Research Article

Insulin-induced hypoglycaemia in an accident and emergency department: the tip of an iceberg?

Br Med J (Clin Res Ed) 1982; 285 doi: https://doi.org/10.1136/bmj.285.6349.1180 (Published 23 October 1982) Cite this as: Br Med J (Clin Res Ed) 1982;285:1180
  1. J Potter,
  2. P Clarke,
  3. E A Gale,
  4. S H Dave,
  5. R B Tattersall

    Abstract

    In one year a prospective survey in a large accident and emergency department identified 204 admissions of adults with severe hypoglycaemia, 200 in insulin-treated patients. Ninety-six had one admission while 34 others were admitted on 104 occasions. Of the 130 patients, 111 attended diabetic clinics in Nottingham, forming 9% of a known clinic population of 1229 on insulin treatment. Since many other episodes of hypoglycaemia were presumably treated outside hospital, 9% a year is a minimum estimate of the incidence of severe hypoglycaemia in our area. The mean insulin dose was 1.2 units/kilogram/day for those admitted twice or more and 0.9 U/kg/day for those admitted once; these doses were significantly higher than those of an age-matched clinic population. A year after the latest admission with hypoglycaemia, the mean insulin dose in the group with two or more admissions had fallen to 0.8 U/kg/day, suggesting that over-treatment had been an important causal factor. A similarly high incidence has been reported in other studies, and we believe that it is due mainly to the inadequacy of conventional subcutaneous insulin treatment.