The Hospital Management of
Hypoglycaemia in Adults with Diabetes Mellitus
March 2010

Supporting, Improving, Caring

Statement for Inpatient Guidelines
This guideline has been developed to advise the treatment and management of The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus.
The guideline recommendations have been developed by a multidisciplinary team led by the Joint British
Diabetes Society (JBDS) and including representation from Diabetes UK. People with diabetes have been involved in the development of the guidelines via stakeholder events organised by Diabetes UK.
It is intended that the guideline will be useful to clinicians and service commissioners in planning, organising and delivering high quality diabetes inpatient care. There remains, however, an individual responsibility of healthcare professionals to make decisions appropriate to the circumstance of the individual patient, informed by the patient and/or their guardian or carer and taking full account of their medical condition and treatment.
When implementing this guideline full account should be taken of the local context and in line with statutory obligations required of the organisation and individual. No part of the guideline should be interpreted in a way that would knowingly put people, patient or clinician at risk.

We would like to thank the service user representatives whose input has informed the development of these guidelines.

Authors:
Debbie Stanisstreet (RGN), East & North Hertfordshire NHS Trust
Esther Walden (RGN), Norfolk and Norwich University Hospitals NHS Foundation Trust
Christine Jones, Norfolk and Norwich University Hospitals NHS Foundation Trust
Dr Alex Graveling, Royal Infirmary of Edinburgh

Contributors:
Professor Stephanie Amiel, King’s College Hospital NHS Foundation Trust
Dr Clare Crowley, Oxford Radcliffe Hospitals NHS Trust
Dr Ketan Dhatariya, Norfolk and Norwich University Hospitals NHS Foundation Trust
Professor Brian Frier, Royal Infirmary of Edinburgh
Dr Rifat Malik, King’s College Hospital NHS Foundation Trust

Distributed and incorporated comments from:
Diabetes Inpatient Specialist Nurse (DISN) UK Group membership
Joint British Diabetes Societies (JBDS) Inpatient Care Working Group members
NHS Diabetes
Diabetes UK
Diabetes UK User Group
Association British Clinical Diabetologists (ABCD)
NHS Institute of Improvement and Innovation, ThinkGlucose team
The Diabetes Management & Education Group of the British Dietetic Association
United Kingdom Clinical Pharmacy Association (UKCPA) Diabetes Committee
Guild of Healthcare Pharmacists

Wider distribution:
Royal College of Nursing
Royal College of Physicians

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Foreword
Hypoglycaemia is the most feared complication of insulin therapy, presenting an increasingly important problem for hospital services. A growing prevalence of diabetes in the community has been accompanied by an even greater increase of diabetes in hospitalised patients such that one in six inpatients has diabetes. Furthermore, more than half of these are being treated with insulin or an oral agent that may cause hypoglycaemia. Approximately one in four people with diabetes suffers a hypoglycaemic episode during their hospital stay. This has serious consequences as inpatient hypoglycaemia not only increases length of stay but is associated with an increased mortality.
Prevention of hypoglycaemia and its prompt and effective treatment is therefore essential. This is the aim of this guideline. It has been written by practicing clinicians and draws from their experiences of managing hypoglycaemia in UK hospitals. It outlines the risk factors for, and causes of hypoglycaemia in hospital, recognising that these are often quite different from those in the community e.g. a dislodged enteral feeding tube in a patient receiving insulin. It gives comprehensive and detailed advice on the management of hypoglycaemia in a variety