title: Self-treating hypoglycaemia: a longitudinal qualitative investigation of the experiences and views of people with Type 1 diabetes.
abstract: OBJECTIVE
  Despite improvements in insulin therapy, hypoglycaemia remains an inevitable part of life for many people with Type 1 diabetes. Little attention has been paid to how individuals self-treat hypoglycaemia and their likes and dislikes of clinically recommended treatments. We explored participants' experiences of self-treating hypoglycaemia after attending a structured education programme for people with Type 1 diabetes. Our aims were: to identify treatments that are acceptable to people with Type 1 diabetes; and to provide recommendations for promoting self-treatment in line with clinical guidelines.
  
  
  METHODS
  Thirty adults with Type 1 diabetes were recruited from the Dose Adjustment for Normal Eating (DAFNE) programme in the UK. Study participants were interviewed post-course and 6 and 12 months later, enabling their experiences to be explored over time.
  
  
  RESULTS
  Study participants described a poor knowledge of how to self-treat hypoglycaemia correctly pre-course. Post-course, individuals often struggled to adhere to clinically recommended guidelines because of: panic, disorientation, hunger sensations and consequent difficulties ingesting fixed quantities of fast-acting carbohydrate; use of sweets to manage hypoglycaemia; reversion to habituated practices when cognitive impairment as a result of hypoglycaemia supervened; difficulties ingesting dextrose tablets; and other people's anxieties about under-treatment.
  
  
  CONCLUSIONS
  Historical experiences of hypoglycaemia and habituated practices can influence present self-treatment approaches. Professionals need to be aware of the range of difficulties individuals may experience restricting themselves to fixed quantities of fast-acting carbohydrate to manage hypoglycaemia. There may be merit in developing a more acceptable range of treatments tailored to people's own preferences, circumstances and needs.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, UK. j.lawton@ed.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Lawton
authors.forename: D
authors.initials: D
authors.lastname: Rankin
authors.forename: D D
authors.initials: DD
authors.lastname: Cooke
authors.forename: J
authors.initials: J
authors.lastname: Elliott
authors.forename: S
authors.initials: S
authors.lastname: Amiel
authors.forename: S
authors.initials: S
authors.lastname: Heller
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D004032:Diet; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control* / Q000523:psychology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D036301:Qualitative Research; D012648:Self Care; D012944:Social Support
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin