An audit of the insulin tolerance test in adult subjects in an acute investigation unit over one year

摘要: Summary OBJECTIVE We audited our practice of insulin tolerance testing (ITT) in terms safety and technical success. reviewed the results those tests performed over a 12-month period. By relating peak Cortisol response to 0900 h screening level, we determined whether could reduce number performed. DESIGN The all ITTs on unit between 1 January 31 December 1991 were reviewed. PATIENTS AND MEASUREMENTS Patients pre-screened by measurement serum thyroxine, recording an electrocardiogram. A subnormal thyroxine (<58 nmoi/l), (<100 nmol/l) or abnormal ECG taken as contraindications test. Minimum glucose maximum levels recorded, along with GH responses when measured. was compared basal levels. RESULTS total 161 performed, 135 which fulfilled inclusion criteria. test technically successful but 5 these; significant adverse event occurred one patient full recovery after reversal hypoglycaemia. Thirty-two patients had suboptimal hypoglycaemia: level ranged from 128 493 nmol/l measured prior ITT 97 431 nmol/l. lowest above would be expected achieve normal 580 is therefore 494 If this cut-off been adopted, 10 (8%) need not have if their only purpose assess reserve. Altering criterion for necessary 500 did affect required. Our lower limit revised upwards 100 Adequacy reserve predict insulin-induced hypoglycaemia. CONCLUSIONS When experienced endocrine adequate supervision, safe procedure. According current sample, fewer without detriment care greater than proceed testing, unless also exclude deficiency. appears reasonable upwards.