Background: Nocturnal hypoglycemia is not regularly predictable on the basis of a bedtime BG level and can only be confirmed by BG tests at regular intervals during the night or continuous glucose monitoring (CGM).
Objective and hypotheses: A bedtime snack containing carbohydrate as well as fat and protein may be useful in preventing nocturnal hypoglycemia, but this should not be at the expense of high overnight BG levels. In many individuals, a lowering of the insulin dose after intense exercise should be considered to prevent nocturnal hypoglycemia. Short- and long-acting insulin analogues and continuous insulin infusion therapy may further decrease risk for nocturnal hypoglycemia.
Method: Availability of CGM results in real-time (RT-CGM) to the patient with diabetes and immediate corrections to keep glucose levels in range have been shown to improve day and nighttime glycemic control more effectively than blinded collection of data analyzed by a health provider retrospectively. Flash Glucose Monitoring (FGM) is the newest method of glucose testing that is seen as a hybrid between meters and CGMs.
Results: FGM does not have hypo- or hyperglycemia alarms and will only provide a trend graph if it has been swiped in the past eight hours. However, the IMPACT trial in adults with type 1 diabetes has revealed significantly lower rates of nocturnal hypoglycemia also with FGM. While RT-CGM is beneficial in both patients using multiple daily injections and insulin pump users, the latter combination is more effective for nocturnal glucose control, particularly when combined with low glucose suspension algorithms or predictive low glucose management. Recently the success of conventional Real-Time CGM has led to the development of hybrid and full closed-loop insulin delivery systems, which have now reached the stage of clinical trials in patients homes. These trials repeatedly showed optimized nocturnal glucose control. A first commercial device may be available on the market as early as 2017.
Conclusion: Diabetes technology offers novel opportunities to optimize nighttime glucose control and may eventually propel wide-spread adaptation and reimbursement of devices for insulin delivery and glucose monitoring.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology