Endocrine Abstracts

Hypoglycaemia in hospitalised patients with Diabetes is common, confers higher morbidity/mortality, prolongs length-of-stay and increases re-admission rates. Previous audit identified adequate initial treatment of hypoglycaemia but poor subsequent management risking recurrent episodes. In March 2023, insulin prescribing moved from paper-based to an electronic medicines management process in line with other medication prescriptions in our institution. An alert for electronic prescription of a hypoglycaemia plan was created for all patients prescribed insulin and a “hypoglycaemia alert” for recurrent hypoglycaemia was incorporated. This audit aimed to clarify that introduction of an electronic insulin management solution did not negatively affect hypoglycaemia management in comparison to the previous paper-based system and to assess for potential benefits. Hypoglycaemia was defined as capillary blood glucose level (CBGL) <4 mmol/l. Management of all episodes of hypoglycaemia in in-patients with Diabetes on medical and surgical wards over 14-days in January 2024 was reviewed and compared to results of a previous audit in 2019. 59 episodes of hypoglycaemia occurred in 27 patients. Recognition and initial treatment of hypoglycaemia with appropriate fast-acting carbohydrate was adhered to in 77.5%; repeat CBGL performed in 83%, with 25.4% tested within the recommended 15 minutes; 48% of patients had recurrent hypoglycaemia. These results were similar to the previous audit. Prescription of hypoglycaemia plans were present in 88% compared to 8% previously. Administration of long-acting carbohydrate post-hypoglycaemia was documented in 27% of cases, an improvement from 13%. In 44%, diabetes treatment was adjusted post hypoglycaemia, a 50% increase compared to the previous audit (44%vs 22%). This study confirms ongoing good compliance with initial management of hypoglycaemia. However, deficiencies remain in relation to monitoring patients post hypoglycaemia. The introduction of an electronic insulin management system has improved administration of long-acting carbohydrate and adjustments to diabetes treatment. Its potential to prevent recurrent hypoglycaemia needs further study.