Background: Hypoglycaemia is considered a medical emergency and is treated as such. However, our experience as junior doctors has shown us that hyperglycaemia, despite being equally damaging to patients long term prognosis, can often be left to run high. This could be due to a number of factors, surrounding how often blood sugars (BM) are checked and how they are managed. We audited three standards set out in local guidelines for BM monitoring in diabetic patients, focussing on hyperglycaemia.
Method: The audit involved monitoring diabetic patients on three general medical wards over a 2 week period. 24 diabetic patients were admitted, four T1DM and 20 T2DM. We retrospectively audited the BMs for each diabetic patient over the previous 24 h against three standards: 100% of diabetic patients should have their BMs checked four times a day (QDS); T1DM should have their ketones checked in 100% of hyperglycaemic episodes (defined as BM >16 mmol/l); 100% of hyperglycaemic episodes should be treated.
Results: Across the three wards QDS BMs were achieved only 71% of diabetic inpatients; in T1DM with hyperglycaemic episodes, only 73% had their ketones checked; only 35% of hyperglycaemic episodes were treated; of these 35%, there was a significant prescribing variation.
Conclusions: Poorly controlled BMs are responsible for extensive inpatient morbidity across all disciplines. Maintaining healthy BMs will optimise patients recovery and expedite their discharge. The above standards should be achieved 100% of the time. We have presented the results of this audit at our local audit meeting and to nursing staff. Subsequently, the BM chart has been improved to prompt QDS BMs, checking of ketones and treating hyperglycaemia. We also recommended standardisation of fast acting insulin prescription for the treatment of hyperglycaemia. We will be re-auditing next week and the results will be presented.