September 28, 2015

Preventing Hypoglycemia

My patience with the American Association of Diabetes Educators (AADE) is wearing very thin. It appears they are totally abandoning diabetes education for patients and concentrating on hospitals, outpatient and long-term care settings like nursing homes and group homes. I am happy that they are concerned for the elderly, but this emphasis seems a little over the top because many patients in these facilities in rural areas will not see any of this education or benefit from any of this education.

With the joint statement that was issued in conjunction with the ADA and AACE, at the ADA meeting, it appears the AADE is redirecting their efforts away from individual patients and to institutions serving patients. This could be great for the elderly, and the people in these institutions that are served by the AADE, but does not sound that great for those in rural areas and those not served by the educators.  With my blog from Sept 19, I need to change my mind and think those people living in rural areas and being cared for in rural hospitals and nursing home may have the advantage and they may not have carbohydrates shoved at them.

Often preventing hypoglycemia becomes a cognitive challenge for the elderly and many times, it is managed by others. This includes nurses and caregivers. Will caregivers receive any of this education – highly doubtful?

During a presentation at AADE 2015, the annual meeting of the American Association of Diabetes Educators, Linda Gottfredson, PhD, professor emeritus at the University of Delaware in Newark, and Kathy Stroh, MS, RD, LDN, CDE, of Westside Family Healthcare in Wilmington, Delaware, said that emergency department (ED) visits and hospitalizations due to hypoglycemia are on the rise, and clinicians have an essential role in educating patients about the risk factors.”

Severe hypoglycemia is preventable in many cases. Insulin and sulfonylureas are essential drugs in the fight against diabetes. Some patients require these medications, but some are at risk for hypoglycemia by not using these medication properly, including when and how much insulin to inject or failing to recognize when they are at risk for hypoglycemia. In addition, many diabetes patients using the various sulfonylureas take their medication when they do not eat or are not feeling like eating.

It is this improper use of insulin or sulfonylureas that are causing the increase in emergency department (ED) use and hospitalizations. Why doctors will not educate these people about the dangers of insulin or sulfonylureas is a real puzzle to me. I have been fortunate to learn on my own and have been able to prevent the need for ED use.

Many cases of hypoglycemia occur during transitions of care. These include transfers for a hospital to a nursing home, or when there are changes in health care providers. It is not uncommon for doctors to provide ineffective communication between providers.

When it comes to individual risk factors, these include some of the comorbid factors, such as depression, cognitive impairment, epilepsy, cardiovascular disease, and advanced diabetes complications.

Age is also an added risk factor, pointing out that older adults are two to three times more likely than younger patients to have an adverse drug event requiring a physician office visit or an ED visit. Older adults are also seven times more likely to have an adverse drug event requiring hospital admission.

Diabetes self-care is a complex, cognitively demanding job for patients. It requires continual vigilance, learning, reasoning, judgment, planning, anticipating, and spotting problems. Then solving them in a timely and appropriate manner under constantly changing or frequently ambiguous circumstances that are unique to the individual.

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