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Avoiding Nocturnal Hypoglycemia: Consideration of an Extra Injection at Bedtime

Andrew W. Norris, MD, PhD; and Lori M.B. Laffel, MD, MPH
[+] Article and Author Information

From the Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts


Requests for Single Reprints: Lori M.B. Laffel, MD, MPH, Pediatric and Adolescent Unit, Joslin Clinic, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215; e-mail, lori.laffel@joslin.harvard.edu.

Current Author Addresses: Dr. Norris: Pediatric and Adolescent Unit, Joslin Clinic, Molecular and Cellular Physiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215.

Dr. Laffel: Pediatric and Adolescent Unit, Joslin Clinic, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215.


Ann Intern Med. 2002;136(7):547-549. doi:10.7326/0003-4819-136-7-200204020-00013
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While sleeping, how do you replace insulin, a life-sustaining hormone with a narrow therapeutic range whose requirements change throughout the night? This challenge has faced patients with type 1 diabetes mellitus and their physicians since the first use of purified insulin for subcutaneous injection in 1922. The Diabetes Control and Complications Trial (1) demonstrated the magnitude of this challenge, showing that intensive insulin therapy not only delays microvascular complications but also increases the risk for hypoglycemia by roughly threefold, with more than half of the episodes occurring during sleep (2).

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