≥150 mg⁄ dl), were related to the IMCI algorithm and case fatality using univariate and multivariate analysis. Results Of 350 children, 62.2% (n = 218) were severely ill and 49.1% (n = 172) had at least one IMCI danger sign. A total of 15 (4.2%, 95%CI: 2.4–6.9) had hypoglycemia, 99 (28.2%, 95%CI: 23.6–33.3) low glycemia, 201 (57.4%, 95% CI: 52.0–62.6) euglycemia and 35 (10.0%, 95% CI: 7.0–13.6) hyperglycemia. Hypoglycemia was associated with longer fasting (p = 0.001) and limited treatment before admission (p = 0.09). Hypoglycemia and hyperglycemia were associated with hypoxemia (SaO2) (p = 0.001). A total of 21 (6.0%) of the children died: 66.6% with hypoglycemic, 6.0% with low glycemic, 5.7% with hyperglycemic and 1.4% with euglycemic groups. A total of 9 (2.5%) deaths occurred during the first 24 hours of admission and 5 (1.7%) within 3 days of ho Continue reading >>

Mild Hypoglycemia Linked To Mortality Rate In Critically Ill Patients

Mild Hypoglycemia Linked To Mortality Rate In Critically Ill Patients

Home | News | Heart Health and Cholesterol A comprehensive global study involving medical centers from New Zealand, Australia and Japan has found that mild to moderate hypoglycemia, or low blood pressure, may increase the mortality rate in critically ill patients. The researchers examined nearly 4,946 critically ill patients, finding that 1,109 experienced hypoglycemia. The remaining 3,837 non-hypoglycemic patients served as the control group for the study. Although mild to moderate hypoglycemia had been previously considered to be clinically irrelevant, the research team found that patients afflicted with the condition had a mortality rate of 36.6 percent, compared to only 19.7 percent for those in the control group. Moreover, the investigators discovered that the severity of hypoglycemia directly correlated with the patient's risk of death. "Our results suggest that any tolerance of mild to moderate hypoglycemia by intensive care clinicians may be undesirable. In this regard, newer technologies such as continuous glucose monitoring in the ICU setting might help avoid hypoglycemia or identify it earlier," concluded Rinaldo Bellomo, from the department of intensive care at Austin Health in Australia. The mortality rate of each group remained the same after accounting for various risk factors, including insulin therapy and the timing of the episode. Related Articles from Private MD: Subscribe to Private MD Health News RSS Feed: News Categories: Advanced Lipid Treatment I Allergy Testing Anemia and RBC disorders Autoimmune Diseases Bariatric Lab Testing Blood and Blood Diseases Breast Cancer Detection and Tumor Markers Celiac Disease Testing Chlamydia Coagulation and blood clotting disorders Colon Diabetes DNA, Paternity and Genetic testing Drug Screening Environmental To Continue reading >>

Diabetes Public Health Resource

Diabetes Public Health Resource

Emergency Department (ED) visit rates for hypoglycemia among adults with diabetes aged 18 years or older remained stable between 2006 and 2009, with about 14 ED visits per 1,000 diabetic adults in 2009. Year Crude Age-Adjusted Rate Std Error Rate Std Error 2006 18.0 0.7 17.8 0.9 2007 18.3 0.8 19.4 1.2 2008 16.4 0.7 17.6 1.1 2009 14.5 0.6 14.2 0.7 Data Source: National Emergency Department Samples, Agency for Healthcare Research and Quality. National Health Interview Survey,Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). Data computed by personnel in CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Continue reading >>

Severe Hypoglycemia Associated With Cv Mortality Risk In Type 1

Severe Hypoglycemia Associated With Cv Mortality Risk In Type 1

A previous history of severe hypoglycemia is linked to increased death rates after a cardiovascular event in type 1 diabetes patients… Hypoglycemia is the most common and life-threatening complication of type 1 diabetes. The average type diabetes patient experiences about two episodes of hypoglycemia per week. Patients with type 1 diabetes are more prone to hypoglycemia than those with type 2 diabetes due to tight insulin therapy. In this study, severe hypoglycemia is considered an episode of hypoglycemia that requires hospitalization. Researchers examined the mortality risk after a major cardiovascular complication in type 1 diabetes patients with prior severe hypoglycemic events. They used data from the Swedish National Diabetes Register (NDR) linked to hospital records, prescription data, and death records. Patients with type 1 diabetes who had experienced major cardiovascular events after the clinic visit were selected between 2002-2010. The authors estimated the impact on 5-year mortality risk at the age of 60 with and without prior diabetes complications. The results showed that 403 out of 1,839 participants who experienced major cardiovascular events had prior severe hypoglycemic events and 703 died within the study period. A prior hypoglycemic episode was associated with a significant increase in mortality after a cardiovascular event (HR 1.79; 95% CI 1.37-2.35) within the first month and after one month (HR 1.25; 95% CI 33.4-46.3). Participants with previous hypoglycemia had an estimated 5-year cumulative mortality risk of 52.4% for MI and 39.8% for stroke. The researchers concluded that patients with a history of a hypoglycemic event had an even greater mortality risk after a major cardiovascular event, with an additional 10% being dead at the 5-year mark. P Continue reading >>

An Observational Study Of Patient Characteristics And Mortality Following Hypoglycemia In The Community

An Observational Study Of Patient Characteristics And Mortality Following Hypoglycemia In The Community

Objectives Characterize patients with diabetes with severe hypoglycemia requiring emergency services intervention at home and investigate 12-month mortality. Research design and methods Emergency services call-outs for hypoglycemia were recorded between 2005 and 2013 in an area covering 34 000 patients with diabetes. Patient characteristics were documented together with capillary blood glucose (CBG), glycated hemoglobin (HbA1c), and treatment for hypoglycemia; 12-month mortality and variables influencing survival were analyzed. Results In 1835 episodes among 1156 patients, 45% had type 1 diabetes (68.2% males) and 44% had type 2 diabetes (49.4% males), with a minority unclassified. CBG at presentation (mean±SD) was 1.76±0.72 mmol/L in patients with type 1 diabetes and 1.96±0.68 mmol/L in patients with type 2 diabetes (p<0.0001), with a higher HbA1c in the former group (8.3±1.52% (67.5±16.4 mmol/mol) and 7.8±1.74% (61.6±19.0 mmol/mol), respectively; p<0.0001). A third of patients with type 2 diabetes were not on insulin therapy and displayed lower HbA1c compared with insulin users. Glucagon was used in 37% of patients with type 1 diabetes and 28% of patients with type 2 diabetes (p<0.0001). One-year mortality was 4.45% in type 1 diabetes and 22.1% in type 2 diabetes. Age and type of diabetes were predictive of mortality in multivariable analysis, whereas CBG levels/frequency of hypoglycemia had no effect. Conclusions Severe hypoglycemia in the community is common with a male predominance in type 1 diabetes. Severe hypoglycemia in non-insulin treated patients with type 2 diabetes is associated with lower HbA1c compared with insulin users. Severe hypoglycemia appears to be associated with increased mortality at 12 months, particularly in type 2 diabetes. This is an Continue reading >>

Hypoglycemia

Hypoglycemia

Hypoglycemia is a common, potentially avoidable consequence of diabetes treatment and is a major barrier to initiating or intensifying antihyperglycemic therapy in efforts to achieve better glycemic control. Therapy regimen and a history of hypoglycemia are the most important predictors of future events. Other risk factors include renal insufficiency, older age, and history of hypoglycemia-associated autonomic failure. Reported rates of hypoglycemia vary considerably among studies because of differences in study design, definitions used, and population included, among other factors. Although occurring more frequently in type 1 diabetes, hypoglycemia also is clinically important in type 2 diabetes. Symptoms experienced by patients vary among individuals, and many events remain undiagnosed. The incidence of severe events is unevenly distributed, with only a small proportion (∼5%) of individuals accounting for >50% of events. Consequently, clinicians must be conscientious in obtaining thorough patient histories, because an accurate picture of the frequency and severity of hypoglycemic events is essential for optimal diabetes management. Severe hypoglycemia in particular is associated with an increased risk of mortality, impairments in cognitive function, and adverse effects on patients' quality of life. Economically, hypoglycemia burdens the healthcare system and adversely affects workplace productivity, particularly after a nocturnal event. Ongoing healthcare reform efforts will result in even more emphasis on reducing this side effect of diabetes treatment. Therefore, improving patients' self-management skills and selecting or modifying therapy to reduce the risk of hypoglycemia will increase in importance for clinicians and patients alike. Type 2 diabetes mellitus is Continue reading >>

Beware The Perils Of Severe Hypoglycemia

Beware The Perils Of Severe Hypoglycemia

Over 80 years ago, famed diabetologist Elliot Joslin said about the treatment of patients with type 1 diabetes: “Ketoacidosis may kill a patient, but frequent hypoglycemic reactions will ruin him.” Unfortunately, hypoglycemia continues to be the most difficult problem facing most patients, families, and caregivers who deal with the management of type 1 diabetes on a daily basis. Frequent hypoglycemia episodes not only can “ruin,” or adversely impact the quality of life for patients, but also, when severe, can cause seizures, coma, and even death. A Tragic Case Recently, our group published a case report in the journal Endocrine Practice describing a tragic death from hypoglycemia that occurred while the patient slept in his own bed. Our patient, a 23-year-old man with type 1 diabetes who had a history of recurrent severe hypoglycemia, was using an older model insulin pump and wearing a separate, non-real-time continuous glucose monitoring (CGM) system. He was given the CGM in 2005 for the purpose of tracking his nocturnal (nighttime) blood glucose values and making further insulin pump adjustments. After he was pronounced dead in the emergency room, our diabetes nurse removed the pump and CGM to help us understand what happened. His insulin pump was found to have been working correctly. What we learned was that after supper, he had a heavy workout at a gym, followed by a late snack. Between 8 pm and midnight, he “stacked” five boluses of insulin, totaling 7.35 units (33% of his basal dose), in an attempt to keep his glucose values in “tight” control. The downloaded sensor demonstrated that his glucose values fell from about 200 mg/dL at midnight to under 50 mg/dL by 2:00 am, and to under 30 mg/dL by 5:00 am – three hours before he was found by his pare Continue reading >>

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