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overnight hypoglycemia; nocturnal hypoglycemia
Etiology:
- evening exercise in patients with type 1 diabetes
Pathology:
- overtreatment or prolonged effects of evening exercise can lead to hypoglycemia with amplification of the release of catecholamines, cortisol, growth hormone & glucagon to increase gluconeogenesis leading to AM hyperglycemia, thus fluctuationg levels of preprandial AM blood glucose
Management:
- measure 3 AM blood glucose
- avoid evening exercise
- diminish QHS insulin as needed
- switching from NPH to degludec, detemir or glargine my reduce episodes of hypoglycemia & improve glycemic control [2]
General
hypoglycemia
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18.
American College of Physicians, Philadelphia 2015, 2018.
- NEJM Knowledge+ Endocrinology