Clinical Case Database / Category: Patient Management
Dr Una Graham, Dr John Lindsay
Foundation Years Journal, volume 8, issue 5, p.54 (123Doc Education, London, May 2014)
Diabetes mellitus is highly prevalent in hospitalised patients affecting around 15% of inpatients in England and Wales (1). Hypoglycaemia is a feared complication of diabetes and affected around a fifth of inpatients with diabetes surveyed during the recent National Inpatient Diabetes Audit (1). Hypoglycaemia episodes are likely to be encountered and managed by doctors in training, particularly during out-of-hours care when specialist support may be limited. Foundation doctors need to be aware of the management of hypoglycaemia in the acute setting and how to prevent further episodes. This case outlines the presentation and emergency management of hypoglycaemia in a patient with type 1 diabetes and discusses the salient points which should be included in their initial assessment and management.
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Dr Una Graham
ST7 Endocrionology and Diabetes,
Belfast Health and Social Care Trust,
Diabetes and Endocrinology, Mater Infirmorum Hospital,
47-51 Crumlin Road, Belfast, BT14 6AB
Dr John Lindsay (Corresponding author)
Consultant in Endocrinology and Diabetes,
Belfast Health and Social Care Trust,
Diabetes and Endocrinology,
Mater Infirmorum Hospital, 47-51 Crumlin Road, Belfast, BT14 6AB
1. National Diabetes Inpatient Audit 2012. www.diabetes.org.uk/Documents/Reports/NaDIA-annualreport- 2012-0613.
2. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ . Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009; 94:709-728.
3. DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med 199; 90: 450-459.
4. Deary IJ, Hepburn DA, MacLeod KM, Frier BM. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia 1993; 36 : 771 â€“777.
5. Joint British Diabetes Societies. The hospital management of hypoglycaemia in patients with diabetes mellitus. http://www.diabetes.org.uk/About_us/What-we-say/Improving-diabetes-healthcare/Thehospital- management-of-Hypoglycaemia-in-adults-with-Diabetes-Mellitus.
6. Foster-Powell K, Holt SHA, Brand-Miller JC. International table of glycemic index and glycemic load values. Am J Clin Nutr 2002; 76: 5-56.
7. Maran A, Pavan P, Bonsembiante B, Brugin E, Ermolao A, Avogaro A, Zaccaria M. Continuous Glucose Monitoring Reveals Delayed Nocturnal Hypoglycemia After Intermittent High-Intensity Exercise in Nontrained Patients with Type 1 Diabetes. Diabetes Technology & Therapeutics 2010; 12: 763-768.
8. Chowdhury TA, Escudier V. Poor glycaemic control caused by insulin induced lipohypertrophy. BMJ 2003; 327: 383.
9.Driver and Vehicle Licencing Agency. DVLAâ€™s current medical guidelines for professionals.https:// www.gov.uk/current-medical-guidelines-dvla-guidance-for-professionals-conditions-d-to-f#diabetes--- insulin-treated.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.