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

Potter, Joseph E.; Clarke, Pat; Gale, E. A. M.; Dave, S H; Tattersall, R. B.

doi:10.1136/bmj.285.6349.1180

Cited by 122 publications

(54 citation statements)

References 10 publications

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“…Furthermore, 10% of all insulin treated diabetics experience at least one severe hypoglycaemic episode each year (Casparie & Elving 1985;Potter et al, 1982). Routine treatment of insulin-induced hypoglycaemia in accident and emergency rooms includes i.v.…”

Section: Introductionmentioning

confidence: 99%

The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man.

Hvidberg

Jørgensen

Hilsted

1992

Brit J Clinical Pharma

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To compare the effect on glucose recovery after insulin-induced hypoglycaemia of intramuscular genetically engineered glucagon, intramuscular glucagon from pancreatic extraction and intravenous glucose, we examined 10 healthy subjects during blockage of glucose counterregulation with somatostatin, propranolol and phentolamine. Each subject was studied on three separate occasions. Thirty min after a bolus injection of 0.075 iu soluble insulin per kilogram body weight the subjects received one of the following treatments: 1 mg glucagon from pancreatic extraction intramuscularly; 1 mg genetically engineered glucagon intramuscularly; and 25 g glucose intravenously, respectively. The two glucagon preparations induced an equally rapid increase in plasma glucose. This was due to an abrupt (within 4 min) and equal increase in glucose appearance rate. The increases in both plasma glucose and in glucose appearance rate were far more protracted after i.m. glucagon than after i.v. glucose. These results suggest that genetically engineered glucagon and glucagon from pancreatic extraction have a similar effect on hepatic glucose production rate. Due to the protracted effect of intramuscular glucagon, a combined treatment consisting of both intravenous glucose and intramuscular glucagon may be more effective in the treatment of hypoglycaemia than any of these given alone.

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Section: Introductionmentioning

confidence: 99%

The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man.

Hvidberg

Jørgensen

Hilsted

1992

Brit J Clinical Pharma

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“…Cases treated in the hospital accident and emergency department are recognized to represent the "tip of the iceberg" (12), and the annual frequency of all emergencytreated episodes is uncertain because of incomplete ascertainment. However, this possibly has a significant resource implication from the viewpoint of ambulance use, general practitioner emergency call outs, hospital accident and emergency department attendance, and, for a small number of patients, hospital admission (13).…”

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confidence: 99%

Frequency of Severe Hypoglycemia Requiring Emergency Treatment in Type 1 and Type 2 Diabetes

et al. 2003

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OBJECTIVE -To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS-Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, ambulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated.RESULTS -A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients treated with insulin, respectively. Age, duration, and socioeconomic status were identified as risk factors for severe hypoglycemia. One in three cases were treated solely by the ambulance service with no other contact from health care professionals. The total estimated cost of emergency treatment of severe hypoglycemia was Յ£92,078 in one year.CONCLUSIONS -Hypoglycemia requiring emergency assistance from health service personnel is as common in people with type 2 diabetes treated with insulin as in people with type 1 diabetes. It is associated with considerable NHS resource use that has a significant economic and personal cost. Diabetes Care 26:1176 -1180, 2003H ypoglycemia is a common sideeffect of insulin therapy in diabetes, particularly in people with type 1 diabetes. Mild (self-treated) episodes occur frequently (1-2 episodes/week) (1,2), while severe hypoglycemia, defined as any episode requiring external help, affects up to 30% of people with type 1 diabetes annually (1-5), with an incidence ranging from 1.0 to 1.6 episodes per patient per year in unselected northern European populations. Although annual prevalence was similar in the intensively treated group of the Diabetes Control and Complications Trial (DCCT) in North America, the recorded incidence was lower at 0.62 episodes per patient year, but people at high risk of severe hypoglycemia were excluded in this study (6). Lower rates have been recorded in German centers where patients have had intensive education to avoid hypoglycemia, but the definition of severe hypoglycemia was restricted to coma and/or parenteral glucose for resuscitation (7). In contrast, the rate of severe hypoglycemia in people with type 2 diabetes treated with insulin is reported to be low (8,9), but these have been recorded in the context of clinical trials and often in people with a short duration of insulin therapy. In the U.K. Prospective Diabetes Study (UKPDS) (9), where the frequency of severe hypoglycemia was low initially, it was increasing in the latter part of the study. With increasing du...

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“…Nevertheless, in patients treated with insulin, alcohol has been implicated in up to one-fifth of hospital attendances with hypoglycemia (1). Recently, in a laboratory-based study, Turner et al (2) reported that ingestion of alcohol with an evening meal increased the risk of hypoglycemia the next morning in patients with type 1 diabetes.…”

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confidence: 99%

Day After the Night Before

et al. 2005

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

Cited by 122 publications

References 10 publications

The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man.

The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man.

Frequency of Severe Hypoglycemia Requiring Emergency Treatment in Type 1 and Type 2 Diabetes

Day After the Night Before

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