A ‘one off’ hypoglycaemic episode (hypo) in a patient on insulin can occur and may need monitored. Please consider the below and always consider causes in recurrent hypoglycaemia:

• Acute illness
• Change in diet
• Change in medication – have we started a medication? Are we giving the patient a medication they are prescribed at home but that they do not take or take a different dose?
• Lipohypertrophy at insulin injection site.

This may be part of a more longstanding pattern of recurrent hypoglycaemia – consider sending HbA1c and asking the patient whether they ‘feel’ their hypos (a good question is ‘at what blood glucose level do you notice you are low’? Be concerned if the answer is 3 or less).

• Gliclazide or insulin doses may need to be reduced. A reduction in insulin dose of 10% for a daytime hypo and 20% for a night-time hypo is a good start. Remember the hypo is caused by the previous insulin dose and shouldn’t stop the next dose being given. See insulin titration protocols
• Diet or oral intake may need reviewed
• Avoid areas of lipohypertrophy if present.

• If initial management is unsuccessful or there is persistent clinical concern
• If there is concern that hypoglycaemia may be a recurrent longstanding issue
• If there is any concern about reduced hypoglycaemia awareness
• If the patient does not know how to test their own CBG or have access to a meter

All people who have experienced hypoglycaemia need to be reminded about the DVLA driving guidelines.