Hypoglycemia in patients with non-critical illness in the hospital setting
Mary T Korytkowski
Diabetic Hypoglycemia September 2013, Volume 6, Issue 2: page 3-8
Hypoglycemia, defined as blood glucose <3.9 mmol/l (70 mg/dl), occurs in 5–15% of hospitalized patients who receive glucose-lowering therapies, and represents a major barrier to treatment of hyperglycemia in the inpatient setting. Patients who experience hypoglycemia are at high risk for adverse outcomes including seizures, falls, cognitive dysfunction, and prolonged hospital stay. An increase in mortality has been observed in patients who experience even one event. Paradoxically, rational insulin therapy, dosed according to clinical status and results of bedside blood glucose monitoring to achieve and maintain recommended inpatient glycemic goals, can be an effective method for the prevention of hypoglycemia. Patients who are older, or who have underlying renal insufficiency or other severe illnesses, represent groups at high risk for hypoglycemia; these patients therefore require modifications to weight-based insulin-dosing strategies. Contingencies, such as nurse-directed Hypoglycemia Treatment Protocols that guide the immediate treatment of hypoglycemia help to limit both the duration and severity of events.
Keywords: diabetes, hospital, hyperglycemia, hypoglycemia, inpatients, insulin, sulfonylurea