open access

Vol 6, No 2 (2017)
Original articles (submitted)
Published online: 2017-08-03
Get Citation

Risk factors for hypoglycaemia in in-patients with diabetes treated with continuous insulin intravenous infusion

Anna Ignaczak, Elektra Szymańska-Garbacz, Ewa Kwiecińska, Leszek Czupryniak
DOI: 10.5603/DK.2017.0008
·
Clinical Diabetology 2017;6(2):41-47.

open access

Vol 6, No 2 (2017)
Original articles (submitted)
Published online: 2017-08-03

Abstract

Introduction. Hypoglycaemia is the most frequent complication of diabetes therapy. It leads to unpleasant symptoms and, if severe may, result in coma and even death. Hospitalized patients treated with intravenous insulin therapy are at particularly high risk of hypoglycaemia. Nursing staff play crucial role in preventing, early detecting and treatment of hypoglycaemia caused by insulin given intravenously.

Material and methods. This observational, prospective and non-interventional study aimed at assessing prevalence and risk factor of hypoglycaemia during continuous intravenous insulin infusion (CIVII) in a hospital setting. Two hundred consecutive patients (48 with type 1 diabetes and 152 with type 2 diabe­tes) were enrolled into the study. Mean age of type 1 diabetes patients was 38 ± 14 years, and those with type 2 diabetes 61 ± 12 years (p < 0.0001), and their HbA1c was 10.1 ± 2.9 and 10.1 ± 2.3%, respectively. Continuous intravenous insulin infusion was given for 2.5 ± 1.1 days (basal infusion and three 90-min prandial boluses) according to standard protocol.

Results. Hypoglycaemia was noted in 48% of patients with type 1 diabetes and in 20% of those with type 2 diabetes (p < 0.001), most often in the second day of CIVII. In type 1 diabetes, the main risk factor for hypoglycaemia while on CIVII was diabetes duration (the longer duration, the higher the risk) and in type 2 diabetes — daily insulin dose, total and per kg of body weight (the lower the dose, the higher the risk).

Conclusions. Continuous intravenous insulin infusion should be used with utmost care in type 1 diabetes patients with long duration of the disease and in those type 2 diabetes patients who show signs of low insulin resistance (little overweight, low insulin requirement).

Abstract

Introduction. Hypoglycaemia is the most frequent complication of diabetes therapy. It leads to unpleasant symptoms and, if severe may, result in coma and even death. Hospitalized patients treated with intravenous insulin therapy are at particularly high risk of hypoglycaemia. Nursing staff play crucial role in preventing, early detecting and treatment of hypoglycaemia caused by insulin given intravenously.

Material and methods. This observational, prospective and non-interventional study aimed at assessing prevalence and risk factor of hypoglycaemia during continuous intravenous insulin infusion (CIVII) in a hospital setting. Two hundred consecutive patients (48 with type 1 diabetes and 152 with type 2 diabe­tes) were enrolled into the study. Mean age of type 1 diabetes patients was 38 ± 14 years, and those with type 2 diabetes 61 ± 12 years (p < 0.0001), and their HbA1c was 10.1 ± 2.9 and 10.1 ± 2.3%, respectively. Continuous intravenous insulin infusion was given for 2.5 ± 1.1 days (basal infusion and three 90-min prandial boluses) according to standard protocol.

Results. Hypoglycaemia was noted in 48% of patients with type 1 diabetes and in 20% of those with type 2 diabetes (p < 0.001), most often in the second day of CIVII. In type 1 diabetes, the main risk factor for hypoglycaemia while on CIVII was diabetes duration (the longer duration, the higher the risk) and in type 2 diabetes — daily insulin dose, total and per kg of body weight (the lower the dose, the higher the risk).

Conclusions. Continuous intravenous insulin infusion should be used with utmost care in type 1 diabetes patients with long duration of the disease and in those type 2 diabetes patients who show signs of low insulin resistance (little overweight, low insulin requirement).

Get Citation

Keywords

hypoglycaemia, insulin therapy, risk factors, hospitalization

About this article
Title

Risk factors for hypoglycaemia in in-patients with diabetes treated with continuous insulin intravenous infusion

Journal

Clinical Diabetology

Issue

Vol 6, No 2 (2017)

Pages

41-47

Published online

2017-08-03

DOI

10.5603/DK.2017.0008

Bibliographic record

Clinical Diabetology 2017;6(2):41-47.

Keywords

hypoglycaemia
insulin therapy
risk factors
hospitalization

Authors

Anna Ignaczak
Elektra Szymańska-Garbacz
Ewa Kwiecińska
Leszek Czupryniak

References (27)
  1. Gajewska M, Gebska-Kuczerowska A, Gorynski P, et al. Analyses of hospitalization of diabetes mellitus patients in Poland by gender, age and place of residence. Ann Agric Environ Med. 2013; 20(1): 61–67.
  2. Schneider ALC, Kalyani RR, Golden S, et al. Diabetes and Prediabetes and Risk of Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 2016; 39(5): 772–779.
  3. Li TC, Kardia SLR, Li CI, et al. Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes. Metabolism. 2015; 64(9): 1013–1021.
  4. Polskie Towarzystwo Diabetologiczne. Zalecenia kliniczne dotyczące postępowania z chorymi na cukrzycę. Stanowisko Polskiego Towarzystwa Diabetologicznego. Clin Diabetol. 2017; 6(supl. A): A30–A31.
  5. Tattersall RB. Frequency, cause and treatment of hypoglycaemia. W: Frier B.M., Fisher B.M. (red.) Hypoglycaemia in Clinical Diabetes. Wiley: Chichester. ; 1999: 55–87.
  6. Polskie Towarzystwo ogiczne. Zalecenia kliniczne dotyczące postępowania z chorymi na cukrzycę. Stanowisko Polskiego Towarzystwa ogicznego. Clin Diabetol. 2017; 6(supl. A): A20–A23.
  7. Ruxer J, Chromińska-Szosland D, Bukowczyk P, et al. Porównanie efektywności intensywnej insulinoterapii z wykorzystaniem dożylnej i podskórnej pompy insulinowej. Diabet Pol. 1995; 2: 24–27.
  8. Dupuy O, Mayaudon H, Palou M, et al. Optimized transient insulin infusion in uncontrolled type 2 diabetes: evaluation of a pragmatic attitude. Diabetes Metab. 2000; 26: 371–375.
  9. Frier BM, Jensen MM, Chubb BD. Hypoglycaemia in adults with insulin-treated diabetes in the UK: self-reported frequency and effects. Diabet Med. 2016; 33(8): 1125–1132.
  10. Allen KV, Pickering MJ, Zammitt NN, et al. Effects of acute hypoglycemia on working memory and language processing in adults with and without type 1 diabetes. Diabetes Care. 2015; 38(6): 1108–1115.
  11. Feinkohl I, Price JF, Strachan MWJ, et al. The impact of diabetes on cognitive decline: potential vascular, metabolic, and psychosocial risk factors. Alzheimers Res Ther. 2015; 7(1): 46.
  12. Moheet A, Seaquist ER. Hypoglycemia as a driver of cardiovascular risk in diabetes. Curr Atheroscler Rep. 2013; 15(9): 351.
  13. Blackshear PJ, Roussell AM, Cohen AM, et al. Basal-Rate Intravenous Insulin Infusion Compared to Conventional Insulin Treatment in Patients With Type II Diabetes: A Prospective Crossover Trial. Diabetes Care. 1989; 12(7): 455–463.
  14. Krzymień J. Dożylne wlewy insuliny podczas hospitalizacji. Przew Lek. 2007; 4: 73–79.
  15. Furnary AP. Insulin infusions for cardiac surgery patients with diabetes: a call to reason. Endocr Pract. 2002; 8(1): 71–72.
  16. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345(19): 1359–1367.
  17. Goldberg PA, Siegel MD, Sherwin RS, et al. Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit. Diabetes Care. 2004; 27(2): 461–467.
  18. Strojek K. Hipoglikemia. W: Cukrzyca (red. J. Sieradzki), wyd. 2. ViaMedica 2, 2016, str, Gdańsk : 539–542.
  19. Szewczyk A. Pielęgniarstwo diabetologiczne. PZWL, Warszawa 2013: 115–126.
  20. Samson WK, Stein LM, Elrick M, et al. Hypoglycemia unawareness prevention: Targeting glucagon production. Physiol Behav. 2016; 162: 147–150.
  21. Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes. 2015; 6(7): 912–926.
  22. Wierzchowska A, Zozulińska-Ziółkiewicz D. Hipoglikemia w cukrzycy typu 1. Diabet Prakt. 2011; 12(6): 210–215.
  23. Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes. Diabetes Care. 2005; 28: 2948–2961.
  24. Allen KV, Frier BM. Nocturnal hypoglycemia: clinical manifestations and therapeutic strategies toward prevention. Endocr Pract. 2003; 9(6): 530–543.
  25. Sircar M, Bhatia A, Munshi M. Review of Hypoglycemia in the Older Adult: Clinical Implications and Management. Can J Diabetes. 2016; 40(1): 66–72.
  26. International Hypoglycaemia Study Group. Minimizing Hypoglycemia in Diabetes. Diabetes Care. 2015; 38(8): 1583–1591.
  27. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013; 36(5): 1384–1395.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl