Kidney Week

Abstract: FR-PO1085

Analysis of Severe Hypoglycemic Events in Hospitalized Patients: A Single-Center Experience

Session Information

• Health Maintenance, Nutrition, and Metabolism
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Shingrani, Hetal R, University of Mississippi School of Medicine, Jackson, Mississippi, United States

Hetal R Shingrani

• Barrier, Kim, The University of Mississippi Medical Center, Jackson, Mississippi, United States

Kim Barrier, RN

• Flores, Emily, The University of Mississippi Medical Center, Jackson, Mississippi, United States

Emily Flores, PharmD

• Garla, Vishnu V, The University of Mississippi Medical Center, Jackson, Mississippi, United States

Vishnu V Garla, MD

• Romero, Damian G., The University of Mississippi Medical Center, Jackson, Mississippi, United States

Damian G. Romero, PhD

• Yanes Cardozo, Licy, The University of Mississippi Medical Center, Jackson, Mississippi, United States

Licy Yanes Cardozo, MD

• Dossabhoy, Neville R., The University of Mississippi Medical Center, Jackson, Mississippi, United States

Neville R. Dossabhoy, MD, FASN

Background

The kidneys are involved in the metabolism and clearance of various substances, including insulin. Renal clearance of insulin is impaired in patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD), especially in patients undergoing dialysis. Decreased clearance can prolong insulin action, increasing risk of hypoglycemia. The total daily dose of insulin is often calculated using a usual starting dose of 0.5 units/kg/day. This study aims to examine the prevalence of CKD and ESKD in hospitalized patients with severe hypoglycemia.

Methods

This single-center study is a retrospective analysis of prospectively collected data, conducted at our tertiary care academic hospital. We reviewed all hospitalized adult patients who experienced severe hypoglycemia (defined as blood glucose < 40 mg/dL) in the month of February 2025. Data on patient demographics, comorbidities, and diet types were collected from electronic health records; adult patients taking insulin were included.

Results

51 severe hypoglycemic events were recorded in 22 patients during the study period. The mean age of the study population was 49±17 years, with 41% female and 59% male participants. ESKD was present in 14% of patients, all of whom were undergoing hemodialysis; the underlying etiology of ESRD was hypertension (66%) and type 1 diabetes mellitus (33%). CKD (stages 1 to 4) was present in 41% of patients. The average eGFR of the cohort was 42 mL/min/1.73 m², and the mean HbA1c was 7.77%. Renal diet was followed by 27.3% of the study population, making that the second most common diet type after diabetic diets (31.8%).

Conclusion

The results of this study confirm that patients with renal dysfunction from CKD and ESRD are at increased risk of severe hypoglycemia. They represent a large proportion of inpatients who undergo severe hypoglycemia. These patients require closer monitoring and individualized insulin dose adjustments to improve patient safety. Recognizing the contributing factors in this high-risk patient population undergoing severe hypoglycemia can help guide interventions to improve clinical outcomes. The insulin dose should be reduced by as much as 50% when the eGFR is <10 mL/min/1.73 m².

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025qvk2khmd