Endocrine Abstracts

We report a 41 yr old man who was found dead in his bed with a continuous glucose monitoring device in situ. He had type 1 diabetes diagnosed at age 14 years. He had poor glycaemic control during his teenage years and suffered from severe hypoglycaemic episodes and reduced hypoglycaemic awareness resulting in three road traffic accidents. His diabetes was complicated by proliferative retinopathy, nephropathy and peripheral neuropathy. He began continuous subcutaneous insulin pump therapy in 2005 and linked continuous real-time glucose monitoring in June 2009. He lived alone and was last seen alive and well by his family seven days prior to being found dead in bed with no signs of any violent injury. The post-mortem download of his glucose monitoring device and insulin pump showed frequent hypoglycaemic episodes over the preceding few days. On the last day of pump and sensor interaction, he was noted to be hypoglycaemic around 16:00 hrs and he temporarily stopped and then restarted his pump. Despite the evidence of alarms from the continuous glucose monitor, he remained persistently hypoglycaemic. At 17.00 hrs, he administered 10 units of insulin boluses on two occasions while still hypoglycaemic. This was the last recorded interaction between the patient and the pump/sensor system. He was found dead in bed 7 days later. Post-mortem examination was consistent with death several days before and showed no specific cause of death. Hypoglycaemia is known to precipitate sudden cardiac arrhythmias which in our patient may have been the cause of death.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.