Insulin-Related Hypoglycemia, Errors Related to Emergencies, Hospitalizations

Main Points:

Elderly patients with diabetes treated with insulin were more likely than younger patients to visit the emergency department (ED) and be hospitalized for insulin-related hypoglycemia (low blood sugar) and insulin-related errors (IHEs).

Published in:

JAMA Internal Medicine


Andrew I. Geller, M.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues.


Insulin remains one of the most challenging aspects of managing diabetes because of complexities in dosing and administration of the medication, as well as the need to monitor blood glucose. The risk of insulin-related hypoglycemia is an important consideration when choosing among treatment options.

How the Study Was Conducted:

The authors estimated annual numbers and rates of ED visits and hospitalizations for IHEs among patients with diabetes treated with insulin by analyzing data on adverse drug events among insulin-treated patients seeking ED care and from a national household survey of insulin use from 2007 through 2011.


Based on 8,100 adverse drug event cases, the authors estimated that 97,648 ED visits for IHEs occurred annually and that nearly one-third (29.3 percent) resulted in hospitalization. Patients 80 years or older treated with insulin were more than twice as likely to visit the ED and nearly five times more likely to be hospitalized because of IHEs than patients 45 to 64 years old. Severe neurological conditions (shock, loss of consciousness, seizure or a hypoglycemia-related fall or injury) were documented in 60.6 percent of cases. In the 20.8 percent of patients in whom factors leading up to the ED visit were documented, meal-related issues (i.e. not eating after taking a fast-acting medication or not adjusting the insulin regimen to make up for reduced calories) were involved in 45.9 percent of cases. About 22.1 percent of those ED visits involved patients taking the wrong insulin product, and 12.2 percent involved patients taking the wrong dose.


“Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients 80 years or older; the risks of hypoglycemic sequelae (conditions) in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning misadventures and insulin product mix-ups are important targets for hypoglycemia prevention efforts.”


Andrew I. Geller MD, Nadine Shehab PharmD, MPH, Maribeth C. Lovegrove MPH, Scott R. Kegler PhD, Kelly N. Weidenbach DrPH, Gina J. Ryan PharmD, CDE, Daniel S. Budnitz MD, MPH. National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations. JAMA Intern Med. 2014;174(5):- doi:10.1001/jamainternmed.2014.136

(JAMA Intern Med. Published online March 10, 2014. doi:10.1001/jamainternmed.2014.136)

Editor’s Note:

Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory:

To contact author Andrew I. Geller, M.D., call Melissa Dankel at 404-639-4718 or email

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