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

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 HbA 1c 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).