Determining Causes of Insulin-Induced Hypoglycemia Using an Electronic-Based Trigger

Hypoglycemia (defined as blood glucose < 70 mg/dL) is a common medication-related harm event in the inpatient setting. In this study, an electronic-based trigger was developed to identify hypoglycemic cases and subsequently analyze reasons for insulin-mediated hypoglycemic events in hospitalized patients. After a multistep validation approach, the trigger identified 111 hypoglycemic events between January 1 and December 31, 2023. Qualitative analysis of these events revealed that the most common reason for hypoglycemia was related to insulin orders, particularly starting or adjusting insulin at too high of a dose and failing to discontinue insulin despite falling glucose levels. Other emerging themes that provided short-term areas for improvement included changes in dietary status and hyperkalemia treatment. Overall, given that multiple causative etiologies emerged during analysis, prevention of hypoglycemia in hospitalized patients will require multifaceted solutions, including the formation of educational groups for providers who prescribe insulin.