BSPED2013 Oral Communications Oral Communications 5 (3 abstracts)
Hypoglycaemia success during the insulin tolerance test: a two centre comparison
Rachel Besser 1 , Suet Ching Chen 2 , Emma Knight 1 , Ethel McNeil 2 , Pauline Musson 1 , Victoria Fisher 2 , Stephanie Kerr 1 , Malcolm Donaldson 2 , Nikki Davis 1 , Faisal Ahmed 2 , M Guftar Shaikh 1 & Justin Davies 2
1Southampton General Hospital, Southampton, UK; 2Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Introduction: The insulin tolerance test (ITT) is the gold standard method to assess GH and/or ACTH deficiency. Safety concerns with the use of this test were raised more than 20 years ago from overtreatment of hypoglycaemia and consequent cerebral oedema, resulting in some centres using alternative tests. We have re-appraised use of the ITT in a contemporary setting and evaluated: i) timing of the glucose nadir, ii) time to resolution of hypoglycaemia, iii) adverse events and iv) staffing levels.
Methods: Data from ITTs in two regional UK paediatric endocrinology centres (A and B) were collected retrospectively during 2012. Both centres use 0.1 unit/kg i.v. actrapid with samples taken at −30, 0, 30, 60, and 90 min. Centre A also samples at 20, 45 and 75 min whereas B samples at 15 and 120 min. Successful hypoglycaemia was defined as laboratory glucose <2.2 mmol/l and/or >50% reduction from baseline.
Results: 49 patients (A, n=23 and B, n=26; 80% male) aged median (interquartile range) 14.8 (11.2–15.6) years were included. Patients from Centre A were older (median 15.0 vs 12.3 years, P=0.04) but had a similar BMI SDS (P=0.19) and gender (P=0.30). Hypoglycaemia occurred in 100% (23/23) patients in Centre A and 73% (19/26) in Centre B, P=0.01). The 7/26 patients from Centre B who did not become hypoglycaemic tended to be older, although this did not reach significance (median 14.0 vs 11.6 years, P=0.59). The glucose nadir was lower in Centre A (1.5 vs 1.9 mmol/l, P=0.007), occurred later (20 vs 15 min, P=0.04) and resolved more quickly (time to BM >4 mmol/l: 45 vs 60 min, P=0.006). None of the patients required i.v. treatment or hospital admission. Two healthcare professionals were present during each ITT. Centre A had two specialist endocrine nurses (EN) for the majority (87%) of the ITTs, whereas B always had one EN and one doctor present.
Conclusions: Successful hypoglycaemia was more likely if samples were taken at 20 min. The ITT is safe when performed under specialist endocrine nurse supervision. This has important resource and safety implications.
Volume 33
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more