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Distribution of FBS values in type 1 and type 2 diabetic patients among diabetic patients attending National Diabetic Referral Clinic at TASH between June 1 and August 31, 2016, Addis Ababa, Ethiopia. 

Distribution of FBS values in type 1 and type 2 diabetic patients among diabetic patients attending National Diabetic Referral Clinic at TASH between June 1 and August 31, 2016, Addis Ababa, Ethiopia. 

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Background: Hypoglycemia poses a barrier to optimum diabetes management especially among patients taking insulin therapy. However little is known about the magnitude and effect of hypoglycemia among diabetic patients in Ethiopia. Methods: A Cross-sectional study was conducted on diabetic patients who were above 14 years of age and attending Nationa...

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... mean fasting blood sugar at the time of study enrollment was 159(SD ± 74.2) mg/dl and 163.3(SD ± 65.5) mg/dl in type 1 and type 2 diabetic patients respectively. FBS of above >130 mg/dl was recorded in about 65% of the study participant [109(56%) of type 1 and 254(69%) of type 2 diabetic patients] (Figure 1). The mean FBS in patients with duration of illness below or above 10 years was 162.7(SD ± 69.3) and 163.8(SD ± 68) respectively. ...

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... The factors associated with hypoglycemia are varied. It may include age, sex, occupational status, residence, body mass index, missed meals or inadequate caloric intake, alcohol consumption, concurrent use of an opioid, level of fasting blood sugar, blood glucose monitoring, glucose checkup period, insulin or diabetes medications, duration of diabetes, and presence of stroke (3,5,8,(21)(22)(23)(24). ...
... This could be because an individual who had better education may be associated with better knowledge of good insulin administration techniques to avoid the problem resulting from using an inappropriately high dose of insulin. This finding was supported by Wako et al., who revealed that low educational status was associated with the occurrence of hypoglycemia (23). ...
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Introduction Glycemic control is a valuable goal for people with diabetes; however, the greatest challenge to achieving tight glycemic control is hypoglycemia. Hypoglycemic events are probably common in type 1 diabetes; however, little is known about hypoglycemia in Ethiopia. Therefore, this study aimed to assess the prevalence and the associated factors of hypoglycemia among type 1 diabetes (T1D) patients after insulin use at Metu Karl Referral Hospital in southwest Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted among 242 T1D patients at Metu Karl Referral Hospital in southwest Ethiopia. The prevalence of hypoglycemia was assessed by a structured questionnaire through a face-to-face interview in which all the possible symptoms of hypoglycemia were included. If the patients reported that they had experienced the symptoms at least two times in a month and the symptoms were relieved upon consuming sugar/candy/honey, such cases were considered to have had a hypoglycemic episode. Binary logistic regression analysis was done to identify the factors associated with the occurrence of hypoglycemia. Results Out of 242 T1D patients interviewed, 114 (47.1%) had self-reported hypoglycemia. The most reported symptom of hypoglycemia was sweating (91.7%), followed by dizziness and hunger and nausea with a prevalence of 24.8 and 14.5%, respectively. The study also found that educational level with reading and writing skills up to primary level [adjusted odds ratio, AOR = 0.41; 95% confidence interval, CI (0.19–0.88)] and secondary level and above [AOR = 0.32, 95% CI (0.14–0.70)], poor knowledge of diabetes [AOR = 2.26, 95% CI (1.06–4.84)], good knowledge of insulin self-administration [AOR = 0.54, 95% CI (0.30–0.99)], and duration of insulin use ≥5 years [AOR = 3.93, 95% CI (1.44–10.7)] were factors associated with hypoglycemia. Conclusions The prevalence of hypoglycemia was found remarkable. We can conclude that hypoglycemia is of public health importance among T1D patients. Since the study assesses hypoglycemia after insulin injection, this prevalence may be due to the poor practice of insulin injection. Therefore, imparting education on the proper technique of insulin administration should be considered at each follow-up visit.
... Despite its significance, the odds of suffering episodes of hypoglycemia since they were diagnosed to have T1DM were about 35% less likely in male patients compared to female patients. This result was consistent with the finding documented in the study done in Ethiopia [32]. Physiologically, there is a large sexual dimorphism in counterregulatory responses to hypoglycemia. ...
... Like other evidences, this finding described as history of diabetes and events of hypoglycemia went almost parallel in patients' life. Previous studies had demonstrated that patients with more than five years of diabetes history were more likely to experience hypoglycemia events [2,5,20,32,38]. Blood glucose monitoring options had also a significant association with the events of hypoglycemia. Our study found that participants who monitored their blood glucose level at home in addition to their regular follow-up reported almost five and a half times of hypoglycemia events compared to those who monitored on follow-up only. ...
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... In a study of hypoglycemia in diabetic patients in Ethiopia, 61.2% had experienced hypoglycemia since their diagnosis and the factors which showed significant association with hypoglycemia were low educational status, female gender and higher body mass index (BMI) [17]. ...
... Sample size calculation for this study was determined using single population proportion formula. The sample size was calculated with the assumption of 61% of patients might have hypoglycemic episode since diagnosis, which was taken from a previous study [17]. After 10% non-response rate consideration, the total sample size for the study was 403. ...
... Data were collected with structured questionnaire, which was developed through reviewing different literature [4,17,20]. The questionnaire had three parts; the first part assessed socio-demographic characteristics of respondents. ...
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Executive Summary and Recommendations A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A). Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A). Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin. Two or three premixed insulin injections per day may be used (A). The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol). The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications (B). For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose (SMBG) (B). Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus (T2DM) include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy (B). In T2DM patients, with regards to achieving glycemic goals, insulin is considered alone or in combination with oral agents when HbA1c is ≥ 7.5% (≥ 58 mmol/mol); and is essential for treatment in those with HbA1c ≥ 10% (≥ 86 mmol/mol), when diet, physical activity, and other antihyperglycemic agents have been optimally used (B). The preferred method of insulin initiation in T2DM is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with glucagon-like peptide-1 receptor agonist (GLP-1 RA) or in combination with other oral antidiabetic drugs (OADs) (B). If the desired glucose targets are not met, rapid-acting or short-acting (bolus or prandial) insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels (C). Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient’s care plan. Fasting plasma glucose (FPG) values should be used to titrate basal insulin, whereas both FPG and postprandial glucose (PPG) values should be used to titrate mealtime insulin (B). Metformin combined with insulin is associated with decreased weight gain, lower insulin dose, and less hypoglycemia when compared with insulin alone (C). Oral medications should not be abruptly discontinued when starting insulin therapy because of the risk of rebound hyperglycemia (D). Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia (B). The shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular (IM) injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them (A). Many patients in East Africa reuse syringes for various reasons, including financial. This is not recommended by the manufacturer and there is an association between needle reuse and lipohypertrophy. However, patients who reuse needles should not be subjected to alarming claims of excessive morbidity from this practice (A). Health care authorities and planners should be alerted to the risks associated with syringe or pen needles 6 mm or longer in children (A).