COMMENTARY

Avoiding Hypoglycemia in Hospitalized Diabetes Patients

'Ridiculous' Insulin Doses, Rigid Feeding Schedules Cause Serious Problems

Peter H. Gaede, MD; Brian M. Frier, MD

October 18, 2013

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The Issue: Inpatient Hypoglycemia

Peter H. Gaede, MD: Hello. I am Peter Gaede, at the 49th meeting of the European Association for the Study of Diabetes (EASD) in Barcelona. With me today is Dr. Brian Frier, and the topic is hypoglycemia, especially in inpatients.

During recent years, much epidemiologic research has told us that inpatient hypoglycemia is associated with severe outcomes. That has led us to construct treatment algorithms to reduce hypoglycemia in these patients. One of the largest studies is the recent NICE SUGAR study,^[1] which told us that patients in the intensive care unit do not benefit from intensive blood glucose-lowering therapy. In fact, excessive lowering of blood glucose is associated with mortality. What do you think is the explanation for that?

Brian M. Frier, MD: The main interest has been on the management of patients in intensive care units. The early work done in Belgium^[2] that suggested that strict glycemic control is beneficial has now been superseded by the findings of large studies such as NICE SUGAR. This has now dictated the target levels of blood glucose that should be aimed for, to try to avoid the risk for severe hypoglycemia in very sick patients. This area has become much clearer within the past few years. Most of the intensivists who look after these patients are not diabetologists. Many are anesthetists or doctors with specific interests in acute care.

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