Avoidance strategies employed to reduce the risk of hypoglycaemia

Journal of Diabetes Nursing, July-August, 2004

Hypoglycaemia is a much cited fear of people with diabetes; in fact many adopt avoidance strategies to help lessen the risk of hypoglycaemic episodes. A recent abstract at the American Diabetes Association conference in Orlando presented the results of an Australian study which showed that in people who experienced severe nocturnal events, 50% reduced their insulin dose to prevent hypoglycaemia. Other avoidance strategies included eating more (76%), reducing levels of physical activities (26%) and taking sick leave (10%).

A postal survey, sent out to individuals identified through the local Diabetes Australia group, posed questions relating to the frequency and impact of hypoglycaemia, diabetes management, lifestyle and diabetes-related complications. Self-reported hypoglycaemia was classified in three ways--symptomatic, nocturnal and severe--and was reported over a 6-month period. Of the 740 patients who responded, 77% had type 1 diabetes and there was a 51:49 ratio of females to males with a mean age of 48 and 55 years respectively. The mean frequency of hypoglycaemia was 22 events per person; multivariate analysis showed that the frequency was directly and independently associated with reduced health-related quality of life (p<0.05). It was estimated that on average it took 2 days to recover from a severe event and 1.3 days from a nocturnal event.

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The paper concluded that hypoglycaemia is a frequent adverse event of existing diabetes treatments, especially in younger people with type 1 diabetes. In addition, because of the adverse effects on quality of life, combined with the possibility that metabolic control might be compromised through reduced insulin dosing, it is likely that reducing hypoglycaemia would offer significant improvements. The authors therefore recommend that measures be taken to reduce the frequency of events.

Connolly M, Morrissey M, Jackson L et al. Abstract 2005-PO at the American Diabetes Association Conference, Orlando, June 2004

ABBREVIATED PRESCRIBING INFORMATION FOR LEVEMIR[R] (INSULIN DETEMIR)

Levemir

Insulin detemir

Levemir Penfill

Levemir FlexPen

All presentations contain insulin detemir 100 U/ml.

Levemir is a long-acting basal insulin used in combination with meal-related short- or rapid-acting insulin

Indication: Treatment of diabetes mellitus

Dosage: Individual by once or twice daily subcutaneous injection. When given twice daily, the evening dose may be administered in the evening or at bedtime. Transfer from other insulins may require adjustment of dosage and timing of administration; monitor glucose during transfer and in initial weeks thereafter. Concurrent short-acting insulin treatment may need to be adjusted. No studies in children and adolescents.

Contraindications: Hypersensitivity to insulin detemir or excipients.

Warnings and precautions for use: Use of dosages which are inadequate, or discontinuation of treatment may lead to hyperglycaemia and ketoacidosis which are potentially lethal. Too much insulin, omission of a meal or strenuous exercise may lead to hypoglycaemia. Reduction of warning symptoms of hypoglycaemia may be seen upon tightening control and also in patients with long-standing diabetes. Transferring to a new type or brand of insulin should be done under strict medical supervision. Careful monitoring is recommended in patients with severe hypoalbuminaemia. Levemir should not be administered intravenously; avoid intramuscular administration; do not use in insulin infusion pumps. Avoid mixing of rapid-acting insulin with Levemir. Contains metacresol, which may cause allergic reactions. Hypoglycaemia may constitute a risk when driving or operating machinery.

Pregnancy and lactation: No dinical experience in pregnancy and lactation; exercise precaution when prescribing to pregnant or lactating women.

Undesirable effects: Common: Hypoglycaemia, injection site reactions, usually transitory. Uncommon: Lipodystrophy; oedema and refraction anomalies on instituting therapy; allergic reactions; generalised hypersensitivity reactions are potentially life-threatening. Rare: Acute painful neuropathy may be associated with rapid improvement in blood glucose control, usually reversible.

MA numbers:

Levemir Penfill EU/1/04/278/002

Levemir FlexPen EU/1/04/278/005

Legal category: POM

Basic NHS price:

5 X 3 ml Penfill [pounds sterling]39.00

5 X 3 ml FlexPen [pounds sterling]39.00

Full prescribing information can be obtained from: Novo Nordisk Limited

Broadfield Park, Brighton Road

Crawley, West Sussex

RH11 9RT

Date of preparation: June 2004

ABBREVIATED PRESCRIBING INFORMATION FOR NOVOMIX[R]30 (BIPHASIC INSULIN ASPART)

NovoMix[R]30

Biphasic Insulin Aspart

NovoMix[R]30 Penfill[R]

NovoMix[R]30 FlexPen[R]

All presentations contain insulin aspart 100 U/ml.

Indication: Treatment of diabetes mellitus.

Dosage: Individual by subcutaneous injection. NovoMix[R] 30 has a faster onset of action than biphasic human insulin and should generally be given immediately before a meal. When necessary NovoMix[R]30 can be given soon after a meal. No studies in children and adolescents under the age of 18 years.