Dead in bed syndrome: Mystery and fear

Abstract

Dead in bed (DIB) syndrome is a poorly understood cause of sudden and mysterious death in young people with type 1 diabetes on insulin therapy. Severe nocturnal hypoglycemia with unawareness is the most plausible mechanism which precipitates fatal arrhythmia in the vulnerable individual. Avoiding recurrent hypoglycemic episodes; screening for proarrhythmic condition in high-risk people with positive family history; and using real-time continuous glucose monitoring device in those with nighttime hypoglycemia and hypoglycemia unawareness can help to reduce the incidence of this deadly condition.

Arrhythmia - dead in bed syndrome - hypoglycemia - type 1 diabetes

• References

• 1 Tattersall RB, Gill GV. Unexplained deaths of type 1 diabetic patients. Diabet Med 1991; 8: 49-58
• 2 Campbell I. Dead in bed syndrome: A new manifestation of nocturnal hypoglycaemia?. Diabet Med 1991; 8: 3-4
• 3 Thordarson H, Søvik O. Dead in bed syndrome in young diabetic patients in Norway. Diabet Med 1995; 12: 782-787
• 4 Sartor G, Dahlquist G. Short-term mortality in childhood onset insulin-dependent diabetes mellitus: A high frequency of unexpected deaths in bed. Diabet Med 1995; 12: 607-611
• 5 Sovik O, Thordarson H. Dead-in-bed syndrome in young diabetic patients. Diabetes Care 1999; 22 (Suppl. 02) B40-B42
• 6 Weston PJ, Gill GV. Is undetected autonomic dysfunction responsible for sudden death in Type 1 diabetes mellitus. The ′dead in bed′ syndrome revisited?. Diabet Med 1999; 16: 626-631
• 7 Clark AL, Best CJ, Fisher SJ. Even silent hypoglycemia induces cardiac arrhythmias. Diabetes 2014; 63: 1457-1459
• 8 Tu E, Twigg SM, Semsarian C. Sudden death in type 1 diabetes: The mystery of the ′dead in bed′ syndrome. Int J Cardiol 2010; 138: 91-93
• 9 Skinner JR, Marquis-Nicholson R, Luangpraseuth A, Cutfield R, Crawford J, Love DR. Diabetic dead-in-bed syndrome: A possible link to a cardiac Ion Channelopathy. Case Rep Med 2014; 2014: 647252
• 10 Gormsen H, Lund A. The diagnostic value of postmortem blood glucose determinations in cases of diabetes mellitus. Forensic Sci Int 1985; 28: 103-107
• 11 Tanenberg RJ, Newton CA, Drake AJ. Confirmation of hypoglycemia in the “dead-in-bed” syndrome, as captured by a retrospective continuous glucose monitoring system. Endocr Pract 2010; 16: 244-248
• 12 Buckingham B, Wilson DM, Lecher T, Hanas R, Kaiserman K, Cameron F. Duration of nocturnal hypoglycemia before seizures. Diabetes Care 2008; 31: 2110-2112
• 13 Cryer PE. Hypoglycemia begets hypoglycemia in IDDM. Diabetes 1993; 42: 1691-1693
• 14 Gerstein HC, Miller ME, Byington RP, Goff Jr DC, Bigger JT, Buse JB. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545-2559
• 15 Strachan MW, Deary IJ, Ewing FM, Frier BM. Recovery of cognitive function and mood after severe hypoglycemia in adults with insulin-treated diabetes. Diabetes Care 2000; 23: 305-312
• 16 McAulay V, Deary IJ, Ferguson SC, Frier BM. Acute hypoglycemia in humans causes attentional dysfunction while nonverbal intelligence is preserved. Diabetes Care 2001; 24: 1745-1750
• 17 Perlmuter LC, Flanagan BP, Shah PH, Singh SP. Glycemic control and hypoglycemia: Is the loser the winner?. Diabetes Care 2008; 31: 2072-2076
• 18 Patton SR, Dolan LM, Henry R, Powers SW. Parental fear of hypoglycemia: Young children treated with continuous subcutaneous insulin infusion. Pediatr Diabetes 2007; 8: 362-368
• 19 Gonder-Frederick L, Cox D, Kovatchev B, Julian D, Clarke W. The psychosocial impact of severe hypoglycemic episodes on spouses of patients with IDDM. Diabetes Care 1997; 20: 1543-1546
• 20 Cryer PE. Banting lecture. Hypoglycemia: The limiting factor in the management of IDDM. Diabetes 1994; 43: 1378-1389
• 21 Surwit RS, Schneider MS, Feinglos MN. Stress and diabetes mellitus. Diabetes Care 1992; 15: 1413-1422
• 22 Hanas R. Dead-in-bed syndrome in diabetes mellitus and hypoglycaemic unawareness. Lancet 1997; 350: 492-493
• 23 Kalra S. Newer basal insulin analogues: Degludec, detemir, glargine. J Pak Med Assoc 2013; 63: 1442-1444
• 24 Goldman-Levine JD, Patel DK, Schnee DM. Insulin degludec: A novel basal insulin analogue. Ann Pharmacother 2013; 47: 269-277
• 25 Kalra S, Unnikrishnan AG, Das AK. Improving adherence to insulin: Hope with degludec. J Soc Health Diabetes 2014; 2: 1-2
• 26 Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP. et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr 2005; 147: 528-534
• 27 Fanelli CG, Epifano L, Rambotti AM, Pampanelli S, Di Vincenzo A, Modarelli F. et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Diabetes 1993; 42: 1683-1689
• 28 Pitzer KR, Desai S, Dunn T, Edelman S, Jayalakshmi Y, Kennedy J. et al. Detection of hypoglycemia with the GlucoWatch biographer. Diabetes Care 2001; 24: 881-885
• 29 Skinner JR, Duflou JA, Semsarian C. Reducing sudden death in young people in Australia and New Zealand: The TRAGADY initiative. Med J Aust 2008; 189: 539-540
• 30 Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H. et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Heart Rhythm 2011; 8: 1308-1339