While the definition of type 1 diabetes – the body doesn’t produce insulin – sounds clear and concise, this disease is anything but, said Lisa Geelen, a type 1 diabetes caregiver, during Benefits Canada’s 2019 Chronic Disease at Work conference in Toronto on June 5.
Diabetes is more of an art than a science to manage, she said. Not only does insulin require balancing out with carbohydrates and exercise, but there are other factors to consider when trying to achieve target blood levels. “Stress, sickness, if the weather changes, hormones, the glycemic index in food and there’s more. It’s nearly impossible to get the flat line, to be in that target and safe zone.”
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Data suggests Canadians with diabetes who are managing it with medication have, on average, 2.4 to 2.5 hypoglycemic events each year, said Dr. Donna Mojdami, clinical research physician and endocrinologist, who also spoke during the session. Severe hypoglycemia is a diabetic emergency, she explained, noting it’s when a person’s blood sugar is so low they’re unable to help themselves and rely on others to assist them.
Studies have also shown that severe hypoglycemia creates fear of future hypoglycemic events, which may lead patients to make poor diabetes management decisions, said Dr. Mojdami. These might include avoiding or reducing their physical activity, increasing their calorie intake or skipping their medications. “These are all the things you’d want to avoid if you have diabetes because they drive your blood sugar up. Ultimately, you don’t want that either.”
As well, hypoglycemic episodes often result in work and school absenteeism. Dr. Mojdami referred to a study that found, on average, those affected by hypoglycemia arrive late to work or school 3.4 days per year, leave work or school earlier than usual (2.3 days per year) and take 2.4 sick days each year. And Canadian data showed work absenteeism due to hypoglycemia costs an average of $815.22 per person with diabetes every year, she added, noting none of these figures account for caregiver absenteeism.
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“We treat hypoglycemia in an outpatient setting depending on whether the person is able to eat or drink or not. If they’re able to swallow, the treatment is to give them oral carbohydrates — honey, glucose tablets, fast-acting candy, etc.”
However, during a hypoglycemic attack, if the person is unable to eat or drink, injectable glucagon is administered, said Dr. Mojdami. “This is a very cumbersome medication. It’s a multi-step process that requires caregivers to prepare the medication with a needle and inject it into the patient.”
Referring to another study, which simulated a severe hypoglycemia emergency, Dr. Mojdami said it highlighted how even instructed caregivers were barely able to administer the injectable glucagon. Thirteen per cent were able to deliver the full dose; 38 per cent were able to deliver a partial dose; and 50 per cent weren’t able to deliver the dose at all. The numbers were even worse when it came to delivery by non-instructed bystanders. No one was able to deliver the full dose; 20 per cent were able to deliver a partial dose; and 80 percent weren’t able to deliver any dose at all. And delivery time was two minutes and 24 seconds.
According to Dr. Mojdami, newer glucagon therapies for management of severe hypoglycemia are on the horizon.
Read more articles from the 2019 Chronic Disease at Work conference.