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Self‐treatment of mild symptomatic hypoglycaemia by people with insulin‐treated diabetes

In the UK, guidelines for self-treatment of symptomatic hypoglycaemia have been prepared by Diabetes UK, and recommend ‘initial’ treatment with 10–15 g of refined carbohydrate (three to five glucose tablets), followed by the consumption of unrefined (starch) carbohydrate (‘follow-up’ treatment) [1]. These guidelines are often used in the education of people who are commencing treatment with insulin, in whom mild (self-treated) hypoglycaemia is a common side-effect [2]. However, the amount of carbohydrate recommended in the guidelines is arbitrary, does not embrace differing circumstances and varying severity of hypoglycaemia, and is not based on scientific evidence [3]. It is not known how many people in the UK follow the guidelines recommended by Diabetes UK and how often symptomatic mild hypoglycaemia is undertreated or overtreated. Either measure might have significant metabolic consequences by compromising subsequent glycaemic control, causing either rebound hyperglycaemia or increasing the risk of progression to more severe hypoglycaemia. To assess how people self-treat mild symptomatic hypoglycaemia, how this is determined by clinical and psychological factors, and the extent of adherence to the Diabetes UK treatment guidelines, a pilot survey was conducted in a group of 101 people (56 male) with insulin-treated diabetes, 74 (73.3%) of whom had Type 1 diabetes, approached at random in the diabetes out-patient clinic. Awareness of hypoglycaemia was assessed using a validated method described previously [4]. Symptomatic awareness of hypoglycaemia was intact in 83 (82.2%), and none had total loss of awareness. A questionnaire was used which estimated their frequency of mild hypoglycaemia and how this was usually treated. General diabetes knowledge was also tested. The subjects were asked to complete the Eysenck Personality Questionnaire [5] which assesses three dimensions of personality—neuroticism, extraversion and psychoticism—and the personality trait of conscientiousness was also assessed using a separate self-rated questionnaire [6]. Intelligence was measured using the National Adult Reading Test (NART) [7]. Mild (self-treated) hypoglycaemia was experienced by 40 (39.6%) subjects at least once per week. When adherence to the Diabetes UK national guidelines was evaluated, it was apparent that most people in the study were not treating hypoglycaemia as recommended, with undertreatment being common. The guidelines were adhered to by 40 (39.6%) in treating hypoglycaemia; 48 (47.5%) undertreated and 13 (12.9%) overtreated hypoglycaemia (Fig. 1). Undertreatment was most common in people with insulin-treated Type 2 diabetes ( r = 0.35, P < 0.05 for initial treatment; r = 0.25, P < 0.05 for follow-up treatment; r = 0.25, P < 0.005 for overall treatment) and was correlated with increasing age ( r = − 0.35, P < 0.001 for initial treatment; r = − 0.37, P < 0.001 for overall treatment). No significant association was observed between