title: Confirmation of hypoglycemia in the "dead-in-bed" syndrome, as captured by a retrospective continuous glucose monitoring system.
abstract: OBJECTIVE
  To report a case that substantiates the presence of hypoglycemia at the time of death of a young man with type 1 diabetes, who was found unresponsive in his undisturbed bed in the morning.
  
  
  METHODS
  We describe a 23-year-old man with a history of type 1 diabetes treated with an insulin pump, who had recurrent severe hypoglycemia. In an effort to understand these episodes better and attempt to eliminate them, a retrospective (non-real-time) continuous subcutaneous glucose monitoring system (CGMS) was attached to the patient. He was found dead in his undisturbed bed 20 hours later. The insulin pump and CGMS were both downloaded for postmortem study.
  
  
  RESULTS
  Postmortem download of the data in the CGMS demonstrated glucose levels below 30 mg/dL around the time of his death, with only a minimal counter-regulatory response. This finding corresponded to a postmortem vitreous humor glucose of 25 mg/dL. An autopsy showed no major anatomic abnormalities that could have contributed to his death.
  
  
  CONCLUSIONS
  To our knowledge, this is the first documentation of hypoglycemia at the time of death in a patient with the "dead-in-bed" syndrome. This report should raise the awareness of physicians to the potentially lethal effects of hypoglycemia and provide justification for efforts directed at avoiding nocturnal hypoglycemia.
authors.affiliation: Department of Endocrinology, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA. tanenbergr@ecu.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tanenberg
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Newton
authors.forename: Almond J
authors.initials: AJ
authors.lastname: Drake
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D017809:Fatal Outcome; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis*; D007332:Insulin Infusion Systems; D008297:Male; D055815:Young Adult
chemical_list: D001786:Blood Glucose