Knowledge regarding hypoglycemia and insulin
Hypoglycemia is one of the most common acute complications of diabetes
mellitus. The knowledge of patients associated with hypoglycemia will
help in the prevention and management of the problem. The study
revealed that that the majority of patients were familiar with symptoms
and remedial measures for hypoglycemia, but much fewer patients knew the
level of glycaemia considered as hypoglycemia, precipitating factors of
hypoglycemia or using glucometer to check blood glucose at home. The
poor knowledge maybe is reasons why the rate of hypoglycemia during
previous month of patients was quite high (57.5%). This hypothesis was
confirmed by statistical analysis when patients having good knowledge
were less likely to get hypoglycemic (p=0.001) (Table 5). These findings
are consistent with the prior study in
India19. They found
that only 66.1% diabetic patients had good knowledge on hypoglycemia.
Other study of Kahsay et al. found that self/family blood glucose
monitoring at home could not guarantee to minimize the occurrence of
hypoglycemia events20.
Regarding the knowledge of the insulin pen use, the majority of the
patients knew various types of insulin, injection sites, requirement of
rotation of the injection sites, injection site complications, and the
right time to inject insulin regard to meals, and storage condition of
spare insulin pens. However, the survey revealed that many patients did
not have good knowledge on insulin needle and expiration date after
opening the pen. For example, only 9 patients (6.1%) knew to have to
use a new pen needle for each injection while the others (93.9%) reused
needles many times for savings. If the needle is not removed from the
pen between two injections, air may leak into the injector causing wrong
dose insulin
injection10. Reusing
the needle may result in distortion, bending of needle encountered in 7
patients and can cause painful injections in 60.1%. Other studies
reported that pen needle reuse was quite high in their study with a
range of
50%-80%9,10and this problem increased the risk of
lipohypertrophy7,8,10.
Compared to other studies, this very disappointing result in our study
requires special attention on this point at patient education.
Many patients misunderstood that the in-use insulin pens had to be kept
in the refrigerator at 2-80C. Mitchell et
al.9 reported that
three-fourths of users did not follow the manufacturer’s instructions
for storage of the in-use insulin pens. All patients knew the location
of abdominal injection, but only 62.8% of patients knew more than one
injection site on the body. A survey in China reported that more than
80% of patients only limited changes in the abdominal
area8. The repetition of
the same injection site increased the risk of
lipohypertrophy7. In our
study, 14.9% patients reported lipodystrophy while this rate was 29.0%
in other study7.