Le « Dead-in-bed » syndrome, ou la « mort subite dans son lit » du jeune diabétique de type 1 : rare, ou méconnu ?

The “Dead-in-bed” syndrome refers to a few subjects with type 1 diabetes (T1D), very young and without forerunners sign except for a high frequency of severe hypoglycemia. These unexplained deaths are up to 10 times more frequent than in the paired non-diabetic population, the sequence could be due to hyperinsulinemia, hypoglycemia, hypokalemia, parallel activation of the sympathetic system and genetic predisposition to trigger severe and fatal rhythm and/or conduction disturbances. However severe nocturnal hypoglycemia is common and rarely causes such dramatic consequences. Hypoglycaemia causes QT prolongation systematically but whose magnitude varies among individuals, probably because of genetic predisposition as in long QT syndrome family. Autonomic neuropathy seems harmless and may even be protective by reducing sympathetic response. Prevention could go through a screening of subjects at risk among youth with T1D. Glucose sensors and closed loop pumps are the first to offer solutions to many of them..