Patient experiences - hypoglycaemia
Hypoglycaemia is the major barrier to improving glycaemic control. It can be frightening both for the person with diabetes, and those who are witnessing it. Understanding the patient experience of hypoglycaemia will help you to consider approaches to overcome those barriers, with your patient as the focus.
The DCCT showed clearly that with improved glycaemic control, hypoglycaemia increases . The focus for the health care professional is to improve glycaemic control, and lower HbA1c. However for the patient, hypoglycaemia can be embarrassing, functionally disruptive and frightening. Health professionals who wish to help their patients to improve their HbA1c need to first understand what it feels like for the patient to experience hypoglycaemia, and the implication that it brings to the individual.
It's easy to overtreat a hypo, or to try to avoid hypoglycaemia completely by running blood glucose levels higher than the recommended targets. Both result in hyperglycaemia which can be damaging in the longer term. Many people treat hypoglycaemia with sweets, or other such 'forbidden fruits', encouraging the patient to want to experience hypoglycaemia in order to get hold of some.
The following testimonials and drawings are taken from confidential interviews, first published in Diabetes Through the Looking Glass . Names have been changed.
Jason, 27 years
I often mistreat a hypo and eat too much. It’s a survival instinct – your body tells you that you need to eat, you open the fridge and gorge. Something makes you feel really hungry. There are different types of hypos. I feel really tired and sleepy. Then I realise I’m hypo and I’m back to my normal self. Self-doubt. I’m trying to do something and I start questioning everything. I feel really strange. You’re falling into a hypo but you’re not thinking. So you can overlook that you’re having a hypo.
Luke, 17 years
I used to be scared of hypos and keep my levels high.
Darren, 12 years
I like having hypos because you can eat sweets.
Janina, 13 years
I don’t like the feeling when I’m hypo. I go shaky and feel irritated. Mum overdoses me on sugar. I guess she’s scared of hypos too.
^ The Diabetes Control and Complications Trial Research Group.Ann Intern Med.Effect of intensive therapy on residual beta-cell function in patients with type 1 diabetes in the diabetes control and complications trial. A randomized, controlled trial. 1998 Apr 1;128(7):517-23.
^ Besser R. Diabetes Through the Looking Glass. Class Publishing, 2009, ISBN: 9781859592090
^ Useful website to visit //www.youthhealthtalk.org/Diabetes_type_1_in_young_people/Topic/1518