Sylvia Shaw

Hypoglycemia (hG) affects 12-18% of inpatients with diabetes mellitus, and is responsible for increase in cardiovascular morbidity and mortality. Objective: The goal of this project was to decrease the hG events (blood glucose <70 mg/dl) by using new insulin regimens. Methods: We reviewed the hG reported in PSN from during September 2012 to August 2013. A pilot program was implemented by end of March 2013, and included: 1) switching basal Insulin (Glargine) to AM administration instead of PM, 2) using bolus insulin (Humalog) after the meals, 3) holding insulin administration if food intake was less than 50% and 4) adjusting the use of sliding scale coverage. Results: During the study period the distribution of hG for the inpatient population was the following: 27 (19 hG in rehab units and 8 hG in med/surgical units) before intervention; 16 episodes of hG occurred after intervention (11 hG in rehab and 5 hG in med/surgical units). Overall this represents a 59% reduction in the hG events. To exclude hospital census as a confounding factor, we also reviewed the incidence of hG over a 14 months period (7 months before and 7 months after the March 2013).The hG events decreased from 49 to 24 episodes, a 48.9% decrease. Conclusions: In the hospital setting the new insulin regimens appears to be helpful in reducing the incidence of hypoglycemia. Since hypoglycemia is a critical part of patient safety in diabetes management, additional studies need to be done to implement safer insulin regimens.