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April 7, 2009

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Question from Red Deer, Alberta, Canada:

Is there any truth to the statistic that a child with type 1 has a 6% chance of being "dead in bed" over the course of their life? This seems way too high. My nine-year-old son has been having numerous lows in the night and isn't waking for them any more. We are decreasing his background insulin and stressing that he must feed for his increased exercise.

Answer:

I suspect that this number is too high. There are some studies from Scandinavia that have looked into this dilemma. Periodic nocturnal monitoring is recommended since we (scientifically) know that many episodes of nocturnal hypoglycemia go undetected by routine monitoring of blood glucose during the day and only about 50% of such nocturnal episodes produce sufficient symptoms to awaken a person with type 1 diabetes. One of the big potential advantages of continuous glucose monitoring systems (CGMS) is the ability to alarm for nocturnal hypoglycemia. One of the big advantages of insulin pumps over conventional treatment is also the ability to fine tune and adjust hour by hour overnight. Similarly, Lantus and Levemir have big advantages over NPH and Lente insulins because they have less peaks overnight while still providing excellent and more stable/predictable basal coverage than older insulins.

SB