Elsevier

The Journal of Pediatrics

Volume 141, Issue 5, November 2002, Pages 625-630
The Journal of Pediatrics

Original Articles
Nocturnal hypoglycemia detected with the continuous glucose monitoring system in pediatric patients with type 1 diabetes☆,☆☆

https://doi.org/10.1067/mpd.2002.129175Get rights and content

Abstract

Objective: To use the Continuous Glucose Monitoring System (CGMS, MiniMed, Sylmar, Calif) to determine if bedtime blood glucose levels were associated with the occurrence of nocturnal hypoglycemia. Study design: Patients (n = 47, 18 boys, mean age 11.8 ± 4.6 years) with type 1 diabetes used CGMS for 167 nights. Data were analyzed for glucose ≤40 or ≤50 mg/dL, comparing bedtime blood glucose levels of ≤100 or >100 mg/dL and ≤150 or >150 mg/dL. Results: A glucose value of ≤40 mg/dL occurred on 27% of nights and ≤50 mg/dL on 35% of nights. There was a 2-fold increase (45% vs 22%, P =.015) in the incidence of hypoglycemia with a bedtime glucose ≤100 mg/dL and a 1.7-fold increase (46% vs 26%, P =.01) with a value of ≤150 mg/dL; most episodes occurred between 9 PM and 1 AM. There was no difference in hypoglycemia duration (86.4 minutes for glucose ≤100 mg/dL vs 84.5 minutes for >100 mg/dL, P = NS), and no bedtime glucose value between 110 and 300 mg/dL decreased the incidence of nocturnal hypoglycemia to ≤10%. The incidence of nocturnal hypoglycemia was similar for patients using insulin pump and injection therapy, and there was no correlation between hemoglobin A1c and incidence or duration of hypoglycemia. Conclusions: Nocturnal hypoglycemia is frequent, of long duration, associated with bedtime glucose values ≤100 to 150 mg/dL, and predominately in the early part of the night. CGMS is a useful tool to diagnose asymptomatic nocturnal hypoglycemia. (J Pediatr 2002;141:625-30)

Section snippets

Patient Population

Pediatric patients with type 1 diabetes were recruited for this study during routine clinic visits to the Comprehensive Diabetes Center at Childrens Hospital Los Angeles during a 6-month period at the end of 1999 and the beginning of 2000. The protocol used, as well as some of the data reported in this study, have been previously described.12 After being shown the sensor and given an explanation of what a 3- to 6-day sensor wear entailed, 47 of 50 subjects and parents agreed to participate and

Results

The mean bedtime blood glucose level by finger stick was 185 ± 94 mg/dL, with a median of 165 mg/dL and a range of 41 to 400 mg/dL. There was a sensor value of ≤40 mg/dL on 45 nights (27%) and ≤50 mg/dL on 59 nights (35%). Table I demonstrates the effect of going to bed with a blood glucose level of ≤100 mg/dL compared with >100 mg/dL on the total night-time sensor glucose level and for distinct time periods throughout the entire night.

. Association of the number of nights with bedtime blood

Discussion

The use of CGMS in this study substantiated what has been documented in previous studies—that nocturnal hypoglycemia is a common occurrence in children and youth with type 1 diabetes6, 7, 8, 9, 10 and that these hypoglycemic episodes are of relatively long duration.10, 13 Regardless of the bedtime blood glucose level, there was a 27% chance of an episode of nocturnal hypoglycemia when defined as a sensor glucose value ≤40 mg/dL and a 35% chance when defined as a sensor glucose value ≤50 mg/dL.

References (19)

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Drs Kaufman and Halvorson have received previous research grants from the MiniMed Company.

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Reprint requests: Francine R. Kaufman, MD, 4650 Sunset Blvd, Los Angeles, CA 90027.

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