Dead in Bed Syndrome: Diabetic Hypoglycemia

Introduction

A strange and abrupt death in young adults with type 1 diabetes receiving insulin therapy is known as the "dead in bed" phenomenon (DIB). The most likely mechanism that causes a fatal arrhythmia in a vulnerable person is severe nocturnal hypoglycemia combined with unawareness.

Using a real-time continuous glucose monitoring device in those with nighttime hypoglycemia and hypoglycemia unawareness can help to lower the incidence of this fatal condition, as can avoiding recurrent hypoglycemic episodes, screening for proarrhythmic condition in high-risk individuals with positive family history, and all of the aforementioned measures.

Pay attention to hypoglycemia's early warning signs and treat low blood sugar as soon as it occurs. A simple sugar source, like glucose tablets, hard candies, or fruit juice, can swiftly elevate blood sugar levels when consumed. Share with loved ones the signs and symptoms to watch for and what to do if an individual can not handle the treatment itself.

What Is the Etiology of Dead in Bed Syndrome?

Although the exact cause of DIB (dead-in-bed syndrome) syndrome is unknown and may vary from case to case, evidence to date points to disturbances in cardiac repolarization (and thus rhythm) brought on by nighttime hypoglycemia, with a potential contribution from cardiac autonomic neuropathy, as the likely cause of the deaths. Although the body produces epinephrine in response to hypoglycemia as a protective measure against extreme hypoglycemia, some studies have suggested that it may also be a factor in abnormal cardiac repolarization.

What Is Diabetic Hypoglycemia?

Diabetes-related hypoglycemia happens when a person's blood sugar (glucose) levels are too low. Patients can not function properly if they do not get enough glucose because it is the body and brain's primary fuel source. Hypoglycemia, often known as low blood sugar, is a condition in which a person's blood sugar level is less than 70 mg/dL or 3.9 mmol/L. However, the figures might vary.

Diabetic hypoglycemia's initial warning signs and symptoms include:

• Palloring (looking pale).

• Shakiness.

• Unsteadiness or faintness.

• Sweating.

• Hunger or sickness.

• A rapid or erratic heartbeat.

• Difficulty paying attention.

• Fatigue: the state of being drained of all energy.

• Irritation or worry.

• Headache.

• Lips, tongue, or cheek tingling or numbness.

Symptoms and Indicators That Appear At Night

The following indications and symptoms may keep the individual awake if diabetic hypoglycemia happens while trying to sleep:

• Sheets or pajamas that are damp from perspiration.

• Nightmares.

• Fatigue.

• Agitation.

• Bewilderment upon awakening.

Severe Symptoms And Signs Are:

The following signs and symptoms of hypoglycemia might worsen if diabetic hypoglycemia is not treated:

• Unusual behavior, confusion, or both, such as the inability to carry out daily chores.

• Inability to coordinate.

• Slurred or difficult-to-understand speech.

• Fuzzy or limited eyesight.

• Not being able to eat or drink.

• Muscle tremor.

• Drowsiness.

Extreme Hypoglycemia May Result In:

• Seizures or tremors.

• Unconsciousness.

Very rarely, the symptoms can vary from one person to the next or from one episode to the next. Some individuals have no observable symptoms. Also possible is the absence of any hypoglycemia-related symptoms. Regular blood sugar checks are crucial, as is keeping track of how a person feels when blood sugar is low.

How to Prevent Dead in Bed Syndrome?

An understanding of the underlying pathophysiology of any event in health and disease is required for prediction and prevention. Because hypoglycemia is the most convincing assumption, avoiding nocturnal hypoglycemia appears to be the best intervention to prevent DIB (dead-in-bed syndrome).

What Are the Risk Factors of Hypoglycemia?

Diabetic hypoglycemia is more likely to occur in certain individuals, such as:

• Insulin users.

• People take sulfonylureas, also known as diabetes medications, such as Glipizide, Glimepiride, or Glyburide.

• Both young children and older adults with weakened liver or renal function.

• Long-term diabetics People who do not experience the symptoms of low blood sugar (hypoglycemia unawareness).

• Those who take several drugs.

• Anyone who suffers from a disability that makes it difficult for them to react quickly when their blood sugar drops.

• Individuals who consume alcohol.

How to Prevent Hypoglycemia?

The following are the ways to prevent hypoglycemia:

• Keep an Eye on the Blood Sugar Level - Several times a week or several times a day, depending on the patient's treatment regimen; the patient may check and record the blood sugar level. Careful monitoring guarantees that the blood sugar level stays within the desired range.

• Never Skip or Postpone Meals or Snacks - If a patient takes insulin or oral diabetic treatment, stay consistent with the calorie intake and meal and snack times.

• Medication Should Be Taken Exactly as Prescribed and on Time - As the doctor directs, take the prescription medication.

• Add More Food to the Medicine- If the Patient becomes physically more active. The modification is based on the drug regimen, exercise level, and blood sugar test results. Make changes as directed by the diabetes treatment plan.

• Ingest Booze with a Meal or Snack- If the patient decides to drink. Hypoglycemia can result from consuming alcohol right before eating. Blood sugar monitoring is crucial since alcohol may result in delayed hypoglycemia hours later.

• Keep Track of Low Blood Sugar Reactions- This can aid in identifying tendencies that lead to hypoglycemia and figuring out how to stop them for people and the medical team.

Conclusion

In type 1 diabetes patients, hypoglycemia caused by diet, exercise, or insulin mismatch, is a dreaded consequence that worsens with each previous episode in the patient's history. The most probable cause of the so-called "dead in bed" syndrome, which manifests as an unexplained death in an undisturbed bed in a previously normal T1D person, is severe nocturnal hypoglycemia in the context of hypoglycemia unawareness.

A lethal arrhythmia from hypoglycemia is the most compelling immediate cause of sudden death. It is impossible to overstate the effectiveness of insulin therapy in treating diabetes and the significance of glycemic control in avoiding long-term consequences. Balance is necessary since hypoglycemia must not be disregarded as a factor restricting the use of insulin therapy.

The prevention of abrupt variations in glucose levels is aided by adjusting the insulin dose to changes in food and physical activity. Using long-acting basal insulin analogs will lessen acute and unexpected nocturnal hypoglycemia episodes and prevent irregular blood glucose levels in sensitive people. Using CGM can be lifesaving in people with a high risk of dying. To know more about the condition, consult the doctor online.