Patient selection: a diabetic is found dead in bed
Criteria for the diagnosis:
(1)
The patient has diabetes, typically type 1.
(2) The patient has been generally well.
(3) The patient does not have obvious cardiovascular diabetic complications.
(4) The patient suffers an unwitnessed sudden death.
(5) The bed is undisturbed.
(6) No clear anatomic cause of death is found after a careful and complete autopsy.
Risk factors:
(1) male
(2) Caucasian
(3) lower body mass index (BMI)
(4) high hemoglobn A1c
(5) higher daily insulin dose
(6) unstable glycemic control
(7) more frequent episodes of severe hypoglycemia
One theory is that the patient experiences prolongation of the QTc interval, resulting in a fatal ventricular arrhythmia, possibly as a result of nocturnal hypoglycemia and/or autonomic neuropathy.
