Ambulance visits for severe hypoglycaemia in insulin-treated diabetes

Aim. To determine, in insulin-treated incidence and risk factors for severe requiring ambulance visits. Methods. A cross-sectional, questionnaire survey was made of patients with type 1 diabetes, who received help for severe hypoglycaemia from Ambulance Association personnel, during the period 1/6/95 to 31/5/96. Results. The ambulance service made 386 emergency visits to 247 persons wit h type 1 diabetes. Of these, 128 respondents (52%) completed a questionnair e detailing personal and diabetes history, usual diabetes care practices an d hypoglycaemia management. Two or more visits for severe hypoglycaemia wer e made to 26.3% of patients, who reported a longer duration of diabetes tha n those who required only one visit (28 vs 20 years, p<0.03). Self-blood-gl ucose monitoring was performed by 98.4% of respondents and 66.4% self-adjus ted insulin doses. Intensively treated patients (greater than or equal to 3 insulin injections daily) reported less awareness of hypoglycaemia than st andard therapy patients (less than or equal to 2 insulin injections daily) (p<0.05). Fifty-four per cent of respondents had glucagon available for eme rgency use, but those who lived alone and in general practitioner care only (27%) were less likely to have glucagon (p<0.05) compared to those with co mpanions and in shared-care arrangements (62%). Hypoglycaemia management wa s influenced by the availability of glucagon. Oral glucose was used by 82% before injecting glucagon, whereas 40% of patients without glucagon called for the ambulance when severe symptoms were present even before initiating treatment with oral glucose. Conclusion. This survey determined the minimum frequency of severe hypoglyc aemia requiring the ambulance at 1.6 episodes patient(-1) year(-1). Precipi tating factors and a lack of coping skills and behaviours that might preven t severe hypoglycaemia and ambulance calls were identified.