Quality Standards for Diabetes Care Toolkit

National Institute of Health and Care Excellence (NICE) guidelines recommend the following:

When hypoglycaemia becomes unusually problematic or of increased frequency, a review should be made of the following possible contributory causes:

Inappropriate insulin regimens (incorrect dose distributions and insulin types).

Meal and activity patterns, including alcohol.

Injection technique and skills, including insulin resuspension.

Injection site problems.

Possible organic causes including gastroparesis.

Changes in insulin sensitivity (the latter including drugs affecting the renin-angiotensin system and renal failure).

Psychological problems.

Previous physical activity.

Lack of appropriate knowledge and skills for self-management (NICE 2004).
The full guidelines can be found here: www.nice.org.uk/guidance/CG15/chapter/1-Guidance.
Craig et al (2011) for the Australian Type 1 Diabetes Expert Advisory Group suggest the following for type 1 diabetes in children, adolescents and adults:

Acute treatment of hypoglycaemia is usually highly effective.

In all cases of hypoglycaemia, consideration of the cause is paramount.

Occurrence of severe episodes of hypoglycaemia may be minimised by identifying and managing risk factors.

Reassessment of the treatment regimen is required to identify precipitating and predisposing factors that have contributed to the severe hypoglycaemia.

The person with diabetes will need to work closely with the treating multidisciplinary diabetes care team of health professionals to reduce the risk of recurrence of severe hypoglycaemia.

It is the overall diabetes management package (diet and exercise) and blood glucose targets and monitoring that will help to minimise hypoglycaemia episodes.

In people with a lack of hypoglycaemia awareness or ‘hypoglycaemia unawareness’, specific education programmes to help recognise symptoms of hypoglycaemia and to reduce further severe hypoglycaemia may be implemented and should be considered.

The Joint British Diabetes Societies Guideline: The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus states ‘People with diabetes who are admitted to hospital with hypoglycaemia are reviewed by a specialist diabetes physician or nurse prior to discharge’ (p 19).