Carmine G. Fanelli, MD, PhD; Simone Pampanelli, MD; Francesca Porcellati, MD, PhD; Paolo Rossetti, MD; Paolo Brunetti, MD; Geremia B. Bolli, MD
Acknowledgments: The authors thank Mad Judge Stout in Falkland Arms, Great Tew, United Kingdom, for his support.
Grant Support: By Juvenile Diabetes Research Foundation International (grant 1-2001-102).
Requests for Single Reprints: Geremia B. Bolli, MD, Department of Internal Medicine, University of Perugia, Via E. Dal Pozzo, I-06126 Perugia, Italy; e-mail, email@example.com.
Current Author Addresses: Drs. Fanelli, Pampanelli, Porcellati, Rossetti, Brunetti, and Bolli: Department of Internal Medicine, University of Perugia, Via E. Dal Pozzo, I-06126 Perugia, Italy.
Author Contributions: Conception and design: C.G. Fanelli, S. Pampanelli, F. Porcellati, P. Rossetti, P. Brunetti, G.B. Bolli.
Analysis and interpretation of the data: C.G. Fanelli, S. Pampanelli, F. Porcellati, P. Brunetti, G.B. Bolli.
Drafting of the article: C.G. Fanelli, S. Pampanelli, F. Porcellati, G.B. Bolli.
Critical revision of the article for important intellectual content: C.G. Fanelli, S. Pampanelli, F. Porcellati, P. Brunetti, G.B. Bolli.
Final approval of the article: C.G. Fanelli, S. Pampanelli, F. Porcellati, P. Rossetti, P. Brunetti, G.B. Bolli.
Provision of study materials or patients: S. Pampanelli, F. Porcellati, P. Rossetti, G.B. Bolli.
Statistical expertise: C.G. Fanelli, G.B. Bolli.
Obtaining of funding: C.G. Fanelli, F. Porcellati, P. Brunetti, G.B. Bolli.
Administrative, technical, or logistic support: P. Brunetti.
Collection and assembly of data: C.G. Fanelli, S. Pampanelli, P. Rossetti.
Fanelli C., Pampanelli S., Porcellati F., Rossetti P., Brunetti P., Bolli G.; Administration of Neutral Protamine Hagedorn Insulin at Bedtime versus with Dinner in Type 1 Diabetes Mellitus To Avoid Nocturnal Hypoglycemia and Improve Control: A Randomized, Controlled Trial. Ann Intern Med. 2002;136:504-514. doi: 10.7326/0003-4819-136-7-200204020-00007
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Published: Ann Intern Med. 2002;136(7):504-514.
Nocturnal hypoglycemia is common in patients with type 1 diabetes mellitus (1-7). When insulin treatment is intensified to achieve near-normoglycemia, the frequency of hypoglycemia increases; approximately half of these episodes occur at night (2, 3). Unrecognized nocturnal hypoglycemia is common (1, 3-8). Overtreatment of symptomatic nocturnal hypoglycemia with snacks often results in hyperglycemia the next day (9-11). Asymptomatic nocturnal hypoglycemia can cause morning headache and malaise and may result in diminished awareness, reduced responses of adrenaline, and adaptation of cognitive function during the episode (12-15). Recurrent nocturnal hypoglycemia may contribute to the vicious cycle of hypoglycemia unawareness and impaired hormonal counterregulation in patients with type 1 diabetes, leading to increased risk for severe hypoglycemia (16).
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Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors.
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