Targeting insulin stacking to address overnight hypoglycaemia in hospitalised patients with diabetes

Inpatient hypoglycaemia is a significant concern in patients with diabetes due to its association with increased mortality. At the Veterans Affairs Greater Los Angeles Healthcare System, we developed a project to reduce overnight hypoglycaemia in hospitalised patients with diabetes by addressing insulin stacking, defined as insulin dosed within 4 hours of each other. By delaying the timing of bedtime correctional insulin administration in the electronic health record, we achieved a 28% reduction in the proportion of patients experiencing insulin stacking after one year. This led to significant decreases in overnight hypoglycaemia.