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New edition of hospital hypos guideline published

By Editor
4th March 2018
Clinical guidance, Hypoglycaemia

A top guideline for managing hypos in hospital has been updated to reflect changes to soft drinks on the back of the forthcoming sugar tax.

The guidance published by the Joint British Diabetes Societies (JBDS) for Inpatient Care has been revised to factor in changes to the sugar content of beverages, including Lucozade and Ribena.

Last April, the makers of Lucozade announced a new formula, which will apply to all Lucozade flavours as well as the original, reducing 100ml of Lucozade Original from 17g of carbohydrate 8.9g.

In response, the third edition of the The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus has been launched.

As well as removing Lucozade and Ribena as suitable examples of a quick acting carbohydrate for the initial treatment for patients able to swallow, the authors also took the opportunity for a wider review.

The limited changes from the previous edition include:

  • The fact that glucagon can be given without a prescription for the purpose of saving a life has been highlighted (although this information was in the original guideline).
  • Throughout the guideline where 4mmol had previously been written this has been changed to 4.0mmol to avoid any confusion.
  • In section E for enterally fed patients the sentence “In patients receiving TPN, treatment should be administered orally or intravenously as appropriate” has been added.
  • The insulin action table on page 30 has been updated to include newer insulins now available.
  • The discussion sections have been updated with any new evidence available.

The guideline is for the management of hypoglycaemia in adults in people aged 16 years or older with diabetes in hospital.

The publication states: “This guideline is aimed at all healthcare professionals involved in the management of people with diabetes in hospital. Since the introduction of the original guideline in 2010, the practice of using 50 per cent intravenous (IV) glucose for the treatment of hypoglycaemia has become much less commonplace, although it is still occasionally used.

“Expert opinion would suggest that the use of hyperosmolar solutions such as 50 per cent glucose increase the risk of extravasation injury. Furthermore, smaller aliquots used to deliver 10 per cent glucose result in lower post treatment glucose levels (Moore and Woollard, 2005). For these reasons 10 per cent or 20 per cent glucose solutions are preferred. The authors recommend the IV glucose preparation chosen is prescribed on an ‘as required’ (PRN) basis for all patients with diabetes.

“If agreed locally, glucagon (and IV glucose) may be given without prescription in an emergency for the purpose of saving a life or via a Patient Group Directive (Royal Pharmaceutical Society, 2016). Please note that intramuscular (IM) glucagon is only licensed for the treatment of insulin overdose, although it is also used in the treatment of hypoglycaemia induced by sulfonylurea therapy.

“Nurses using this guideline must work within the Nursing and Midwifery Council (NMC) professional code of conduct and work within their own competencies. This guideline is designed to enable adaptation to suit local practice where required.”

The lead authors were Diabetes Inpatient Specialist Nurse Esther Walden, from Norfolk and Norwich University Hospitals NHS Foundation Trust, Debbie Stanisstreet, Lead Nurse for Diabetes and Endocrinology at East and North Hertfordshire NHS Trust and Dr Alex Graveling, from Aberdeen Royal Infirmary.

The writing group included Professor Stephanie Amiel, of King’s College Hospital NHS Foundation Trust, Dr Clare Crowley, from Oxford University Hospitals NHS Foundation Trust, Dr Ketan Dhatariya, of Norfolk and Norwich University Hospitals NHS Foundation Trust, Professor Brian Frier, of The Queen’s Medical Institute, University of Edinburgh, and Dr Rifat Malik, from King’s College Hospital NHS Foundation Trust.

It was extensively reviewed by the JBDS IP Review Group, which also contains leading experts in the field of inpatient diabetes.

To view the guideline, click here.

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