Ambulance visits for severe hypoglycaemia in insulin-treated diabetes

To determine, in insulin-treated diabetes the incidence and risk factors for severe hypoglycaemia requiring ambulance visits.

A cross-sectional, questionnaire survey was made of patients with type 1 diabetes, who received help for severe hypoglycaemia from Ambulance Association personnel, during the period 1/6/95 to 31/5/96.

The ambulance service made 386 emergency visits to 247 persons with type 1 diabetes. Of these, 128 respondents (52%) completed a questionnaire detailing personal and diabetes history, usual diabetes care practices and hypoglycaemia management. Two or more visits for severe hypoglycaemia were made to 26.3% of patients, who reported a longer duration of diabetes than those who required only one visit (28 vs 20 years, p<0.03). Self-blood-glucose monitoring was performed by 98.4% of respondents and 66.4% self-adjusted insulin doses. Intensively treated patients (> or = 3 insulin injections daily) reported less awareness of hypoglycaemia than standard therapy patients (< or = 2 insulin injections daily) (p<0.05). Fifty-four per cent of respondents had glucagon available for emergency use, but those who lived alone and in general practitioner care only (27%) were less likely to have glucagon (p<0.05) compared to those with companions and in shared-care arrangements (62%). Hypoglycaemia management was influenced by the availability of glucagon. Oral glucose was used by 82% before injecting glucagon, whereas 40% of patients without glucagon called for the ambulance when severe symptoms were present even before initiating treatment with oral glucose.

This survey determined the minimum frequency of severe hypoglycaemia requiring the ambulance at 1.6 episodes patient(-1) year(-1). Precipitating factors and a lack of coping skills and behaviours that might prevent severe hypoglycaemia and ambulance calls were identified.