Hypoglycaemia and Diabetes Senior Mandatory Training

Misconception about Diabetes Not all about obesity and high sugars

Hypoglycaemia is a lower than normal level of blood glucose. It can be defined as “mild” if the episode is self treated and “severe” if assistance by a third party is required (DCCT, 1993). For the purposes of people with diabetes requiring hospital admission, any blood glucose less than 4.0mmol/L should be treated.

Mild, Moderate or Severe

SUI and Datix at RCHT Never events New data/evidence Widespread and effects all of us National Guidance Why are we doing it?

SUI-1 Type 1 diabetic – mid thirties Unstable glucose control Not rousable in the morning BM checked 1 hour later- patient unconscious, low BM ITU- died

SUI-2 Anorexic patient BM checked- less than 2.5- not repeated, not treated Patient entered terminal collapse>24 hours later Died

SUI-3 Type 2 diabetic Glucose more than 20mmol/l so Dr gave verbal order for stat sc insulin-4units Given sliding scale sc as sliding scale chart (50 units sc infused stat)- Patient became profoundly hypoglycaemic and comatose for 36 hours- survived

Never Events " Never events" are very serious, largely preventable patient safety incidents that should not occur if the relevant preventative measures have been put in place.

1 definite never event 1 probable never event Multiple datix- hypoglycaemia ignored, not treated or treatment not completed

What to look for Elderly and long term diabetics may develop hypoglycaemic unawareness so lose autonomic symptoms

Risk factors

Who to worry about

In sick patient check the glucose A B C DEFG – don’t ever forget glucose Even if not diabetic

Public awareness Check glucose and C peptide/insulin in non diabetics

Write insulin up carefully Look at drug chart/glucose results Refer to Diabetes Nurses if hypos Ensure treatment has been treated and then glucose rechecked