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Diabetes Sudden Death Syndrome

Dead In Bed Syndrome

Dead In Bed Syndrome

Twitter recently got in a twit about a statement someone found on the Internet: "One in 20 type 1 diabetics die in their sleep due to a sudden drop in their blood sugar." That’s quite a statistic, and one that raises all sorts of questions. Where did this strange and disturbing statistic come from? Does this mean that of all T1 PWD who die, 1 in 20 (5%) die in their sleep from something relating to dropping blood sugar? Does "sudden drop" mean any kind of drop - for instance, from high to normal, or only if it goes low? What’s the evidence that these deaths are indeed due to low blood sugar? And what can we do to prevent such a death? The "Dead in Bed Syndrome" is quite a problem, both for parents of kids with diabetes, and their physicians. One pediatric endocrinologist said "my patients are totally freaked out about this (as am I). My problem is that we have about 1200 patients in our practice with type 1 dm- does that mean statistically 6 patients in my practice will_ __eventually _drop dead in their sleep." A thorough discussion with multiple references, is on-line at the Children With Diabetes website, at The Dead in Bed Syndrome. It should be noted that different authors have developed different definitions for the Dead in Bed Syndrome (sometimes abbreviated DIB), and partially as a result of the differing definitions, and probably mainly as a result of differing patient populations (e.g., country where the study was done, degree of diabetes control of the patients, age breakdown, etc.) the rate of DIB varies widely. The Dead in Bed Syndrome was first discussed in 1991 when the Professional Advisory Committee of the British Diabetic Association published a report, Unexplained deaths of type 1 diabetic patients. They evaluated 50 autopsied deaths of people with Continue reading >>

New Risk Factors Identified For Sudden Cardiac Death In Type 2 Diabetes

New Risk Factors Identified For Sudden Cardiac Death In Type 2 Diabetes

New Risk Factors Identified for Sudden Cardiac Death in Type 2 Diabetes New Risk Factors Identified for Sudden Cardiac Death in Type 2 Diabetes Biomarkers, baseline HbA1c, and amputation predicted sudden cardiac death. New insights from the SAVOR-TIMI 53 Trial indicate that unexpected sudden cardiac death is a common cause of death in patients with type 2 diabetes, representing slightly less than one-third of all deaths. Additionally, researchers found that specific biomarkers may help identify patients with diabetes who are at high risk for sudden cardiac death. Study results were presented at the American College of Cardiology's (ACC) 65th Scientific Sessions . Sudden cardiac death represents a public health burden responsible for approximately 4 000 000 deaths every year in the world, said lead study author Ilaria Cavallari, MD, a postdoctoral research fellow and member of the TIMI Study Group at Brigham and Women's Hospital in Boston. Different epidemiological studies have shown that type 2 diabetes is associated with a 2-to-3-fold increased risk for sudden cardiac death. The most recent estimates suggest of 400 000 sudden cardiac deaths each year in the United States, approximately 80 000 involve diabetic patients. All together, these numbers are expected to increase according to the increasing prevalence of diabetes worldwide and strengthen the importance of early detection of additional modifiable risk factors. Until now the actual risk factors for sudden cardiac death in patients with type 2 diabetes have not been well described, noted Dr Cavallari. She and colleagues mined data from SAVOR-TIMI 53, a randomized trial of patients with type 2 diabetes and established cardiovascular disease (CVD) or multiple risk factors. In this trial, deaths were adjudicated by Continue reading >>

Diabetes Linked To All-cause And Sudden Death In The Young

Diabetes Linked To All-cause And Sudden Death In The Young

Diabetes Linked to All-Cause and Sudden Death in the Young ANAHEIM, CA Among patients ranging in age from infants to young adults who died in Denmark over the course of a decade, rates of all-cause death and sudden cardiac death were disproportionately higher among those who had type 1 or type 2 diabetes compared with those without diabetes, in a new study[ 1 ]. The findings showed that during a 10-year period, people aged 1 to 49 years with diabetes had a fivefold increased risk of all-cause death and a sevenfold increased risk of sudden cardiac death compared with their peers without diabetes, Jesper Svane (Copenhagen University Hospital, Rigshospitalet, Denmark) told a press conference here. He presented their results at the American Heart Association (AHA) 2017 Scientific Sessions . "We always knew that persons with diabetes have increased risks of all kinds of diseases and dying, but I think it's underestimated how much diabetes has an impact among the young and particularly on heart disease," Svane told theheart.org|Medscape Cardiology. "We know from previous studies that persons who die from sudden cardiac arrest have complained about either chest pain or syncope prior to death, so particularly among persons with diabetes, this needs to be taken seriously," he said. The study is "another spotlight" showing that "diabetes is a powerful predictor of premature heart disease and that we should be that much more careful in those patients, even in young people," AHA spokesperson Dr Vincent Bufalino (Advocate Health Care, Chicago) said in an interview. However, the registry lacked data about patient symptoms, glycemic control, or use of an insulin pump, Svane admitted, so some of the deaths classified as due to sudden cardiac arrest may have been related to glycemia. I Continue reading >>

Sudden Death And Hypoglycemia

Sudden Death And Hypoglycemia

Feature Article Simon Heller, BA, MB BChir, DM, FRCP Diabetic Hypoglycemia September 2008, Volume 1, Issue 2: page 2-7 Abstract There is considerable evidence implicating hypoglycemia as a cause of sudden death in patients with both type 1 and type 2 diabetes. Hypoglycemia has been recognized as a potential cause of death, particularly due to cerebral damage, ever since the introduction of insulin therapy. The pathophysiological changes that occur during hypoglycemia may also increase the risk of sudden death in patients with advanced cardiovascular disease. This feature article provides a detailed examination of the potential connection between sudden death and hypoglycemia. It discusses the findings of a number of studies, including the recent ACCORD study, and examines the phenomenon of sudden death in young people with diabetes, reviewing the potential mechanisms and therapeutic interventions. Risk of death from hypoglycemia and the problem of identifying deaths due to hypoglycemia are covered, as is nocturnal hypoglycemia - a common side effect of insulin treatment which is feared by many diabetes patients. The relationship between sudden death and the ‘dead in bed’ syndrome is also reviewed in detail. The review concludes that the risk of hypoglycemia-induced mortality is difficult to calculate accurately, but that there is considerable evidence implicating hypoglycemia as a rare cause of sudden death in individuals with type 1 diabetes. The review also indicates that hypoglycemia may increase the risk of ischemia and sudden death in individuals with type 2 diabetes, but points out that it is unclear whether the same mechanisms as in type 1 diabetes are responsible. Keywords: hypoglycemia, sudden death, cardiovascular disease, cerebral damage Continue reading >>

Sudden Death In Type 1 Diabetes: The Mystery Of The Dead In Bed Syndrome - Sciencedirect

Sudden Death In Type 1 Diabetes: The Mystery Of The Dead In Bed Syndrome - Sciencedirect

Volume 138, Issue 1 , 7 January 2010, Pages 91-93 Author links open overlay panel EmilyTuab Stephen M.Twiggbc ChristopherSemsarianabd Get rights and content Sudden cardiac death is an unpredictable and devastating event, particularly in the young. A significant proportion of sudden deaths in the young are unexplainedno cause is identified either during life or at post-mortem. This is seen in a subgroup of young patients with type 1 diabetes who have dead in bed syndrome, where these victims are in good health, retire to bed, only to be found dead the following morning in a bed which is undisturbed, suggesting no terminal struggle or seizure. The underlying cause of dead in bed syndrome remains unknown, but is likely to be due to a terminal malignant arrhythmia. A plausible hypothesis is that it may be secondary to QT interval prolongation (followed by a degenerate ventricular tachycardia), caused by a number of factors including acute hypoglycaemia, on a background of cardiac autonomic neuropathy, and possible genetic influences. It is envisaged that understanding the causes and triggers of dead in bed syndrome will allow appropriate therapeutic interventions to be initiated in high-risk patients with type 1 diabetes, with the ultimate goal to prevent sudden death. Continue reading >>

Dead-in-bed Syndrome In Young Diabetic Patients

Dead-in-bed Syndrome In Young Diabetic Patients

These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. ORIGINAL ARTICLE Oddmund Sovik, MD, DRMEDSCI Hrafnkell Thordarson, MD The so-called dead-in-bed syndrome refers to sudden death in young diabetic patients without any history of long-term complications. Autopsy is typically negative. The present report summarizes frequency data on this condition from studies in the U.K. and the Scandinavian countries. It appears that such deaths occur in 6% of all deaths in diabetic patients below age 40 years. The frequency may also be expressed as 2–6 events per 100,000 patient-years. The causes are by definition unknown, but a plausible theory is a death in hypoglycemia, since a history of nocturnal hypoglycemia is noted in most cases. While waiting for the clarification of the underlying pathophysiology, one should attempt to identify patients who are at particular risk of hypoglycemia and advocate caution in efforts to normalize blood glucose and HbA1c in these cases. Diabetes Care 22 (Suppl. 2):B40–B42, 1999 During the years 1988–1990, we observed in Bergen, Norway, four cases of unexpected deaths in young type 1 diabetic patients (1). The patients were found dead in an undisturbed bed, after having been observed in apparently good health the day before. No cause of death was established, and autopsy was not informative. Tattersall and Gill (2) observed 22 similar cases in Great Britain during 1989. The British patients were 12–43 years old; most of them had gone to bed in apparently good health and were found dead in the morning. Of the 22 patients, 19 were sleeping alone at the time of the death and 20 were found lying in Continue reading >>

Dead In Bed Syndrome: Mystery And Fear

Dead In Bed Syndrome: Mystery And Fear

Taking the wrong type of insulin before going to bed can cause severe nighttime hypoglycemia. [22] If a relatively large dose of bedtime basal insulin is replaced with a similar dose of regular or rapid-acting insulin, it can lower the blood glucose considerably and trigger a severe hypoglycemic reaction, which in turn can further precipitate a cardiac arrhythmia. [6],[7],[8],[9] Regimens using the newer basal insulin analogues-degludec, detemir, glargine reduce the incidence of hypoglycemia, especially the severe and nocturnal hypoglycemia, compared to those using regular and neutral protamine hagedorn (NPH) insulin; [23],[24] while improving adherence to insulin therapy. [25] For physically active persons, we should focus on late post-exercise hypoglycemia. [5] It is important to check glucose level after exercise, at bedtime and at 3:00 am if the activity is on or after late evening; in anticipation of possible hypoglycemia. If patients who are taking insulin increase their physical activity, they must either eat more or reduce the insulin dose before and after their activity; as an activity can cause hypoglycemia both during the activity and for several hours afterward. Late afternoon exercise can also cause nocturnal hypoglycemia. [26] The dose of bedtime insulin should be decreased after more strenuous exercise, especially in the ones who do not regularly exercise. Patients on insulin who eat much less than usual need to reduce their insulin dose to prevent hypoglycemia. As the indiscriminate alcohol intake can cause severe hypoglycemia, its use should be restricted. In patients with T1D and a history of hypoglycemia, particularly who sleep alone; HbA1c targets should be more relaxed. [5] In persons with hypoglycemia unawareness, this will also allow the awareness Continue reading >>

‘dead In Bed Syndrome’

‘dead In Bed Syndrome’

Home » About Diabetes » GM Vs Animal Insulin » ‘Dead in Bed Syndrome’ GM Vs animal insulin Choices – The Evidence Evidence from people with diabetes A little bit of history Facts Action and duration times of animal and GM ‘human’ insulins Hypoglycaemia and loss of warnings ‘Dead in Bed Syndrome’ The concerns of patients are justified Availability of animal insulins in the UK Changing your insulin What to do if your consultant refuses to change your insulin Availability of animal insulin if admitted to hospital Frequently asked questions Allergic reactions to insulin ‘Dead in Bed Syndrome’ Review of Dead In Bed Syndrome Unfortunately IDDT has also received reports from the relatives of young people with diabetes who have died suddenly in their sleep. Some reports from the families show that some of the above symptoms were already occurring. These deaths have become known as ‘dead in bed syndrome’, and are thought to be caused by hypoglycaemia although this is difficult to confirm in a post mortem. While this appears to be a very small number of deaths, an estimated 6% of all deaths in people with diabetes under 40, there are particular circumstances that surround them: The person is found dead in an undisturbed bed. The person was observed to be in good health before going to bed. It seems to happen most commonly in young people, especially those living alone. ‘Dead in bed syndrome’ and the association with GM ‘human’ insulin In 1989 Dr Patrick Toseland, then a senior and well-respected pathologist at Guy’s Hospital, London, was asked to investigate 19 deaths reported by doctors in the previous 18 months that had occurred in young people with diabetes. The deaths were unusual – they all happened suddenly, they all appeared to follow a Continue reading >>

Family's Heartbreak After Diabetic 29-year-old Who Planned To Run The London Marathon Dies From 'dead In Bed' Syndrome

Family's Heartbreak After Diabetic 29-year-old Who Planned To Run The London Marathon Dies From 'dead In Bed' Syndrome

Friends described 'the tragedy, the horror' of losing her suddenly Her type 1 diabetes had always been well managed up until her death Had place in Marathon but now family and friends are running in her place Family and friends of a 29-year-old diabetic have described the 'suffocating helplessness' of losing their loved one to a rare condition known as 'dead in bed syndrome'. Emily Pearce, a type 1 diabetic, died a year ago from the condition which causes unexplained deaths in young people suffering with the disease. Despite having managed her blood sugars successfully for 10 years, Emily died in her sleep after experiencing a suspected hypoglycaemic episode – a period of extremely low blood sugar levels. It is the term used to describe unexplained deaths of young people with type 1 diabetes. There is little evidence as to the exact cause of this rare phenomenon. One theory is that it is caused by an episode of extreme low blood sugar while the person is asleep. It is thought to account for around six per cent of deaths in under-40s suffering with type 1 diabetes. Emily, a social worker from Crowthorne in Berkshire, was diagnosed with type 1 diabetes when she was a 19-year-old university student. She was very successful at managing her condition and managed to live life to the full, taking part in everything from scuba diving to abseiling and charity runs. However, despite showing no previous signs of illness, Emily was found dead in her bed at Easter last year. Following Emily’s death, her older sister Alison wrote a tribute to her on a memorial blog: ‘I am Emily's big sister and I am heartbroken. ‘The period from April has been the hardest of my life and I wrestle daily with my emotions to keep it all together and trust that my mind and body somehow knows what Continue reading >>

Diabetic Dead-in-bed Syndrome: A Possible Link To A Cardiac Ion Channelopathy

Diabetic Dead-in-bed Syndrome: A Possible Link To A Cardiac Ion Channelopathy

Copyright © 2014 Jonathan R. Skinner 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. Sudden unexpected nocturnal death among patients with diabetes occurs approximately ten times more commonly than in the general population. Malignant ventricular arrhythmia due to Brugada syndrome has been postulated as a cause, since a glucose-insulin bolus can unmask the Brugada electrocardiographic signature in genetically predisposed individuals. In this report we present a 16-year-old male with insulin-dependent diabetes who died suddenly at night. His diabetes had been well controlled, without significant hypoglycaemia. At autopsy, he had a full stomach and a glucose level of 7 mmol/L in vitreous humor, excluding hypoglycaemia. Genetic analysis of autopsy DNA revealed a missense mutation, c.370A>G (p.Ile124Val), in the GPD1L gene. A parent carried the same mutation and has QT prolongation. Mutations in this gene have been linked to Brugada syndrome and sudden infant death. The patient may have died from a ventricular arrhythmia, secondary to occult Brugada syndrome, triggered by a full stomach and insulin. The data suggest that molecular autopsies are warranted to investigate other cases of the diabetic dead-in-bed syndrome. 1. Introduction Sudden unexpected nocturnal death among patients with diabetes is greatly feared and poorly understood, occurring approximately ten times more commonly than in the general population [1]. The “dead-in-bed” syndrome, by definition, has a negative autopsy and accounts for up to 6% of all deaths in type I diabetics under the age of 40 years [2]. Hypoglycaemia has been put Continue reading >>

Dead In Bed Syndrome

Dead In Bed Syndrome

Tweet Dead in bed syndrome (DIB) is a term used to describe the sudden unexplained deaths of young people with type 1 diabetes. The syndrome is characterised as when someone with insulin dependent diabetes has gone to bed seemingly perfectly fine and has been found dead in an undisturbed bed. How common is dead in bed syndrome? The syndrome is relatively rare but is thought to account for about 6% of cases of all deaths in under 40 year old people with type 1 diabetes. By comparison, diabetic ketoacidosis is a significantly more common cause of death, accounting for around 2% to 3% of all deaths in diabetic patients. What causes dead in bed syndrome? A lack of detailed post-mortem notes has meant that the cause or causes of dead in bed syndrome have not been confirmed with certainty. The evidence that has been available suggests that deaths could be caused by night time hypoglycemia triggering disturbances in heart rhythm or cardiac autonomic neuropathy (damage to nerves that control the functioning of the heart).[140] Hypoglycemia-associated autonomic failure (HAAF) is also thought to play a part. HAAF means patients have a reduced counter-regulatory response to hypos and reduced hypo awareness. The reduced counter-regulatory response means that the body has reduced ability to produce the adrenaline (epinephrine) or glucagon in response to a hypo. Glucagon is the body’s blood glucose raising hormone, and so a lack of glucagon response takes away a key life saving mechanism. Dead in bed syndrome and human insulin It has been noted that dead in bed syndrome became more commonplace since the introduction of human (synthetic) insulin within the 1980s. Research indicates that synthetic insulin has a reduced stress response in comparison to animal insulin. [141] This could Continue reading >>

Diabetic Daniella Meads-barlow, 17, Among Rising Number Of 'dead In Bed' Victims

Diabetic Daniella Meads-barlow, 17, Among Rising Number Of 'dead In Bed' Victims

Unable to playback video BY the time 17-year-old diabetic Daniella Meads-Barlow was discovered dead in her bed in November 2011, it was many hours since she had fitted and asphyxiated. The lively strawberry blonde Year 11 student, who lived with her family in Chatswood on Sydney's north shore, had turned in as usual at 10.30pm. Sometime in the night, her blood sugar levels had fallen so low she became unresponsive, asphyxiated and her heart stopped. The cause of death was nocturnal hypoglycaemia, an unusual event but one whose incidence is rising at a rate that has diabetics, their families and doctors alarmed. That Danii died in silence is a tragic irony to her family and friends: her nickname was ''Moty'' or ''Mo-mo'' short for ''motormouth''. But that night, in common with a growing number of victims of what doctors call ''dead in bed'' syndrome, she didn't make enough sound to her sleeping family. There was none of the primitive wailing that usually marked the start of her hypoglycaemic fits. Donna and Brian Meads-Barlow, who had rescued their daughter from so many other traumatic episodes, are tortured by that silence. ''A parent with a child with diabetes never sleeps with the door closed - and never sleeps properly through the night ever again,'' Donna says. ''They are walking on broken glass forever. ''That night there was nothing unusual, nothing. She came into our room and said 'Good night mummy, I love you so, so much'. Then Brian asked her what her (blood sugar) readings were. Daniella was a bit cranky with the question and said 12.2 which was normal. That's the last thing she ever said to us.'' As Donna and Brian managed police, paramedics and Danii's screaming brothers that morning, they found time to call the man who had been treating her for 12 years, en 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 >>

Characterising Sudden Death And Dead-in-bed Syndrome In Type 1 Diabetes: Analysis From 2 Childhood-onset Type 1 Diabetes Registries

Characterising Sudden Death And Dead-in-bed Syndrome In Type 1 Diabetes: Analysis From 2 Childhood-onset Type 1 Diabetes Registries

Go to: Abstract Type 1 diabetes mellitus increases the risk for sudden unexplained death (SUD), generating concern that diabetes processes and/or treatments underlie these deaths. Young (<50 yrs) and otherwise healthy patients who are found dead in bed have been classified as experiencing “dead in bed” (DIB) syndrome. We thus identified all un-witnessed deaths in two related registries (Children’s Hospital of Pittsburgh and Allegheny County) yielding 1,319 persons with childhood-onset (age<18 yrs) Type 1 DM diagnosed between 1965 and 1979. Cause of death was determined by a mortality classification committee (MCC) of at least 2 physician epidemiologists, based on the death certificate and additional records surrounding the death. Of the 329 participants who had died, the MCC has so far reviewed and assigned a final cause of death to 255 (78%). Nineteen (8%) of these were SUDs (13 male), and 7 met DIB criteria. The MCC adjudicated cause of death in the 7 DIB persons as: diabetic coma (n=4), unknown (n=2), and cardiomyopathy (n=1, found on autopsy). The 3 DIB individuals who participated in a clinical study had higher HbA1c, lower BMI, and higher daily insulin dose compared to both those dying from other causes and those surviving. SUD in Type 1 DM seems to be increased 10-fold and associated with male sex, while DIB individuals have a high HbA1c and insulin dose, and low BMI. Though sample size is too small for definitive conclusions, these results suggest specific sex and metabolic factors predispose to SUD and DIB. Keywords: Type 1 diabetes, mortality, dead-in-bed syndrome, sudden death Comparison of incidence densities of sudden deaths, sudden unexplained deaths (SUDs), and dead-in-bed in young Type 1 diabetes and general populations Type 1 Diabetes Mellitus Gen Continue reading >>

Dead-in-bed Syndrome

Dead-in-bed Syndrome

The syndrome of sudden unexpected death or "dead in bed" syndrome is considered to account for around 5% of deaths in type 1 diabetes, a rate equivalent to 2-6 cases per 10,000 patient-years. The condition may be 10 times more common in type 1 diabetes than in the rest of the population, and males are more commonly affected. Typically, the patient is found lying in an undisturbed bed, with no obvious antecedents or abnormal post-mortem findings. The proximate cause of death is likely to be a cardiac dysrhythmia, possibly triggered by hypoglycaemia against a background of autonomic dysfunction. Background The syndrome first came to attention against the background of concerns about the possible risks of human insulin. This was at one time considered to be a cause of loss of hypoglycaemia awareness, and a pathologist in the UK linked this to a number of cases which occurred at around the time when many were converted from animal source to biosynthetic insulin - see Porcine insulin. The syndrome occurs in insulin-treated patients, but is no longer considered to be linked to any specific formulation. Tattersall and Gill published the first report on the condition in 1991. This described 22 apparently healthy people with type 1 diabetes aged 12-43 years who died in their sleep with no evidence of a struggle, and suggested nocturnal hypoglycaemia as the cause[1]. Further experience Subsequent reports identified around 100 further similar deaths. Thus, although rare, the syndrome accounts for an important minority - some 5-10%[2] - of all deaths in type 1 diabetes. One challenge has been to estimate the frequency of this phenomenon in the non-diabetic population. The syndrome has some similarity to the sudden-infant death syndrome (SIDS), but no common factors have been identi Continue reading >>

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