Feature Article

Sudden death and hypoglycemia

Simon Heller, BA, MB BChir, DM, FRCP

Diabetic Hypoglycemia September 2008, Volume 1, Issue 2: page 2-7

Abstract

There is considerable evidence implicating hypoglycemia as a cause of sudden death in patients with both type 1 and type 2 diabetes. Hypoglycemia has been recognized as a potential cause of death, particularly due to cerebral damage, ever since the introduction of insulin therapy. The pathophysiological changes that occur during hypoglycemia may also increase the risk of sudden death in patients with advanced cardiovascular disease.

This feature article provides a detailed examination of the potential connection between sudden death and hypoglycemia. It discusses the findings of a number of studies, including the recent ACCORD study, and examines the phenomenon of sudden death in young people with diabetes, reviewing the potential mechanisms and therapeutic interventions. Risk of death from hypoglycemia and the problem of identifying deaths due to hypoglycemia are covered, as is nocturnal hypoglycemia - a common side effect of insulin treatment which is feared by many diabetes patients. The relationship between sudden death and the ‘dead in bed’ syndrome is also reviewed in detail.

The review concludes that the risk of hypoglycemia-induced mortality is difficult to calculate accurately, but that there is considerable evidence implicating hypoglycemia as a rare cause of sudden death in individuals with type 1 diabetes. The review also indicates that hypoglycemia may increase the risk of ischemia and sudden death in individuals with type 2 diabetes, but points out that it is unclear whether the same mechanisms as in type 1 diabetes are responsible.

Keywords: hypoglycemia, sudden death, cardiovascular disease, cerebral damage