Introduction: Inpatient hypoglycemia is commonly associated with high mortality and morbidity. Several factors contribute to hypoglycemia in patients with diabetes, and not all causes are inevitable. However, it is important to recognize the causes of hypoglycemia to prevent further episodes. We investigate the potential causes of hypoglycemic episodes in our community hospital as part of a quality improvement project. Our aim is to reduce risks of hypoglycemia by identifying potential preventable etiologies and educate providers and the nursing team.
Methods: A retrospective chart review of patients was performed for all non-critically ill diabetic patients who experienced point of care blood glucose<70mg/dl testing between March to June 2019 (n=63). Potential causes of each hypoglycemia episode were reviewed retrospectively by a single endocrinologist.
Results: The mean age was 62.3 years+/-17.1, 63.5% males, BMI (mean 33.31+/-20.8kg/m2), 79.4% type 2 diabetes with mean A1C 8.2+/-1.6%. Median length of hospital stay was 6 days. 16(25.4%) patients had >2 episodes of hypoglycemia and 15 patients (23.9%) had severe hypoglycemia (defined as blood glucose < or = to 45 mg/dl). 8 patients (12%) were readmitted within 7 days and 20 patients (31%) had readmission within 30 days.
The most common cause of hypoglycemia was due to basal insulin excess (n=17 patients, 27%), overuse of sliding scale (n=16 patients, 25.4%), reduce food intake (n=11 patients , 25.4%), inpatient use of premixed insulin (n=6 patients, 9.5%) and use of sulfonylurea (n=2 patients, 3.2%). Two other hypoglycemic events appeared to occur when steroids dose was tapered without insulin dose adjustments.
Conclusion: The results demonstrate that several major causes of hypoglycemia are preventable and reinforce the need for determination of the cause of these events as a way of modifying therapy to prevent further episodes.
N. Mehrotra: None. H. Atalay: None. M.T. Korytkowski: None. S. Mon: None.
