[Nocturnal hypoglycemia in insulin-dependent diabetics].
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.
Verny
C
C
Service de Diabétologie-Métabolisme, Hôpital de la Pitié, Paris.
Remy
C
C
Sachon
C
C
Bosquet
F
F
Casanova
S
S
Grimaldi
A
A
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
D001786:Blood Glucose; D007328:Insulin
Hypoglycémie nocturne du diabétique insulinodépendant.