Food selection for treatment of hypoglycaemia in insulin-treated diabetes: what happens in real life?

Abstract

Hypoglycaemia is a feared complication of insulin-treated diabetes. Treatment recommendations vary worldwide and their implementation is poorly documented. The primary study objective was to assess adherence to broad guidelines of hypoglycaemic treatment; initially with quick-acting carbohydrate and follow up with long-acting carbohydrate. The secondary objective was to assess if initial treating carbohydrate quantity complied with current worldwide recommendations. Assessment was by questionnaire, which was validated, piloted and administered to all insulin-treated individuals attending routine outpatient diabetes clinic appointments over four weeks. The questionnaire response rate, readability and validity were acceptable at 74%, grade 6 level and 0.61 (Cohen's kappa), respectively. Assessment of broad guidelines for treatment of hypoglycaemia showed 78% of responders reported initial treatment with recommended foods, but only 40.8% of these were quick-acting carbohydrate. Only 55.8% reported ingesting follow-up food. Assessment of initial treating carbohydrate quantity showed 20.6% of responders used quantities exceeding all guidelines. Of the remaining, 46.4% used quantities consistent with the most liberal recommendations (European Association for the Study of Diabetes). Most study participants reported treating with recommended foods in quantities exceeding minimum recommendations, possibly attempting to resolve unpleasant symptoms of hypoglycaemia quickly. Failure of many to ingest follow-up food is concerning and warrants investigation. Increased patient education and standardisation of guidelines for treatment of hypoglycaemia are indicated.