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[IP] Dead-In-Bed Syndrome abstracts (VERY LONG)

You can write to the researchers - I have written once and one researcher 
didn't know if any of the patients had been on insulin-pump therapy.  I don't 
think the pump is a safety net.  I will tell you that my son often wakes up 
and tests and eats when he feels low at night.  I test him if I hear him 
stirring a lot - his room is that close and I don't sleep well.

Here are several abstracts on the subject:

Diabet Med 1999 Aug;16(8):626-31Related Articles 

Is undetected autonomic dysfunction responsible for sudden death in Type 
1 diabetes mellitus? The 'dead in bed' syndrome revisited. 
Weston PJ, Gill GV 
Diabetes Research Unit, University Hospital Aintree, Liverpool, UK.
[Medline record in process]
AIMS: Sudden nocturnal death in young persons with Type 1 diabetes 
mellitus has been recently described, and is known as the 'dead in bed' 
syndrome. Its aetiology is unknown, and we have therefore explored the 
details of all papers recording the syndrome, to formulate a hypothesis 
of causation. METHODS: Literature review of 'dead in bed' reports as 
well as of nocturnal hypoglycaemia, and autonomic dysfunction in 
relation to baroreceptor-cardiac reflex sensitivity. RESULTS: Clinical 
reports of 'dead in bed' cases strongly suggest that nocturnal 
hypoglycaemia is a likely precipitant, but that the death is sudden and 
probably arrhythmic. Ventricular dysrhythmias may occur in the context 
of early autonomic neuropathy, with relative sympathetic overactivity, 
in young Type 1 diabetic persons. CONCLUSION: We conclude that the 'dead 
in bed' syndrome probably occurs in Type 1 diabetic persons with early 
autonomic neuropathy, resulting in relative sympathetic overactivity. In 
such persons, risks of ventricular dysrhythmias will be compounded by 
nocturnal hypoglycaemia, which may be associated with an increase in the 
electrocardiographic Q-T interval, and Q-T dispersion. This could lead 
to the observed sudden death in undisturbed beds. Further research in 
this area is urgently needed, in particular into the possible protective 
use of drugs that modulate the autonomic nervous system. 
PMID: 10477206, UI: 99404856 
 Diabetes Care 1999 Mar;22 Suppl 2:B40-2Related Articles 
Dead-in-bed syndrome in young diabetic patients. 
Sovik O, Thordarson H 
Department of Pediatrics, University Hospital, Bergen, Norway. 
email @ redacted
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 HbAlc in these cases. 
PMID: 10097898, UI: 99197971 
 : Diabet Med 1995 Sep;12(9):782-7Related Articles 
Dead in bed syndrome in young diabetic patients in Norway. 
Thordarson H, Sovik O 
Department of Medicine, Haukeland Hospital, Bergen, Norway.
The incidence of unexplained deaths ('dead in bed syndrome') in 
Norwegian diabetic patients under the age of 40 was investigated during 
the period 1981-1990. During this 10-year period there were 240 deaths 
of all causes in the age group 0-39 years. Sixteen of these cases 
fulfilled the following criteria of the 'dead in bed syndrome': (1) 
patient found dead in an undisturbed bed; (2) patient observed to be in 
good health condition the day before; (3) no clinical evidence of late 
complications (except background retinopathy in two cases). Of the 16 
cases ascertained, 10 were males and 6 females. The age range was 7-35 
years, and the duration of diabetes varied between a few months and 26 
years. Autopsy, performed in 13 cases, did not reveal any cause of 
death. Nine patients had been using insulin regimens with multiple daily 
doses. Twelve patients were reported as having had frequent episodes of 
hypoglycaemia, with nocturnal episodes in 10 cases. There was apparently 
an increasing incidence of unexplained deaths during the study period, 
with 12 of 16 cases occurring in the years 1988 to 1990. 
Comments:•Comment in: Diabet Med 1996 May;13(5):495-6 
PMID: 8542738, UI: 96081040 

Anyone have access to this one?

 Diabet Med 1999 Aug;16(8):623-5Related Articles 
Sudden death in young patients with Type 1 diabetes: a consequence of 
disease, treatment or both? 
Harris ND, Heller SR 
[Medline record in process]
PMID: 10477205, UI: 99404855
: Diabet Med 1997 Jan;14(1):82-5Related Articles 
Is impaired baroreflex sensitivity a predictor or cause of sudden death 
in insulin-dependent diabetes mellitus? 
Lawrence IG, Weston PJ, Bennett MA, McNally PG, Burden AC, Thurston H 
Department of Medicine and Therapeutics, University of Leicester, 
Leicester Royal Infirmary, UK.
Sudden death at night is known to occur in young patients with 
insulin-dependent (Type 1) diabetes mellitus (IDDM) but the aetiology is 
uncertain. A cardiac arrhythmia has been postulated, but there has been 
little evidence to support this. We present the case of a 31-year-old 
man with IDDM of 17 years duration, who died suddenly while asleep. Over 
preceding months, he had had strict glycaemic control (HbA1 8.9%), 
normal 24 h blood pressure (mean 131 +/- 2.1/76 +/- 2.2 mmHg), no 
evidence of microangiopathy or endothelial dysfunction and normal 
standard clinical tests of autonomic function. An electrocardiogram was 
similarly unremarkable, with a QTc interval of 0.414 s, and an 
echocardiogram had demonstrated normal left ventricular mass index (96.4 
g m-2). However, there was no nocturnal dip in heart rate (daytime 74 
+/- 2.7, and nocturnal 68 +/- 1.6 beats min-1), and he had grossly 
impaired baroreflex sensitivity during Phase 4 of the valsalva manoeuvre 
(0.5 ms mmHg-1), with power spectral analysis studies suggesting an 
abnormality of parasympathetic function. The coroner's autopsy 
demonstrated no structural abnormalities. We hypothesize that abnormal 
baroreflex sensitivity could either predict a risk of or account for 
some of the unexplained deaths in IDDM, in that relative overactivity of 
the sympathetic nervous system could cause ventricular arrhythmias. 
PMID: 9017359, UI: 97169811 
1 : Diabet Med 1991 Jan;8(1):49-58Related Articles 
Unexplained deaths of type 1 diabetic patients. 
Tattersall RB, Gill GV 
Professional Advisory Committee, British Diabetic Association, London, 
The suggestion of an increase in the number of sudden deaths of young 
people with Type 1 diabetes in the UK has been investigated. It was 
suggested that such deaths were due to hypoglycaemia and related to the 
increasing use of human insulin. In total we were notified of 50 deaths 
of people with Type 1 diabetes under age 50 years in the UK in 1989 
which our informants (relatives, physicians, and pathologists) 
considered sudden and unexpected. An autopsy had been done in all cases 
and we supplemented this with detailed clinical information from 
relatives and case records. Of the 50 cases we excluded five with a 
definite cause of death, 11 suicides or self-poisonings, six cases of 
ketoacidosis, and four in which there was insufficient information about 
the circumstances of death to drawn any conclusions. Of the other 24 
cases, two patients had been found with irreversible hypoglycaemic brain 
damage and died after a period of artificial ventilation. The most 
puzzling group were 22, aged 12-43 years, most of whom had gone to bed 
in apparently good health and been found dead in the morning. Nineteen 
of the 22 were sleeping alone at the time of death and 20 were found 
lying in an undisturbed bed. Most had uncomplicated diabetes and in none 
were anatomical lesions found at autopsy. There are major difficulties 
in diagnosing hypoglycaemia post-mortem, but the timing of death and 
other circumstantial evidence suggests that hypoglycaemia or a 
hypoglycaemia-associated event was responsible. All patients were taking 
human insulin at the time of death but most had been changed from animal 
insulin between 6 months and 2 years earlier and there was nothing to 
implicate the species of insulin as a factor in these deaths. 
PMID: 1826245, UI: 91183829
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