Education Plan for Managing Hypoglycemia in Diabetes Mellitus – Educational needs Assessment

Physiological, psychological and socio-cultural characteristics

Patients with Diabetes mellitus have broad educational needs. Such needs primarily rest on effective management of blood glucose levels while avoiding complications that arise with such management. While poorly controlled diabetes mellitus results in high glucose concentration in the blood (hyperglycemia) for both T1DM and advanced T2DM patients, tightly controlled cases risk pushing blood  glucose levels to hypoglycemic conditions (Cryer 2002; Cryer et al., 2003; Boyle & Zrebiec, 2007b). The mechanisms that are involved in glucose feedback control enabling rapid correction of hypoglycemia in non-diabetic patients are deficient in persons suffering from diabetes mellitus (Cryer, 2001; Cryer 2002; Jackson, Williams, Burchell, Coughtrie & Hume, 2004; Israelian et al, 2006 Boyle & Zrebiec, 2007b). A number of physiological responses accompany declining glucose concentrations in the blood. First, such decreases within the physiological range (approximately 70-110mg/dl) result into decreased insulin secretion (Cryer 2002, p. 938; Cryer et al., 2003 p. 1904). In diabetes mellitus, declining levels of blood glucose do not result into decreased insulin secretion since passive absorption of exogenous insulin from subcutaneous administration sites continues unabated (Cryer 2002).

The second physiological response of declining blood glucose levels is increased glucagon and epinephrine levels (being part of other neuroendocrine responses) that arise with a fall of the glucose plasma levels just below the physiological range (Cryer 2002, p. 938; Cryer et al., 2003 p. 1904). In diabetes mellitus subjects, such glucagon response aimed at correcting sugar levels is lost, a loss that may be associated to the lack of insulin effect that accompanies the primary response (Cryer, 2001).  Further, epinephrine response in diabetics is attenuated due to the development of recent hypoglycemia that shifts the glucose plasma levels required for epinephrine response-initiation to subsequent hypoglycemia lower (Cryer, 2001).  At lower plasma concentrations, the third set of physiological responses – neurogenic and neuroglycopenic symptoms together with cognitive decline – occur (Cryer 2002, p. 938; Cryer et al., 2003 p. 1904; Asvold, Sand, Hestad & Bjorgaas, 2010).

Educational needs for diabetics also relate to psychological effects. With respect to hypoglycemia episodes, every episode at the very least is a nuisance and a distraction. Psychological effects such as fear of hypoglycemia, high levels of anxiety and lowered happiness levels are characteristics of Diabetics (Cryer 2002; Cryer et al., 2003). Episodes of hypoglycemia could be embarrassing and may result into an individuals excluding one from the social activities peers engage in.  One T1DM patient – Lisa Roney – in her recount of life with TIDM for instance observes: “[T]hese episodes [of hypoglycemia] shame and haunt me, the most apparent shadow on my semblance of a normal life” (as cited in Cryer et al., 2003, p. 1903). When episodes of hypoglycemia recur frequently, the psychological effects are not only limited to patients but also their families who could experience depression, feelings of powerlessness and anxiety thus affecting the quality of life for both family members and the patient (Weinger & Jacobson, 2001; Boyle & Zrebiec, 2007a).

Apart from the above challenges, various socio-cultural aspects affect people who are diagnosed with diabetes. Since diabetes surveillance involves complex aspects such as monitoring blood glucose levels, planning food and exercises, and managing co-existing illnesses; the lifestyle of such individuals is greatly modified (Boyle & Zrebiec, 2007b). Making such lifestyle changes could be challenging to many individuals thus affecting their social lifestyles. Fear of hypoglycemia is for instance one of the factors that act as a strong barrier for T1DM patients to engage in physical activities (Dube, Valois, Pud’homme, Weisnager, & Lavoie, 2006; Brazeau, Rabasa-Lhoret, Strychar, & Mircescu, 2008). Such aspects could become significant social integration hindrances in certain age groups (e.g. adolescents) where aggressive physical activity is a characteristic of events such as camping. This education plan thus seeks to confer skills to patients to alleviate the physiological, psychological and socio-cultural outcomes associated with hypoglycemia.

2.20 Working Environment

For effective dissemination during the education session, various human, physical and financial resources may be required. Human resources include assistants (volunteers) who will help demonstrate procedures in patient groups and in cases where the patient has compromised mental or physical ability to perform self-care actions, individuals who will be responsible for providing such care will be required to be present throughout the session. Physical resources include a venue for the session, seats for the session participants and pamphlets that will reinforce the verbal instructions provided during the session. The pamphlets will also serve as reference materials that patients can carry to keep themselves abreast with the aspects learnt during the training. Although human resources required are mainly volunteers, the provision of physical activities and aspects such as meal allowances for the volunteers are possible candidates that will require financial facilitation for the training session to be effective. A noisy venue could also limit the effectiveness of verbal communication hence a quite venue will be required for the training session. Go to part 3 here.

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