Mind the Spike: Compliance With Inpatient Hyperglycaemia Management Guidelines on an Acute Mental Health Ward in Nottinghamshire
Oluwabunmi OgungbemiAims:
Hyperglycaemia is common among psychiatric inpatients due to comorbid diabetes, medication side-effects, and challenges in self-care. Poor recognition and escalation increase risk of diabetic emergencies.
There is also the ongoing dilemma of Insulin misuse and poor glucose management, as a form of self-harm in a subset of psychiatry patients. These factors lead to increasing difficulties in managing patients with Diabetes admitted on inpatient wards.
This audit aimed to assess compliance with the Trust’s Inpatient Hyperglycaemia Guideline for episodes of blood glucose >15 mmol/L on an Acute male inpatient Ward in Nottinghamshire.
Methods:
Retrospective audit of RiO electronic records Records reviewed over a 6 month period, spanning January–August 2025 30 hyperglycaemic episodes (>15 mmol/L) in 7 patients. Results collected, organized and analysed using Microsoft excel. Standards assessed: ketone testing, wellness status reviews, escalation to medic, clear documentation, insulin use and repeat monitoring. Standards were devised based on the Nottinghamshire Healthcare NHS Trust’s “Inpatient guide for acute Hyperglycaemia in Diabetes Type 1 or 2”,
Results:
Ketones checked in
14/30 (46.7%)
Wellness status documented in
14/30 (46.7%)
, NEWS2 recorded only
3/30(10%)
Escalation gaps:
7/25(23.1%) episodes with BG >18 mmol/L not escalated to a medic.
No documentation of pre-meal glucose review in
all cases.
Insulin dosing appropriate in
36.7% of cases with an indication.
BG rechecked at 2h in
10/30(33.3%)
, at 4h in
7/30 (23.3%)
Cause identified in
10/30 (33.3%)
, mostly dietary