Endocrine Abstracts

Background: Hypoglycaemia frequently occurs in hospital inpatients with diabetes mellitus. With better vigilance amongst healthcare staff, episodes of hypoglycaemia could be prevented and with better awareness of the treatment process, early reversal of hypoglycaemia could avert the development of adverse events in these patients. This study aimed to assess the management of hypoglycaemia in hospital inpatients.

Methods: This was a retrospective study of 58 randomly selected episodes of hypoglycaemia in ward patients at a district general hospital. The cut off level used to define hypoglycaemia was <4.0 mmol/l. The medical management of individual cases was assessed for adherence to the hospital guideline.

Results: In 58 episodes of hypoglycaemia, 18 occurred in patients managed with insulin only, 3 with oral agents only and 18 with combined insulin and oral therapy. Nineteen episodes occurred in patients on insulin-sliding scale, with only 8 of these correctly prescribed. The initial capillary blood sugar (CBS) ranged from 1.2 to 3.9 mmol/l (mean 2.7±S.D. 0.68 mmol/l). Food and drink were given in 24 episodes, hypostop in 21 episodes and intravenous dextrose was administered in 15 episodes. In addition, two patients received glucagon and 2 patients were subsequently commenced on an insulin sliding scale. In 56 episodes with repeat CBS, the mean value was 6.6±S.D. 4.3 mmol/l and the values ranged from 1.6 to 21.3 mmol/l. Repeat CBS was not done in 2 episodes. In 20 episodes, a doctor was called and attended.

Conclusion: Hypoglycaemia is a medical emergency that can be prevented and reversed if detected early. Most episodes of hypoglycaemia occurred in patients treated with insulin. Insulin sliding scale should only be commenced when it is absolutely indicated and correct prescription should be ensured in all cases. In addition, hypoglycaemia protocol should be made more accessible to staff. Educating healthcare staff, strict CBS monitoring and active involvement of patients are crucial in preventing hypoglycaemia.