August 15, 2020
3 min read
Dickinson JK and Litchman ML. T06B – Hypoglycemia in the Real World. Presented at: Association of Diabetes Care & Education Specialists Annual Meeting; Aug. 13 – 16, 2020; (virtual meeting).
Litchman reports she received a research grant from Abbott Diabetes Care. Dickinson reports no relevant financial disclosures.
People with diabetes reported identifying and treating “low” and “hypo” at relatively high blood glucose levels, and that symptoms of hypoglycemia changed over time, according to survey results.
“Compared to published hypoglycemia categories, people living with diabetes who responded to our survey reported they treat, feel and worry about hypoglycemia at higher levels, and they don’t use the same terminology to describe or talk about hypoglycemia,” Jane K. Dickinson, RN, PhD, CDCES, program director and lecturer at Teachers College Columbia University, told Healio.
Dickinson and Michelle L. Litchman, PhD, FNP-BC, a nurse practitioner and assistant professor of nursing at the University of Utah College of Nursing, surveyed 394 adults with primarily type 1 diabetes or caregivers of people with type 1 diabetes (median age, 38 years; mean diabetes duration, 21 years) about their experiences with hypoglycemia. The researchers asked 28 mostly multiple-choice questions with some open-ended questions.
Among the respondents, 50% reported using an insulin pump, 78% reported using a continuous glucose monitor, and 58% reported that they had spoken with their health care provider about hypoglycemia and awareness in the last year.
Most respondents referred to hypoglycemia as some version of “low” followed by “hypo,” the researchers said during a presentation.
Jane K. Dickinson
“However, there are still people who are calling hypoglycemia things like ‘reaction’ or ‘crash’ or ‘bomb,’” Dickinson said. “Same thing with when they were asked what they hear other people refer to it as.”
Respondents reported experiencing hypoglycemia with neurogenic symptoms — hunger, numbness, palpitations, shaking, sweating, tingling and weakness — or neuroglycopenic symptoms — blurry vision, confusion, coma, fatigue, headache, mood change or seizure; 76% reported both types of symptoms.
Older respondents and those with longer diabetes duration reported hypoglycemia awareness at lower glucose levels; 4.2% said they did not experience symptoms, and 35% said they had hypoglycemia unawareness at least once. Among the cohort, 57% (61% with type 1 diabetes) reported that symptoms or symptom severity changed over time.
CGM users reported using the alerts and alarms on the sensor then confirming with a fingerstick.
“People who don’t wear CGM are going by either symptoms alone or backing that up with a finger stick or just a finger stick, and so we can teach around that around detection,” Dickinson said.
When, how much to treat
The researchers asked several questions about treating hypoglycemia.
Michelle L. Litchman
“People started to treat their hypoglycemia at an average of 72 mg/dL, and they would start to feel low around 64 [mg/dL] and become worried at an average of 63 [mg/dL],” Litchman said.
Most respondents (70%) treated hypoglycemia with a rapid-acting carbohydrate, such as juice or regular soda, and 37% of those reported consuming more than 15 g of carbohydrate, according to the researchers.
Only 58% of respondents said they always carry something to treat hypoglycemia.
“That means that 42% of people are not always prepared, and that’s something that we definitely reinforce with the people we work with; also, in terms of treating with rapid-acting carbohydrate sources and therefore avoiding rebound hyperglycemia … treating with 15 grams as opposed to overtreating,” Dickinson said.
CGM users reported using less carbohydrate.
“When you look at the qualitative data, people describe using those arrows as indicators and how they would help, how much they would treat and when they would treat those hypoglycemia episodes,” Litchman said.
Insights for educators
Consistent terminology use is a must for diabetes care and education specialists. Educators should ask individuals how they refer to hypoglycemia, whether they understand the term “hypoglycemia” and how to detect and treat it, Dickinson said, as well as discuss the benefits of technology.
“The opportunity that we have as DCESs is to teach people about CGM and how it works and what it is and the benefits of using it, and then recommend that people get it. Hopefully over time, more and more people — and one day all people — will be eligible to be covered for CGM,” she said.