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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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 >>
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.
Abstract Sudden cardiac death is an unpredictable and devastating event, particularly in the young. A significant proportion of sudden deaths in the young are unexplained-no 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 >>
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 >>
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 >>
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 >>
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 >>
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 >>
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 >>
My Wife Died From Diabetes In Her Sleep Aged Just 41 While We Were Celebrating Our Wedding Anniversary
My wife died from diabetes in her sleep aged just 41 while we were celebrating our wedding anniversary Former Everton goalkeeper Stephen Reeve's life plans were left shattered by the unexpected death of his wife Louise who suffered from type 1 diabetes Loving couple: Stephen said Louise coped "exceptionally well" with diabetes before her death Could not subscribe, try again laterInvalid Email When his wife Louise died in her sleep, aged just 41, while they were on holiday celebrating their wedding anniversary, Stephen Reeves life plans were shattered. Although Louise had lived with type 1 diabetes since she was 16, former Everton goalkeeper Steve believed they had everything to look forward to. It never defined her as a person, she never complained about it, she just got on with everything and battled through, he told the Liverpool ECHO. She managed her diabetes exceptionally well, she was very shrewd about her condition and we were looking to have children. The couple met when 40-year-old Stephen, who played for the Everton in the 1990s, went to Liverpool Tennis Tournament with a friend who was working on the event. Louise was there with her uncle who was a tennis trainer, we fell in love straight away and wed both reached a point in our lives where we knew what we wanted, he recalls. Louise had been mentoring students at Liverpool College for 11 years, while Stephen - having been forced to retire from football through injury in his late 20s - was working in finance with Lloyds Bank. The couple married a year after meeting, in the summer of 2012, and Louise never allowed their lives to be dominated by her diabetes. Because of it she had something called autonomic neuropathy which affected the nerves in her body, so it did restrict her walking and her diet, but she und Continue reading >>
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 >>
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 >>
Mortality In Childhood-onset Type 1 Diabetes
A population-based study Abstract OBJECTIVE—To describe the age- and sex-specific mortality in a cohort of young type 1 diabetic patients and to analyze the causes of death with special focus on suicide, accidents, and unexplained deaths. RESEARCH DESIGN AND METHODS—A population-based incident childhood diabetes register, covering onset cases since 1 July 1977, was linked to the Swedish Cause of Death Register up to 31 December 2000. The official Swedish population register was used to calculate age- and sex-standardized mortality rates (SMRs), excluding neonatal deaths. To analyze excess risks for specific diagnoses, case subjects were compared with five nondiabetic control subjects, matched by age, sex, and year of death. Death certificates were collected for all case and control subjects. For case subjects with an unclear diagnosis, hospital records and/or forensic autopsy reports were obtained. RESULTS—Mean age- and sex-SMR was 2.15 (95% CI 1.70–2.68) and tended to be higher among females (2.65 vs. 1.93, P = 0.045). Mean age at death was 15.2 years (range 1.2–27.3) and mean duration 8.2 years (0–20.7). Twenty-three deaths were clearly related to diabetes; 20 died of diabetic ketoacidosis. Only two case subjects died with late diabetes complications (acute coronary infarction). Thirty-three case subjects died with a diagnosis not directly related to diabetes; 7 of them committed suicide, and 14 died from accidents. There was no significant difference in traffic accidents (odds ratio 1.02 [95% CI 0.40–2.37]). Obvious suicide tended to be increased but not statistically significantly so (1.55 [0.54–3.89]). Seventeen diabetic case subjects were found deceased in bed without any cause of death found at forensic autopsy. Only two of the control subjects di Continue reading >>
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 >>
