Medicine — Discharge to GP after a Hypoglycaemic Episode
A doctor discharges a 52-year-old man with type 2 diabetes to his GP after a hospital admission for a hypoglycaemic episode. The discharge letter must hand over the insulin dose adjustment, the precipitant identified, and the driving restriction clearly — the GP cannot safely continue care without them.
Letter type
Discharge
Write to
General Practitioner
Target length
180–200 words
The case notes
Patient: Mr Adil Rahman, 52 years old, bus driver
Admission: 2-day admission; found unresponsive at home; blood glucose 1.8 mmol/L on paramedic arrival
Background: T2DM (13 years); on insulin glargine 28 units nocte and metformin 1 g BD; HbA1c 58 mmol/mol at last review
Precipitant: Missed evening meal after an unusually long shift; insulin dose unchanged; first episode of hypoglycaemia
Insulin change: Glargine reduced from 28 to 22 units once nightly; metformin continued unchanged
Safety advice: Driving restriction discussed — DVLA requires 3-month hypoglycaemia-free period before resuming driving; bus company notified by patient
Glucose monitoring: Twice-daily fasting and post-meal glucose monitoring requested; diary provided
Endocrine follow-up: Diabetes specialist nurse counselled regarding meal timing and recognition of hypoglycaemia; endocrinology review in 6 weeks
Task: Write a discharge letter to the patient's GP, Dr Sofia Okonkwo, summarising the admission and the management required in primary care.
Writing task
Write a discharge letter to the patient's GP, Dr Sofia Okonkwo, summarising the admission and the management required in primary care.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The new insulin dose with the exact units (22 not 28)
The single most important hand-over: the GP must prescribe the new dose. 'Insulin adjusted' without the actual number is a Content failure. Numerical precision in insulin letters is a specific examiner expectation.
-
The driving restriction and the DVLA three-month condition
A patient safety and medicolegal matter the GP must reinforce and document. A bus driver returning to work before the restriction period is a significant safety risk.
-
The precipitant (missed meal, unchanged insulin) and that safety education has been given
Informs the GP that the episode was preventable and counselling has occurred, so they can reinforce — not repeat — the education at the next review.
Leave out
-
The pre-admission HbA1c in detail
Context only — the GP holds this result. A brief mention to frame the background is enough; a detailed glycaemic history is not.
-
The occupation beyond the driving restriction
That he is a bus driver is relevant only because of the DVLA restriction. Do not narrate his employment situation.
Criterion in focus · Content
Discharge after hypoglycaemia has two non-negotiable Content items: the new insulin dose (exact units) and the driving restriction with its condition. Omitting either is a Content mark loss. The 2026 marking places particular weight on medication precision — 'dose reduced' is insufficient.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.