Provider response to insulin-induced hypoglycemia in hospitalized patients

BACKGROUND: Risk of hypoglycemia is a major barrier to the implementation of tight blood glucose (BG) control in hospitalized patients. The objective of this study was to evaluate the changes in diabetes treatment after an episode of hypoglycemia. METHODS: The study was a retrospective data analysis of patients who received 50% dextrose for an episode of hypoglycemia. Data on immediate and subsequent changes in the antidiabetic medications the patients received were collected and evaluated by 2 diabetes specialists. RESULTS: Data from 52 patients were included in the study. Mean BG at the time of dextrose administration was 52.1 +/- 9.3 mg/dL (range 31-68). Mean BG during the 24 hours before the hypoglycemic episode was 137.5 +/- 57.0 mg/dL (range 63-287). Insulin dose was held at the time of the hypoglycemic episode in all 52 patients. Diabetes specialists agreed with this decision 100% of the time. Changes were subsequently made in the treatment of only 21 patients (40%), and diabetes specialists agreed with the changes made for 11 of these patients (52%). Thirty-one patients (60%) received no changes in treatment, and diabetes specialists agreed with that decision for 10 patients (32%). CONCLUSIONS: Provider response in making treatment changes after an episode of hypoglycemia is suboptimal. Standardized protocols to make changes in diabetes treatment after an episode of hypoglycemia need to be tested.