Prevalence and consequences of nocturnal hypoglycemia among conventionally treated children with diabetes mellitus

Robert A. Shalwitz, Ruth Farkas-Hirsch, Neil H. White, Julio V. Santiago

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39 Scopus citations


To determine the prevalence and predictors of, and the glucose responses after, nocturnal hypoglycemia, we studied 135 pediatric patients with insulin-dependent diabetes mellitus on 388 nights. The frequencies of blood glucose values less than 60, 50, and 40 mg/dl (3.3, 2.8, and 2.2 mmol/L) at 2 am were 14.4%, 7.0%, and 2.1%, and at 6 am were 6.7%, 2.6%, and 0.5%, respectively. Longer duration of diabetes, higher daily insulin doses, and lower glycosylated hemoglobin values were all significant but weak predictors of 2 am hypoglycemia (glucose ≤60 mg/dl (≤3.3 mmol/L). A 10 pm glucose concentration ≤100 mg/dl (≤5.6 mmol/L) was present on 48% of nights with 2 am glucose values ≤60 mg/dl (≤3.3 mmol/L), but only 24% of nights with 10 pm blood glucose values ≤100 mg/dl (≤5.6 mmol/L) were followed by 2 am hypoglycemia. After treatment of 70 episodes of 2 am glucose concentrations ≤60 mg/dl (≤3.3 mmol/L), mean 6 am glucose concentration was 95±6 mg/dl (5.7±0.3 mmol/L) and ≤100 mg/dl in 68.6%. In only 4.3% of these cases was the 6 am glucose concentration >200 mg/dl (>11.1 mmol/L). Among patients who experienced 2 am hypoglycemia, after-breakfast glucose values were not greater on days with 2 am hypoglycemia than on days without it. These data indicate that 2 am hypoglycemia is relatively common in patients with insulin-dependent diabetes mellitus, is frequently preceded by a 10 pm glucose value ≤5.6 mmol/L, and is less well predicted by other factors. Appropriate treatment of 2 am hypoglycemia seldom results in either before-breakfast or after-breakfast blood glucose values >200 mg/dl (>11.1 mmol/L). Early-morning hypoglycemia is an uncommon cause of otherwise unexplained, prebreakfast hyperglycemia in children with insulin-dependent diabetes mellitus.

Original languageEnglish
Pages (from-to)685-689
Number of pages5
JournalThe Journal of Pediatrics
Issue number5
StatePublished - May 1990


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