Avoiding Nocturnal Hypoglycemia: Consideration of an Extra Injection at Bedtime
Authors: Andrew W. Norris, Lori M.B. Laffel
Journal: Annals of Internal Medicine (2002)

Editorials2 April 2002Avoiding Nocturnal Hypoglycemia: Consideration of an Extra Injection at BedtimeAndrew W. Norris, MD, PhD and Lori M.B. Laffel, MD, MPHAndrew W. Norris, MD, PhDFrom the Joslin Diabetes Center, Harvard Medical School, Boston, MassachusettsSearch for more papers by this author and Lori M.B. Laffel, MD, MPHFrom the Joslin Diabetes Center, Harvard Medical School, Boston, MassachusettsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-7-200204020-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail While sleeping, how do you replace insulin, a life-sustaining hormone with a narrow therapeutic range whose requirements change throughout the night? This challenge has faced patients with type 1 diabetes mellitus and their physicians since the first use of purified insulin for subcutaneous injection in 1922. The Diabetes Control and Complications Trial (1) demonstrated the magnitude of this challenge, showing that intensive insulin therapy not only delays microvascular complications but also increases the risk for hypoglycemia by roughly threefold, with more than half of the episodes occurring during sleep (2).It has long been assumed that the risk for nocturnal ...References1. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977-86. [PMID: 8366922] CrossrefMedlineGoogle Scholar2. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am J Med. 1991;90:450-9. [PMID: 2012085] CrossrefMedlineGoogle Scholar3. Bolli GB. How to ameliorate the problem of hypoglycemia in intensive as well as nonintensive treatment of type 1 diabetes. 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U.S. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group. Diabetes Care. 2000;23:1137-42. [PMID: 10937511] CrossrefMedlineGoogle Scholar15. Pieber TR, Eugène-Jolchine I, Derobert E. Efficacy and safety of HOE 901 versus NPH insulin in patients with type 1 diabetes. The European Study Group of HOE 901 in type 1 diabetes. Diabetes Care. 2000;23:157-62. [PMID: 10868824] CrossrefMedlineGoogle Scholar16. Raskin P, Klaff L, Bergenstal R, Hallé JP, Donley D, Mecca T. A 16-week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care. 2000;23:1666-71. [PMID: 11092290] CrossrefMedlineGoogle Scholar17. Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. U.S. Study Group of Insulin Glargine in Type 1 Diabetes. Diabetes Care. 2000;23:639-43. 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Laffel, MD, MPHAffiliations: From the Joslin Diabetes Center, Harvard Medical School, Boston, MassachusettsCorresponding Author: Lori M.B. Laffel, MD, MPH, Pediatric and Adolescent Unit, Joslin Clinic, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215; e-mail, lori.[email protected]harvard.edu.Current Author Addresses: Dr. Norris: Pediatric and Adolescent Unit, Joslin Clinic, Molecular and Cellular Physiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215.Dr. Laffel: Pediatric and Adolescent Unit, Joslin Clinic, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAdministration of Neutral Protamine Hagedorn Insulin at Bedtime versus with Dinner in Type 1 Diabetes Mellitus To Avoid Nocturnal Hypoglycemia and Improve Control Carmine G. Fanelli , Simone Pampanelli , Francesca Porcellati , Paolo Rossetti , Paolo Brunetti , and Geremia B. Bolli Metrics Cited byMinder nachtelijke hypoglykemie door ander insulineregime 2 April 2002Volume 136, Issue 7Page: 547-549KeywordsAdolescentsBloodGenetic epidemiologyGlucoseHemoglobinHypoglycemiaHypoglycemicsInsulinMolecular epidemiologyType 1 diabetes ePublished: 2 April 2002 Issue Published: 2 April 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...