Hypoglycaemia: a case report

Diabetes mellitus is one of the most common and important medical conditions in the UK (Diabetes in the UK, 2010). Hypoglycaemia is the most common diabetic emergency (Brackenridge et al, 2006). It is a major obstacle in achieving the tight glycaemic control required to prevent the long-term complications of diabetes (Diabetes Control and Complications Trial Research Group (DCCT), 1993). Prolonged hypoglycaemia can result in severe neurological and psychosocial morbidity and even death. Prompt and effective treatment is therefore essential in preventing the associated significant morbidity and mortality. The diagnosis and treatment of hypoglycaemia is commonly encountered by paramedics.

A 42-year-old gentleman called 999 after taking an insulin overdose. On arrival at his house, paramedics found him ambulant and conversant, but confused (Glasgow coma scale (GCS) 14/15; Eyes 4/4; Verbal 4/5; Motor 6/6). Initial examination found that his airway was patent and he was haemodynamically stable. Capillary blood glucose (CBG) was low (3.2 mmol/L). Observation of the scene revealed empty cartridges of glargine (cumulative total of 1500 units of insulin), three empty cans of lager, and five empty 500 ml bottles of Lucozade®. The paramedics administered 20 ml of Hypostop® (40% glucose gel), before gaining large bore intravenous (IV) access and administering 5% glucose solution.