Background and Aims

Use of injectable glucagon (IG) challenges caregivers of a person with diabetes (PWD) during stressful severe hypoglycemia (SH) rescue. Success rates, administration time, and user preference for nasal glucagon (NG) vs IG devices were evaluated after treating SH simulations.

Methods

Adult PWDs were trained to use NG or IG, and then trained their caregivers (1 hour later) in its use; 1 week later, caregivers attempted administration to a manikin exhibiting SH in a simulated real life setting. Untrained adults were shown the device pre-simulation. After 1 week, procedures were repeated with the alternative device. Proportions of success with each device (complete dose+critical steps) and administration times were studied. Device comparative questionnaires were completed after viewing videos of simulations after the second simulation.

Results

Of PWD trained users, 90% and 16% were successful with NG and IG, respectively (McNemar p<0.0001). Similarly, 91% of untrained users were successful with NG, 0% with IG (p<0.0001). Median time to NG success was 30 sec (trained and untrained users); 5 trained users successful with IG took 73 sec. NG was rated preferred by those successful with NG or IG, and PWDs indicated feeling safer with NG even with IG success (Table).

Conclusions

PWD-trained and untrained users were more successful and faster in administering NG than IG. None of the few preferring IG were successful with IG, while the few successful IG-users preferred NG or stated no preference. Training was not critical for NG success and ease of preparation/use likely contribute to overall preference.

Background and Aims

Injectable glucagon (IG) is challenging to use for caregivers of a person with diabetes (PWD) during severe hypoglycaemia (SH) rescue. We assessed overall workload for the administration of nasal glucagon (NG) and IG using National Aeronautics and Space Administration – Task Load Index (NASA-TLX) questionnaires, during a randomized, crossover, SH simulation study.

Methods

Adult PWDs (N=33) were trained to use NG or IG and then trained their caregiver (1 hour later) in its use; 1 week later caregivers attempted administration to a manikin exhibiting SH in a simulated real life setting. Untrained adults (N=33; no PWD association) were shown the device pre-simulation. After 1 week the process was repeated with the other device. After each simulation, users completed the NASA-TLX questionnaire assessing overall workload on 6 subscales, each rated on a scale of 0 to 20 (higher scores indicating greater workload). Participants also evaluated the weighting of each subscale to the overall workload of the task through pairwise comparisons of the 6 subscales (15 pairs in total; weights ranging from 0=not relevant to 5=most important).

Results

Users reported a mean overall workload score of 37.8 following NG simulation, compared with 48.4 following IG simulation (p=0.0020; weighted average). A similar trend was observed for a mean regular average (p=0.0025). Users reported lesser mental demand (p=0.0048, weighted score difference) and effort (p=0.0240) for the administration of NG, compared with IG (Table).

Conclusions

Users perceived a lesser workload administering NG, compared with IG, during simulated SH rescue.

Background and Aims

Aim: To investigate similarities and differences between men and women in self-reported psychological factors associated with sexual health and diabetes in the context of diabetes technology.

Methods

Methods: An online survey was distributed via social media platforms including Twitter, Facebook and LinkedIn over four weeks. Questions addressed a range of psychological factors. Free text response questions enabled participants to elaborate.

Results

Results:

358 individuals participated (258 women, 100 men), aged 18-73. >80% were sexually active. Technology and other diabetes treatments played a key negative role in relationships and sexual health. Namely sites for cannulas and/or sensors (19.4% of women, 15.0% of men) and scarring (7.8% of women, 1.0% of men), as well as injection scarring/lumps/bruises (5.4% women, 1.0% of men) contributed to feeling less attractive and concerns around pain and injury by partners. 62.0% of men and 61.6% of women reported a negative impact on relationships due to the presence of diabetes, which often directly related to diabetes technology. 11.1% of men and 17.1% of women felt isolated, reported low self-esteem (13.0% of men and 7.3% of women and difficulty achieving desired weight (15.5% women, 6.0% men) Notably, many participants had also not sought help for sexual health issues (men 42.0%, women 69.4%).

Conclusions

Conclusion: Diabetes technologies decrease overall burden, but they also contribute to increased self-management tasks and potentially trigger psychological challenges associated with sexual health for men and women in similar and diverse ways. Interventions are needed to manage this trade-off and improve body image, loneliness and relationships of users.

Background and Aims

Insulin therapy needs adaptation in adolescents with type 1 diabetes (T1D) while exercising. Hypoglycemia is the major issue and while insulin reduction is recommended, carbohydrate supplementation is also needed.
We conducted a study to evaluate carbohydrate supplementation to prevent hypoglycemia in T1D adolescents during a sport-school camp.

Methods

27 adolescents with T1D >1 year, treated with multiple injections, without co-morbidities, were enrolled in a 4-day sport-school camp with different session of physical activity.
During camp, participants reduced their basal insulin by 20% and pre-meal insulins up to 50%, as recommended by international guidelines. Patients wore a glucose sensor (Dexcom ® G6) to monitor their glucose to prevent hypoglycemia (< 70 mg/dL). All corrections, made with glucose, were decided using glucose value corrected for the trend, with a protocol showed in the figure. Time spent in range 70-180 mg/dL (TIR), below (TBR), above (TAR) and coefficient of variation (CV) were compared with values 3 days before camp.

Results

No severe hypoglycemia and ketoacidosis were observed. Mean glucose and SD resulted similar during and before camp (177±56 and 170±59 mg/dL, p=0.38). TBR was lower during camp (1% vs. 2,7%, p=0,04), and time spent with glucose < 54 mg/dL was 0.03% (before was 0.9%, p=0.008).
TIR was comparable (54.3 vs. 59.8%, p=0.25), as well as TAR (44.8 vs. 37.5%, p=0.14) and CV (34.6 vs. 32.2, p = 0.18).

Conclusions

Correction with glucose using sensor value adjusted for trend were helpful in strongly reducing values below 70 and 54 mg/dL, without increasing TAR in T1D adolescents while exercising.