overnight hypoglycemia; nocturnal hypoglycemia
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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]