And they didn't have any idea that nearly 30% of those patients' hypoglycemic conditions were serious enough to require hospitalization.
"We really didn't appreciate is the full severity of these insulin-related emergency visits," he told me in a telephone interview. "Almost two thirds of these visits involved hypoglycemia with either loss of consciousness, seizure, confusion or brain injury, injuries from falls, and altered mental status," Geller says.
Octogenarians Most Vulnerable
The study should, the authors suggest, provoke a much more individualized examination of which patients are prescribed insulin, with special attention to their life expectancy and level of frailty, and what other diseases or conditions they have.
It's essential to note that those most at risk were people over the age of 80.
Octogenarians were more than twice as likely to have taken an insulin-related trip to the ED than younger insulin users, and nearly five times as likely to be admitted, prompting questions about whether people at that age should be taking insulin in the first place.
"We need to go back to old fashioned doctoring, back to the basics," where each patient's diabetes treatment is tailored to their specific needs, Geller says.
What's particularly interesting, Geller says, is that the precipitating factor resulting in the insulin hypoglycemic event (IHE) was documented in 21% of the patients, and when that was sorted out, meal-related misadventures were the number one cause.