title: [Nocturnal hypoglycemia in insulin-dependent diabetics].
abstract: OBJECTIVE
  Repeated hypoglycaemia has been reported to impair recognition of subsequent hypoglycaemia with a high risk of severe hypoglycaemia. This intensified insulin therapy may be dangerous in insulin-dependent diabetes mellitus (IDDM) patients with unawareness of hypoglycaemia.
  
  
  METHODS
  We assessed the incidence of nocturnal hypoglycaemia and the benefit of an additional bedtime snack in IDDM patients treated by 2 or 3 daily injections. Capillary blood glucose was measured by finger strip at 10 p.m. and plasma venous glycaemia was determined at 0, 2, 4 and 8 a.m.
  
  
  RESULTS
  The study was composed of two phases. In the first phase, patients (n = 93) did not receive any snack at bedtime. Blood glucose fell to 2.75 mmol/l or less in 33%. Among the 40 patients with a 10 p.m. glycaemia of 9 mmol/l or less, 57.5% experienced nocturnal hypoglycaemia vs 15% of the 53 others. The second phase concerned 106 IDD patients. An additional bedtime snack was given when 10 p.m. blood glucose was 9 mmol/l or less. The incidence of hypoglycaemia fell to 32% (14 of 44 IDDM) i.e. a significant benefit of 44% (p < 0.01). However patients who received this additional bedtime snack had a slightly higher 8 a.m. glycaemia than those with 10 p.m. glycaemia at 9 mmol/l or less during the first phase (9.61 +/- 5.67 mmol/l vs 7.75 +/- 4.30 mmol/l) but this result is not significant.
  
  
  CONCLUSIONS
  Prevention of nocturnal hypoglycaemia may be achieved in IDDM patients by bedtime glucose determination and an additional snack when glycaemia is 9 mmol/l or less.
authors.affiliation: Service de Diabétologie-Métabolisme, Hôpital de la Pitié, Paris.
authors.forename: C
authors.initials: C
authors.lastname: Verny
authors.forename: C
authors.initials: C
authors.lastname: Remy
authors.forename: C
authors.initials: C
authors.lastname: Sachon
authors.forename: F
authors.initials: F
authors.lastname: Bosquet
authors.forename: S
authors.initials: S
authors.lastname: Casanova
authors.forename: A
authors.initials: A
authors.lastname: Grimaldi
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D004326:Drinking; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007328:Insulin
vernacular_title: Hypoglycémie nocturne du diabétique insulinodépendant.