SAT-558 Factors Associated With Insulin-Related Severe Hypoglycemia in Hospitalized Patients: A Retrospective Analysis in a Tertiary Medical Center

Abstract Disclosure: H. Shingrani: None. K.S. Barrier: None. E.B. White: None. V. Garla: None. D.G. Romero: None. L.L. Yanes Cardozo: None. Background: Severe hypoglycemia, defined as blood glucose <40 mg/dL, can result in seizures, coma, or death and is particularly concerning in hospitalized patients with comorbidities. Secondary hypoglycemia in hospitalized patients may be caused by modifiable factors such as insulin dosing errors, diet mismatches, or medication use, and non-modifiable factors such as age, sex, end-stage renal disease (ESRD), or cardiovascular disease. Basal-bolus insulin therapy, commonly used to manage blood glucose, can increase severe hypoglycemia risk if not properly monitored and tailored to individual needs. Despite its importance, data on severe hypoglycemia prevalence and risk factors in tertiary care settings remain limited. This study aimed to identify factors associated with insulin-related severe hypoglycemia among hospitalized patients. Methods: A retrospective chart review was conducted at a tertiary medical center from October 1, 2023, to October 31, 2024. Adult patients who experienced severe hypoglycemia (<40 mg/dL) while on insulin were included. Data from electronic health records (EHR) included demographics, comorbidities, insulin regimens, medications, diet types, and clinical outcomes. Factors assessed included insulin type, other antidiabetic medications, renal function (eGFR), and the timing of hypoglycemic episodes. Data were stratified by gender and diet type for analysis. Results: A total of 208 severe hypoglycemic episodes were identified. Of these, 51.4% were in females and 48.5% in males, with a mean age of 50 years. 21% had ESRD, with a mean eGFR of 39 mL/min. The most common diet types were diabetic (32.07%) and NPO (29.89%). Insulin sensitivity decreased with increasing BMI, with the lowest sensitivity in BMI >30. Prior to severe hypoglycemia, median glucose was 150 mg/dL in females and 145 mg/dL in males. During severe hypoglycemia, median glucose dropped to 34 mg/dL in females and 33 mg/dL in males. Short-acting insulin was administered primarily within 0-30 minutes of glucose measurements. Mismatches between insulin administration and dietary intake, ESRD, and short-acting insulin use were identified as significant risk factors for severe hypoglycemia. Conclusion: This study highlights critical factors contributing to severe hypoglycemia in hospitalized patients, including NPO diet, short-acting insulin use, and mismatched insulin-diet regimens. Patients with renal dysfunction, particularly those with low eGFR, are at increased risk and may require reduced insulin dosages. Standardized protocols for coordinating insulin therapy with dietary changes and further research are needed to improve patient safety and clinical outcomes in hospitalized patients. Presentation: Saturday, July 12, 2025