title: PREVENTION AND MANAGEMENT OF INSULIN-ASSOCIATED HYPOGLYCEMIA IN HOSPITALIZED PATIENTS.
abstract: OBJECTIVE
  To determine whether appropriate therapeutic changes in insulin doses are made to prevent and manage insulin-associated hypoglycemic events in non-critically ill hospitalized patients.
  
  
  METHODS
  This retrospective study was conducted in hospitalized adults on medical or surgical floors with insulin-associated hypoglycemia, excluding treatment with insulin infusions, insulin pumps, and parenteral nutrition. The first hypoglycemic event after 48 hours of admission was the index event. Over the 1-year study period, a total of 457 insulin-associated hypoglycemic events were included as index events.
  
  
  RESULTS
  An indication for an insulin dose adjustment was identified in 32 and 42% of patients on day -2 and day -1, respectively, before the index hypoglycemic event, of which 35 and 55%, respectively, had an insulin dose reduction ≥10%. Following the hypoglycemic event, 44% of patients had an insulin dose reduction of ≥20%. Therapeutic reduction of the total daily insulin dose by ≥20% was associated with increased odds of normoglycemia and lower odds of hyperglycemia but was not associated with lower odds of recurrent hypoglycemia on the day following the index hypoglycemic event. There was a high prevalence of hypoglycemic risk factors in this population, with kidney disease and nil per os status being the most prevalent contributing factors.
  
  
  CONCLUSIONS
  Adherence to the current practice recommendation to reduce insulin doses in patients with borderline hypoglycemia and following overt hypoglycemia was modest. Further studies are needed to understand the associated risks and to define appropriate therapeutic changes for insulin treated patients with borderline and overt hypoglycemia.
  
  
  BACKGROUND
  AKI = acute kidney injury BG = blood glucose CKD = chronic kidney disease ESRD = end-stage renal disease ICU = intensive care unit NPH = Neutral Protamine Hagedorn NPO = nil per os OR = odds ratio TDD = total daily dose.
authors.forename: Nestoras
authors.initials: N
authors.lastname: Mathioudakis
authors.forename: Estelle
authors.initials: E
authors.lastname: Everett
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications / Q000188:drug therapy / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin