A new report from the Royal College of Emergency Medicine (RCEM) has raised serious concerns about the timely administration of time-critical medications (TCMs) such as insulin, in UK emergency departments.
The findings highlight a potentially life-threatening issue for people living with diabetes and other chronic conditions.
Key findings
The study, which analysed data from over 13,000 A&E patients across 136 emergency departments, focused on those who rely on insulin for diabetes and levodopa for Parkinson’s disease – two medications that must be taken promptly to prevent rapid deterioration.
- 68% of medication doses were not administered within 30 minutes of the scheduled time.
- More than half of patients on time-critical medications were not identified as such within the first 30 minutes of arrival.
These delays can have dangerous consequences, especially for people with insulin-treated diabetes.
Missed or late insulin doses can result in severe hyperglycaemia, diabetic ketoacidosis and in some cases, can be life-threatening.
Why timely medication matters
For people with diabetes, especially those using insulin, routine and timing are essential.
Any disruption to this can lead to a cascade of complications – particularly in the high-stress, fast-paced environment of emergency care.
Dr Jonny Acheson, an emergency medicine consultant who lives with Parkinson’s and led the study, said: “These medicines are critical to patients’ quality of life and we have a duty of care to ensure that they receive them on time. The findings should serve as a call to action for both emergency staff and patients alike.”
Importance of communication
While patients are encouraged to bring their medications to A&E and communicate what they are taking, the responsibility also lies with emergency staff to ask, document and act quickly.
The report calls for improvements in system design to ensure that patients on critical medications are promptly identified and treated appropriately.
Dr Ian Higginson, RCEM’s president-elect, stressed that delays are often a symptom of overstretched emergency departments, with patients facing waits of 12, 24, or even 48 hours – far beyond what the system was designed to handle.
“Missing a dose of insulin isn’t just inconvenient—it can be dangerous,” he said. “We need robust systems to ensure patients don’t fall through the cracks.”
Diabetes UK Responds
Diabetes UK praised the RCEM’s findings and reiterated that delayed or missed insulin doses can be a medical emergency. The charity continues to advocate for better systems and safeguards to protect people with diabetes, particularly in urgent care settings.
NHS Pledge to Review and Act
An NHS spokesperson welcomed the report, stating: “We will closely review the findings to ensure that every patient in need of time-critical medicine receives timely support, whether through direct administration or assistance to self-manage as they would at home.”
As part of its upcoming Urgent and Emergency Care Plan, the NHS has pledged to tackle excessive A&E waiting times and improve patient flow – key steps in ensuring no dose is missed in the future.
What can I do to help myself?
If you or someone you care for lives with diabetes and requires insulin:
- Always carry your medication when attending A&E.
- Inform staff immediately on arrival that you are on insulin or other time-critical medications.
- Keep a list of your medications (and doses) with you at all times.
- Don’t hesitate to speak up if your medication is delayed – your safety depends on it.
