The experience of a severe hypoglycemic event from the perspective of people with diabetes and their caregivers: "What am I going to do?"

AIMS Among people with diabetes using insulin, severe hypoglycemia (SH) can be a life-threatening complication, if untreated. The personal experiences during an SH event from the perspectives of people with diabetes and their caregivers are not well-characterized. This study assessed the perceptions of the event and the decision-making processes of people with diabetes (T1D n=36; T2D n=24) and their caregivers during SH events. METHODS In-depth one-on-one telephone interviews were conducted with dyads of people with diabetes and caregivers in the US (n=120). An initial synopsis and inductive codebook schema were used to analyze the data with 2 independent coders (kappa=0.87-0.89). Themes were developed from the codes, and codes were re-mapped to the themes. RESULTS Four themes were formed: (1) Caregivers scramble to do the right thing and support people with diabetes in treating SH; food/drink is the first arsenal to manage SH, after which most caregivers report that the only option is to call for emergency help. (2) Decision-making capacity is impaired during an SH event, often a panicked time. (3) People learn to manage SH events through their own experiences and frequently make lifestyle changes to prevent and treat future events. (4) Discussion with healthcare providers about SH, and particularly SH treatment, is limited. CONCLUSIONS SH events are stressful and often evoke emotional reactions that can impair decision-making. Much of the knowledge about SH treatment derives from prior experience rather than healthcare provider guidance, suggesting a need for healthcare providers to initiate proactive discussions about SH treatment.