Hypoglycemia – Diagnosis and Treatment

Introduction

This project is concerned with an innovation that would enhance care delivery in the community. The area of focus is the hypoglycaemic effects on diabetes patients and the use of home remedies to manage hypoglycaemia. Diabetic patients know what kinds of food they have to consume to keep healthy, and how to restore their blood sugar levels in case of a hypoglycaemic episode. According Frier and Schernthaner (2011), people may know the right food to give or take, but most do not know the right quantity. The biggest challenge, however, lies with those family members who may not even be aware of the right food and quantity of carbohydrates that push the blood sugar to the accepted levels (Ali, 2011; Boughton, 2011; Onwudiwe et al., 2011). Usually, it is recommended that patients take fast-acting carbohydrates with 15-20 gms of carbohydrates. The blood sugar level is rechecked after 15 minutes, which prompts another dose of 15-20 gms if the blood sugar level is still low (Fonseca, 2010). Determining the right quantity of food that contains 15-20 gms of fast-acting carbohydrate is a challenge (Onwudiwe et al., 2011; Ali, 2011). Consequently, an innovation that can easily guide people on how to handle instances of hypoglycaemic attacks at home using the right quantity of household ingredients will ensure that such attacks are handled appropriately.

The Innovation

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Health care delivery can be enhanced through a variety of means depending on available resources, ideas and the patient’s health conditions. In this research, focus is on diabetic patients who suffer from hypoglycaemia. Hypoglycaemia is a condition of low sugar levels than the recommended (Boughton, 2011). These patients can suffer from hypoglycaemic episodes anytime and anywhere. Because of that, their families, friends and other people around them should be aware of a quicker way to handle the situation. There are proposed means of getting out of the hypoglycaemic episode which includes taking foods and drinks that have fast acting carbohydrates (15-20gms). This is the best home remedy to the condition. Foods always recommended include; coke, table sugar, fruit juice, raisins, Lucozade, and many more (Boughton, 2011). The problem is, people may be aware of these fast-acting carbohydrates, but do not know the right quantity to take or give the patient suffering from hypoglycaemia (Boughton, 2011). The new idea is to provide a leaflet containing the quantity of fast-acting carbohydrates that these patients should receive. Examples are; eight ounces of skimmed milk, four ounces of soda or fruit juice, and five-six life savers candies.

Hypoglycaemia

Hypoglycaemia is the state of low blood sugar in the body. For diabetic patients, it is the episodes of abnormal low plasma glucose concentration that can cause harm to the patient. It occurs when there is too much insulin or too little glucose in the body all which may be due to; eating less than usual, taking too much insulin, more exercise than normal, eating later than usual, and medication interaction or due to an illness (Frier, Heller & McCrimmon, 2013).

According to Yakubovich & Gerstein (2011), hypoglycaemia can either occur with or without symptoms. If the blood glucose level of a diabetic patient is ?70 mg/dL, then the patient should be concerned about hypoglycaemia and take necessary measures to increase the blood glucose level (Yakubovich & Gerstein, 2011), since they are likely to suffer from life threatening conditions such as insulin shock. Hypoglycaemia is a common problem among diabetic patients. Boughton (2011) posits that both diabetes type I and II patients can experience hypoglycaemic episodes several times a week. Briscoe and Davis (2006) also postulate that about 90% of patients who use insulin experience hypoglycaemic episodes. Hypoglycaemia is commonly a complication of diabetes treatment. Current treatment guidelines recommend intensive glycaemic control. Hypoglycaemia, however, is a threat to the achievement of this state, both because of its occurrence and incidence. The need for intensive glycaemic control proved that some microvascular complications and some macrovascular complications could be reduced by comprehensive metabolic control. This kind of control cannot be achieved when the available treatment regimens cause hypoglycaemia (Briscoe and Davis, 2006). Because of the regularity of occurrence and the high likelihood of such episodes occurring at home, school or far away from the hospitals, diabetic patients should have a quick way of managing them. A common way of managing hypoglycaemic episodes is by administering fast acting carbohydrates. This will ensure increased body sugar levels (Briscoe and Davis, 2006). Leaflets provide access to such information easy and quick. They also act as health promotional devices.

Why Is It An Innovation?

People may have the needed ingredients to stop a hypoglycaemic attack around them, but making use of these ingredients can be limited if they lack knowledge. There are health sources with information about fast-acting carbohydrates and the right quantity that should be taken in case a diabetic patient suffers a hypoglycaemic episode at home. The main problem is that these foods may be available randomly, and not all their quantities can be remembered easily. Additionally, one may think that he/she has the right quantity to give the patient, yet such a quantity can be confused by the other. It is from such a problem that the proposition to develop a leaflet containing the recommended quantity was developed. With such leaflets at home, anybody can help the patient.

The Need for the Innovation

This innovation is one of the ways of preventing the damaging effects of hypoglycaemia. If a diabetic patient can detect low blood glucose levels early enough, the detrimental effects of hypoglycaemia that have been documented can be reduced. Hypoglycaemia has been associated with increased risk of mortality (Kalra et al., 2013; Werner, 2013; Mccoy et al., 2012; Cryer, 2012; Frier, Schernthaner & Heller, 2011; Yakubovich & Gerstein, 2011, Heller, 2008). There are studies that have directly found links between hypoglycaemia and high mortality rates in diabetic patients and those that link it directly through other complications. According to Mccoy et al., (2012), severe hypoglycaemia has been associated with 3.4 times increased threat of death. This was a conclusion obtained from self-reports on hypoglycaemia. Additional information from patient-reported hypoglycaemia from hospitals could only mean that the risk is higher (Mccoy et al., 2012). Any health management officer would think of preventing hypoglycaemia so that this increased risk is reduced. One way of preventing it is through access to relevant information about its management. This proposed idea will contribute to the reduction of severe hypoglycaemic cases that may then lead to death.

The same information about 3.4 fold risks is communicated in Cryer (2012). The

study also indicates that hypoglycaemia is an impeding factor in the glycaemic management of diabetes. It damages the defences that can protect an individual from subsequent hypoglycaemia, therefore, causes recurrent hypoglycaemia. It causes morbidity in many with advanced type II diabetes and in most people with type I diabetes. It prohibits the maintenance of euglycemia and reduces the quality of life; the benefits of glycaemic control are never realized by the patient. Cryer (2012) also reviewed information from various reports about hypoglycaemia and found out that one in every ten or one in every twenty-five people with type I diabetes die from hypoglycaemia. It concluded that hypoglycaemia episodes need not to be life threatening for them to cause devastating effects (Cryer, 2012). This only emphasises the impact that this proposed innovation may have on diabetes patients. It has the potential of preventing any devastating effects, including death.

Hypoglycaemia also has other health effects, for example, the effect on the cardio -vascular system, which in turn contributes to increased mortality. According to Frier, Schernthaner and Heller (2011), hypoglycaemia cause hemodynamic changes such as peripheral systolic blood pressure, and increased heart rate, reduced peripheral arterial resistance, a fall in central blood pressure and increased stroke volume, myocardial contractility and cardiac output. If such high work load finds an already weakened heart, like the ones found in type II diabetic patients with coronary heart disease, dangerous consequences should be expected. Hypoglycaemia has also been associated with abnormal electrical activity in the heart, therefore, has high chances of causing sudden death (Frier, Schernthaner & Heller, 2011; Yakubovich & Gerstein, 2011). All these evidences support the importance of preventing hypoglycaemia, at all levels. Prevention or good maintenance of blood glucose levels can enhance the quality of life.

Risks and Benefits of the Innovation

Provision of the leaflets is a way of providing high-quality information recommended for self-care and helps in decision-making. In this case, there will be a variety of fast-acting carbohydrates with the right quantities. A patient may get tired of taking non-diet soda all the time, and decide on other options such as fruit juice, glucose tablets, and honey. The leaflets will improve: health literacy, clinical decision making, patient safety, care experience, self-care, service development, and access to health advice for both the patient and the family members (Greenwood, 2002).

Research evidence has shown that chronic conditions cause anxiety, but understanding of the condition and how to manage and treat it improves the ability of the patient to cope with the condition or to recover from it. It is for this reason that the leaflets with information on what to take when attacked by an episode of hypoglycaemia are very important for diabetic patients. Patient information leaflets merge information (Lowry, 2005). The leaflets also act as health promotion devices and will assist nurses in their health education and promotional activities (Greenwood, 2002).

This innovation has other advantages, such as they contain information relevant for the individual, ensure consistency of information, are cheap and easy to produce and can be easily updated. This proposed innovation would also allow readers to work through their own pace. According to Lowry (2005), they provide the carer and the patient with a focus for shared knowledge and discussion, and can also be used as a resource to healthcare organizations for informing their new staff members.

In order to ensure that the leaflets have specific information specific to an individual patient, it will make use of a structure that allows for a variety of options to be included.

Disadvantages of Leaflets

Some are usually produced for general issues, therefore not individualised. This may be a problem to diabetic patients who need special attention or have specific restrictions when it comes to taking some fast acting carbohydrates. Some may be allergic to some foods. This may not be a problem in this case since the leaflet will provide a variety of food and their quantities.

The leaflets can remain unused unless those they are meant for are motivated to use them. In the case of managing hypoglycaemia among diabetic patients, for those who do not suffer hypoglycaemia, these leaflets may remain unused. To avoid this problem, here will be monitoring of the use of the leaflets (Lowry, 2005). The leaflets may do more harm than good if they are badly produced. There are specific recommendations on how to produce a health information leaflet. If the leaflets are, for example, produced in a manner that can lead to the misconception of information, they may not achieve their aims as expected (Lowry, 2005). This will be avoided by a series of tests with the draft leaflet to ensure they are not misunderstood.

Leaflets can be lost or misplaced easily. A proposed idea to eliminate this is to encourage the users to stick some of them on walls where they can easily be seen and have others in their bags, or wallets. Those that require professional attention may take longer to update and may also be costly. It needs some groundwork done before the resource is developed. As in the case of the proposed leaflet, there will be the groundwork needed to determine those with diabetes in the community, the number of the patients, and complications that they suffer. Groundwork will also find out about the family members around, their current self-care practices, and other important information that can inform the development of this health promotional resource (Lowry, 2005).

Potential Resources Needed to Implement the Innovation

A research study will be conducted on the community to find out the number of people with diabetes, what they know about hypoglycaemia and how they currently manage the episodes. There is also need to prepare for an education program for these people and their family members on how to manage such episodes and get the neighbours, and friends involved. One can experience a hypoglycaemic episode unexpectedly and can need help. It is important to know how to relay relevant information, and quick to the person that the patient may seek help. Resources needed, therefore, are;

Field researchers or interviewers

Health educators or just nurses

Financial resources to undertake the research and educational program activities

The innovation development and implementation have about five main stages. There is the planning stage, the writing stage, conducting final checks, the consultation, and finally the distribution stage.

Planning

This is the initial preparation stage where the leaflet developer will consider the kind of information he or she will need, and for what purpose, the kind of resources, needed and the people who will be involved. It will entail identification of those who will be involved and how each of them will be involved, for example, the research will need interviewers who will seek specific information from the patients. The person has to state why specific information is needed from a clinician, patient or carers. It is while planning that the individual should review all relevant and available information from relevant sources, for example, the NHS, peer-reviewed journal articles and Diabetes associations. He or she should also think of distribution methods, for example, if the leaflets will be given to the patients directly, placed on the rack where they can easily be accessed, emailed, or even just posted (NHS, 2008).

Writing

This stage involves writing down patient information and assessing its effects. One can look for recommended frameworks to guide the development of patient information. With the evidence from previously conducted research, the leaflet should contain the right information and should be easy to read. It involves a series of writing and testing until the right product is finally produced. When assessing readability, the developer can check the draft against leaflet development guidelines, and then check with team members, and maybe members of the public. When assessing whether it is good for patients, the developer can test it on people who are not familiar with the condition. The draft can also be checked by clinicians, patient support groups, experts, to confirm that it is right for the targeted patients (NHS, 2008).

Conducting Final Checks

Whatever is to be done in this stage depends on the contents in the leaflet and the purpose of producing such leaflets. In this proposed innovation, the leaflets are meant to improve patient self-care. Final checks may include confirming the patients’ and family members’ numbers and checking if the information conflicts with other information from influential and reliable health sources (NHS, 2008).

Consultation

In this stage, the draft is given to the patients and interested groups for feedback. Changes can be made depending on the responses received from the parties (NHS, 2008).

Distribution

This stage is all about identifying the right distribution strategies in relation to the aim of developing the leaflets. For example, if the leaflets are meant for improving self-care, the healthcare professional will have to think of how these leaflets will reach the targeted patients. The perfect method is to deliver each leaflet to each patient and family members after consultation with them, and educating them on its benefits. They should also be informed about the whole project of improving health care delivery. The stage also involves monitoring to identify how the information is used, and if there is a need for any improvements (NHS, 2008). Additional resources that will be needed are; writing materials, human resource for distribution, and financial resources for distribution and other project activities such as testing the leaflet draft.

Implementation Difficulties

There are no current implementation difficulties except for finding adequate resources to conduct the research in the community and identify the patients. It may also be difficult to convince all diabetes patients to come to educational programs on how to manage hypoglycaemia alongside the management of diabetes. According to the NHS guideline, the best approach is educating the patients and their families on a one-on-one basis, but this is expensive and time consuming. It may depend on the patients’ visit to the hospitals, which is an unsure way of reaching the patients.

Leadership and Management Skills Needed

The leadership and management skills belong to one category of management which is; project management. Under this category, these skills can again be classified under technical project management skills, general management skills, and leadership skills (Hallows, 2002). Technical project management skills are such as project planning and execution skills. Planning skills gives one the ability gather and assess information for estimates, identify dependencies, develop a work breakdown structure, assign and level resources, and analyse the risks among other abilities. Project execution skills give one the ability to develop estimates at completion, gather and evaluate data, prepare meaningful reports, and monitor the progress of the project (Hallows, 2002). These technical skills are very important for planning and execution of the proposed project. Project leadership skills involve managing the expectations and relationships of the participants. Hallows (2002) indicates that project management leadership requires the ability to engage the main stakeholders involved in the project in each phase. An example, is, in the planning stage, the project manager has to get all the relevant departments involved, and any other parties that will be involved. Like in the leaflet development case, the project manager has to find a way of engaging the patients, the carers, family members and the health care organization supporting or sponsoring the project. The project manager can decide when it is necessary to share ideas, and the communication strategy that is necessary for attainment of the objectives of the project (Hallows, 2002). The project manager of this proposed project should have the ability to convince others about the benefits of the project, and explain the value of their roles. General management skills are such as; the ability to listen, delegate, goal setting, time management, communications, negotiation, and meeting management. There is also the need for human resource management skills. Project planning and implementation will require people to perform different duties. The performance of the project depends on the employees’ activities, without good management skills, the outcome of the project may be affected negatively (Hallows, 2002).

References

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Boughton, B. (2011). Patients with Diabetes Lack Knowledge about Hypoglycemia.

Medscape Medical News. Retrieved from: http://www.medscape.com/viewarticle/740881

Briscoe, V. J. and Davis, S. N. (2006). Hypoglycemia in Type 1 and Type 2 Diabetes:

Physiology, Pathophysiology, and Management. Clinical Diabetes, 24 (3): 115-121.

Cryer, P. E. (2012). Severe Hypoglycemia Predicts Mortality in Diabetes, Diabetes Care. 35(9):

1814-1816.

Fonseca, V. (2010). Diabetes: Improving Patient Care. New York: Oxford University Press.

Frier, B. M., Heller, S. and McCrimmon, R. (2013). Hypoglycaemia in Clinical Diabetes. (3rd

Ed.). West Sussex, UK: John Wiley & Sons.

Frier, B. M., Schernthaner, G. and Heller, S. R. (2011). Hypoglycemia and Cardiovascular Risks.

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Greenwood, J. (2002). Employing a Range of Methods to meet Patient Information

Needs. Nursing Times. Retrieved from:

http://www.nursingtimes.net/employing-a-range-of-methods-to-meet-patient-information-needs/200054.article.

Hallows, J. E. (2002). The Project Management Office Toolkit. New York: AMACOM Div

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Heller, S. (2008). Sudden Death and Hypoglycaemia. Diabetic Hypoglycemia, 1(2): 2-7.

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Ramachandran, A. (2013). Hypoglycemia: The Neglected Complication. Indian Journal of Endocrinology and Metabolism, 17(5): 819–834.

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NHS. (2008). Quality and Service Improvement Tools. Retrieved from:

http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/patient_information.html

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