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. Author manuscript; available in PMC: 2015 Nov 3.
Published in final edited form as: JAMA Intern Med. 2014 May;174(5):678–686. doi: 10.1001/jamainternmed.2014.136

Table 4.

Number of Cases and Estimates of Precipitating Factors Identified in Emergency Department Visits for Insulin-related Hypoglycemia and Errors—United States, 2007–2011a

Precipitating Factors ED Visits for IHEs Illustrative Casesb
Cases,
No.		 Annual National
Estimate
% 95% Confidence
Interval
Meal-related misadventure 952 45.9 38.2 – 53.6

  • Unrestrained 19 YOF driver hit tree & brick wall. Blood sugar was 24. Took insulin 2 hours ago, but no time to eat. Diagnosis: Scalp abrasion, hypoglycemia.

  • 75 YOM is an insulin-dependent diabetic, had a syncopal episode at home, found with blood sugar in the 20's by paramedics. EMS gave patient an amp of D50 IV. Per wife, patient has been having low blood sugar & it has been difficult to keep elevated. She feels it is due to chemo, possibly not eating enough. Diagnosis: Hypoglycemia.
Unintentionally took wrong insulin product 332 22.1 17.2 – 26.9

  • 51 YOM, per spouse she injected patient with 50 units of NovoLog instead of 50 units of Lantus, blood glucose 33 at time of arrival. Diagnosis: Hypoglycemia.

  • 67 YOM accidentally took wrong medication. Confused Humalog insulin with Humulin insulin, blood sugar 36. Diagnosis: Hypoglycemia.
Unintentionally took wrong dose / Confused units 205 12.2 9.2 – 15.2

  • Patient started new insulin regimen, 30–35 units of Lantus, 3–6 units of NovoLog, patient took 35 units of NovoLog accidentally, Blood sugar 40. Diagnosis: Insulin OD.

  • 62 YOM given 40 units of regular insulin instead of 4, fingerstick blood sugar 47. Diagnosis: insulin overdose, hypoglycemia.
Intentionally took "additional" dose 113 6.0 4.4 – 7.6

  • 69 YOM hypoglycemic--patient's blood sugar was over 400; took 12 units insulin in addition to his insulin pump--Blood sugar dropped to 38; found unresponsive by wife. Diagnosis: Insulin shock.
Pump-related misadventure 38 1.5 0.7 – 2.2

  • 33 YOF accidentally gave self bolus of 36 units regular insulin while changing insulin pump. Diagnosis: Overdose, accidental.

  • 27 YOM is an insulin-dependent diabetic on insulin pump, had a witnessed tonoclonic seizure, EMS found blood sugar of 20. Patient admitted that he had eaten dinner but his pump had run out so he gave himself an injection & feels he may have overcompensated. Diagnosis: Hypoglycemia, seizure.
Other misadventurec 211 13.4 10.4 – 16.4

  • 76 YOM with syncopal episode after mowing lawn for 3 hours; took usual insulin at noon rather than AM--passed out. Diagnosis: Hypoglycemic reaction.

Abbreviations: ED, emergency department; EMS, emergency medical services; IHEs, insulin-related hypoglycemia and errors.

a

Case counts and estimates from the National Electronic Injury Surveillance System - Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project, CDC. Percentages are out of a total of 1,829 cases (20,346 estimated ED visits) where a precipitating factor was documented. Refer to eTable 1 for definitions of precipitating factors. Categories are not mutually exclusive; therefore, percentages may total more than 100%.

b

Case descriptions are verbatim excerpts as reported by medical coders based on review of ED medical record narrative (with spelling corrected and abbreviations spelled out).

c

"Other misadventure" includes: insulin administration at the incorrect time or without regard to checking blood glucose, administration of "too much insulin" not further described, or medication error with insulin not otherwise specified.