There were 1779 emergency calls to the SAS in the 12 month period coded for diabetes. 883 (50%) calls resulted in a transfer to hospital; 22 people were responsible for three or more calls.
Of the 113 calls in a one month period, 58 (51%) were taken to hospital. One hundred and eleven calls were from people known to have diabetes; 70% of calls were from the patient's own home and 13% were from a public place. The BM was less than 4 mmol/l (a “low” reading) in 58 (51%) patients. Only 27% of these were transferred to hospital. A total of 40 patients were treated with glucagon and oral carbohydrates. Mean age of the patients was 54 years. Age did not influence the likelihood of transfer to hospital. Of the 113 patients, 65 (57%) were men, and 60% of women and 44% of men were transferred to hospital.
During the 12 month period the SAS brought 251 patients to the Royal Surrey County Hospital and Frimley Park Hospital with a primary diagnosis of diabetes. Of these 251 patients, A&E records could be traced for 221. Of the 221 attendances, 94 (37%) were for hypoglycaemia in 89 patients. The next most common reason for attendance was hyperglycaemia, affecting 33 patients (14.9%). Of 94 people with hypoglycaemia, 55% were men, the mean (SEM) age was 52.6 (2.44) years, and 93% were treated with insulin. Only one patient did not have a documented BM in A&E. The mean BM was 5.66 (0.41) mmol/l, 45% of patients had a BM less than 4 mmol/l and 35% had a BM less than 3.5 mmol/l. The commonest method of treatment was glucagon administered by the ambulance service followed by oral carbohydrate (CHO) and intravenous (IV) dextrose given in A&E (table 1).
Table 1Treatment received by patients with hypoglycaemia seen in A&E
Of the 94 hypoglycaemic patients, 62 (66%) had no other illness; 6 had a urinary tract infection; 4 had a decreased Glasgow Coma Scale score and 3 had a head injury; 3 had chest infections; 3 had renal impairment; 2 had diarrhoea and/or vomiting, hypothermia, fit, and confusion; and 1 had each of stroke, generally unwell, not eating, insulin overdose, alcohol intoxication, fall, nausea, social problems, chicken pox, collapse of unknown cause, and pregnancy.
Only 11% of patients with hypoglycaemia were admitted to hospital from A&E, 83% of patients were discharged and 6% self‐discharged. Of the patients who were discharged, 50% had no documented follow up arrangements, 21% had documented advice to see their general practitioner (GP), 13% were advised to see their specialist nurse, and 6% had an outpatient appointment made with their physician. Three patients (4%) saw a diabetes specialist nurse before discharge from A&E. Patients who required admission tended to be at the extremes of age and had concurrent illness (table 2).
Table 2Characteristics of patients who were admitted to hospital following hypoglycaemia