Nocturnal hypoglycaemia

George E, Bedford C, Peacey SR, Hardisty CA, Heller SR. Further evidence for a high incidence of nocturnal hypoglycaemia in IDDM no effect of dose for dose transfer between human and porcine insulins. Diabet Med 1997 14(6) 442—8. 

Matyka KA, Wigg L, Pramming S, Stores G, Dunger DB. Cognitive function and mood after profound nocturnal hypoglycaemia in prepubertal children with conventional insulin treatment for diabetes. Arch Dis Child 1999 81(2) 138-42. 

Ford-Adams ME, Murphy NP, Moore EJ, Edge JA, Ong KL, Watts AP, Acerini CL, Dunger DB. Insulin lispro a potential role in preventing nocturnal hypoglycaemia in young children with diabetes mellitus. Diabetic Med 2003 20 656-60. 

Porter PA, Byrne G, Stick S, Jones TW. Nocturnal hypoglycaemia and sleep disturbances in young teenagers with insulin dependent diabetes mellitus. Arch Dis Child 1996 75 120-123. 

Wentholt IM, Maran A, Masurel N, Heine RJ, Hoekstra JB, DeVries JH. Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring frequency, duration and associations. Diabetic Medicine 2007, 24, 527-532. 

Excessive dose of insulin leads to overeating and obesity it also leads to hypoglycaemia (especially nocturnal), that may be followed by reboimd morning hyperglycaemia that is mistakenly treated by increased insulin, thus establishing a vicious cycle (Somogyi effect). 

Fig. 12.6. Twelve hours in vivo monitoring with the GlucoDay on a diabetic patient on day 1. When indicated, the patient assumed some amoimts of insulin, both in regular and fast (NPH) formulation. The grey box highlights a nocturnal episode of hypoglycaemia. The grey dots represent the finger-stick controls, while the black dots correspond to blood meaisurements (with the permission of A. Menarini Diagnostic, Florence, Italy).

It is important to prevent nocturnal hypoglycaemia, not only to protect brain function, but also to prevent insulin resistance. This may easily result in exaggerated hyperglycaemia and initiate the vicious circle -hypoglycaemia, hyperglycaemia, increase in insulin dose and risk of subsequent hypoglycaemia (Bolli and Perriello, 1990). The mechanism, frequency and even the existence of the Somogyi phenomenon, however, are all still controversial. 

Growth hormone deficiency may be present from birth or due to later pituitary-failure. A variety of stimulation tests have been used to evaluate GH deficiency. Seram GH concentrations rise in response to exercise, and this may be u.sed as a preliminary screening test. They also rise during sleep, and high concentrations in a nocturnal sample may exclude GH deficiency. The lack of GH response to clonidine, a potent stimulant of GH secretion, isdiagnostic. Some centres have now abandoned the use of insulin-induced hypoglycaemia as a diagnostic test in children because of its hazards. 

If die patient cannot control night time blood glucose levels on MDI even after having tried a long-acting insuUn analogue, for example, patients with dawn phenomenon where die dose of basal insulin cannot be increased due to nocturnal hypoglycaemia... 

De Leeuw I, Vague P, Selam JL, Skeie S, Lang H, Draeger E, Elte JW. Insulin detemir used in basal-bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin. Diabetes Obes Metab 2005 7(l) 73-82. 

In a second smdy detemir plus aspart was compared with NPH and hnman fast-acting insuhn [47]. Nocturnal hypoglycaemia weight gain and... 

McNally PG, Nelson G, Fitch M. Patients with Type 2 diabetes mellitus have lower rates of nocturnal hypoglycaemia on biphasic insulin aspart (BIAsp30) than on biphasic human insulin-30 (BHI30) data from the REACH study. Diabetologia 2004 47 A327. 

---