Clinical Case Database / Category: Patient Management


Publication details

Dr Una Graham, Dr John Lindsay
Foundation Years Journal, volume 8, issue 5, p.54 (123Doc Education, London, May 2014)


Diabetes mellitus is highly prevalent in hospitalised patients affecting around 15% of inpatients in England and Wales (1). Hypoglycaemia is a feared complication of diabetes and affected around a fifth of inpatients with diabetes surveyed during the recent National Inpatient Diabetes Audit (1). Hypoglycaemia episodes are likely to be encountered and managed by doctors in training, particularly during out-of-hours care when specialist support may be limited. Foundation doctors need to be aware of the management of hypoglycaemia in the acute setting and how to prevent further episodes. This case outlines the presentation and emergency management of hypoglycaemia in a patient with type 1 diabetes and discusses the salient points which should be included in their initial assessment and management.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


Dr Una Graham

ST7 Endocrionology and Diabetes,
Belfast Health and Social Care Trust,
Diabetes and Endocrinology, Mater Infirmorum Hospital,
47-51 Crumlin Road, Belfast, BT14 6AB

Dr John Lindsay (Corresponding author)

Consultant in Endocrinology and Diabetes,
Belfast Health and Social Care Trust,
Diabetes and Endocrinology,
Mater Infirmorum Hospital, 47-51 Crumlin Road, Belfast, BT14 6AB


1. National Diabetes Inpatient Audit 2012. 2012-0613.
2. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ . Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009; 94:709-728.
3. DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med 199; 90: 450-459.
4. Deary IJ, Hepburn DA, MacLeod KM, Frier BM. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia 1993; 36 : 771 –777.
5. Joint British Diabetes Societies. The hospital management of hypoglycaemia in patients with diabetes mellitus. management-of-Hypoglycaemia-in-adults-with-Diabetes-Mellitus.
6. Foster-Powell K, Holt SHA, Brand-Miller JC. International table of glycemic index and glycemic load values. Am J Clin Nutr 2002; 76: 5-56.
7. Maran A, Pavan P, Bonsembiante B, Brugin E, Ermolao A, Avogaro A, Zaccaria M. Continuous Glucose Monitoring Reveals Delayed Nocturnal Hypoglycemia After Intermittent High-Intensity Exercise in Nontrained Patients with Type 1 Diabetes. Diabetes Technology & Therapeutics 2010; 12: 763-768.
8. Chowdhury TA, Escudier V. Poor glycaemic control caused by insulin induced lipohypertrophy. BMJ 2003; 327: 383.
9.Driver and Vehicle Licencing Agency. DVLA’s current medical guidelines for professionals.https:// insulin-treated.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.