INTRODUCTION:

“Know your Rights and Demand your Rights”

Diabetes is a group of metabolic disease characterized by increased levels of glucose in the blood resulting from defects in insulin secretion, insulin action or both. The effects of diabetes mellitus include long term damage, dysfunction and failure of different organs, especially the eyes, kidneys, nerves, heart and blood vessels.¹

World diabetes day is the major campaign for patient with diabetes mellitus through out the world. International Diabetes Federation and World Health Organization established world diabetes day in 1991, celebrated on 14 November every year, marked the birthday of Sir Fredrick Banting for the discover of insulin with Charles Best in 1922. The International Diabetes Federation helps in this. It also promotes the role of the family in the management, care, prevention, treatment and education of diabetes.²

According to International diabetes federation diabetes atlas (9^th edition) the global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high income (10.4%) than low income countries (4.0%). The global prevalence of impaired glucose tolerance is estimated to be 7.5% (374million) in 2019 and projected to reach 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045.³

India, the second most populous country of the world, has been severely affected by the global diabetes epidemic as per the international diabetes federation (2013), approximately 50% of all people with diabetes live in just three countries: China (98.4 million), India (65.1 million) and USA (24.4 million). There is evidence to show that diabetes prevalence is rapidly increasing, especially in urban India. The conventional risk factors of urbanization, unhealthy eating habits and physical inactivity, couple with inherent genetic attributes and difference in body composition are propelling the increase in cases of diabetes. Accordingly diabetes 2 related complications are also on the rise and contribute significantly to overall morbidity and mortality.⁴

Globally in 2013 it is estimated that almost 382 million suffer from diabetes hypoglycemia is at true medical emergency, which requires prompt recognition and treatment to prevent organ and brain damage. The short and long term complications includes neurologic damage, trauma, cardiovascular events and death. Severe untreated hypoglycemia can cause a significant economic and personal burden.⁵ Normally, blood glucose levels are tightly controlled by insulin. Insulin is a hormone produced by the pancreas, controls the level of glucose in the body by regulating production and storage of glucose. Insulin hormone is produced by the beta cells in the islet of Langerhans of the pancreas. In normal conditions, insulin is continuously released into the blood stream. The normal glucose range of approximately 70 to 110mg/dl. The average amount of insulin secreted daily by an adult is approximately 40 to 50 units or 0.6U per kg of body weight.⁶

Hypoglycemia means low sugar in the blood and occurs when the blood glucose falls less than 70mg/dl. Severe hypoglycemia is when glucose levels are less than 40mg/dl. It can occur when having little food or excessive physical activity and over dose of insulin. It may occur at any time of the day or night. It often occurs before meals, especially if meals are delayed or snacks are omitted.⁷ Hypoglycemia is often related to diabetes treatment. When blood sugar levels are low, it needs immediate treatment. Hypoglycemia can also occur if eat less than usual after taking diabetes medication or if exercise more than normally do. Signs and symptoms include fatigue, pale skin, shakiness, anxiety, sweating, hunger, irritability, numbness of lips, tongue or cheek. Worsen signs and symptoms include confusion, blurred vision, seizures, loss of consciousness. Immediate actions of getting blood sugar back to normal either with high sugar foods or drinks or with medications. Untreated hypoglycemia can lead to seizure, loss of consciousness and death.⁸

Hypoglycaemia leads to serious condition if delay in recognizing the symptoms and treating. Therefore, the investigator felt the need for giving and assessing the effectiveness of structured teaching programme regarding management of hypoglycaemia among people with diabetes mellitus.

OBJECTIVES OF THE STUDY:

· To assess the existing knowledge level regarding management of hypoglycemia among people with diabetes mellitus.

· To assess effectiveness of structured teaching programme on knowledge regarding management of hypoglycemia among people with diabetes mellitus.

· To find out the association between the post test level of knowledge with their selected demographic variables.

HYPOTHESIS:

H1: There is a significant difference between pre test and post test level of knowledge scores regarding management of hypoglycemia among people with diabetes mellitus.

H2: There is a significant association between post test level of knowledge scores with their selected demographic variables.

MATERIALS AND METHODS:

Quantitative pre experimental research design with one group pre-test and post-test research design was used in this study. The study was conducted at selected Rural Areas in Rajanagaram, Andhra Pradesh. 60 peoples (n=60) with diabetes mellitus were selected by using simple random sampling technique. Self structured questionnaire was developed to collect socio demographic data and knowledge on management of hypoglycaemia. It comprises of 30 multiple choice questions regarding management of hypoglycemia. Each question carries four options, each correct answer was given a score of “1” and “0” for wrong answer. Thus, a total of 30 marks were allotted for 30 items.

RESULTS:

The collected data were analyzed by using inferential and descriptive statistics.

Table 1: Frequency and Percentage Distribution of Samples According To Their Demographic Data (n=60)

Sl. No

Selected Demographic variables

Frequency (f)

Percentage

(%)

Age in years

a) ≤ 30

b) 31 to 40

c) 41 to 50

d) 51 and above

Gender

a) Male

b) Female

Religion

a) Hindu

b) Christen

c) Muslim

d) Others

Marital status

a) Married

b) Single

c) Widow

d) Divorced

Educational status

a) Non literate

b) Primary education

c) Secondary education

d) Graduate and above

Occupation

a) Home maker

b) Unemployed

c) Employed

d) Business

Family income in rupees

a) Below 5,000

b) 5001 to 10,000

c) 10001 to 15,000

d) 15001 and above

Are you taking any medication for D.M?

a) Yes

b) No

100

Any history of hypoglycemic attack?

a) Yes

b) No

Table No 1 describe the socio demographic, Majority 16(27%) of diabetes mellitus peoples were in the age group of ≤30 years. Majority 32(53%) were females and 28(47%) were males. Majority 45(75%) of peoples were married. Majority 60(100%) of peoples were in treatment. Majority 45(75%) of peoples were no history of hypoglycemic attack.

Table 2: Frequency and Percentage Distribution of sample According to Pre Test and Post Test Levels of Knowledge (n=60)

SL. No	Knowledge on Management of Hypoglycemia	Level of Knowledge
		Inadequte (1-33%)		Moderate (34-66%)		Adequate (>67%)
		f	%	F	%	f	%
1	Pre-Test	32	54	26	43	2	3
2	Post Test	4	7	20	33	36	60

Table No 2 Pretest level of knowledge regarding management of hypoglycemia among people with diabetes mellitus in selected Rural areas reveals that majority 32(54%) had inadequate knowledge, 26(43%) had moderate knowledge and 2(3%) had adequate knowledge. Post test reveals that majority 36 (60%) had adequate knowledge, 20(33%) had moderate knowledge and 4(7%) had inadequate knowledge.

Table 3: Difference Between Pre Test and Post TEST Level of Knowledge (n = 60)

S.no	Category	Mean	Standard deviation	Mean differ-ence	Paired ‘t’ test		p Value	Inference
					Cal value	Tab value
1	Pre test knowledge	11	4.01	9	28.7	2.00	0.0001	P<0.05
2	Post test knowledge	20	4.8

Table 4: Association Between Post Test Levels of Knowledge with Their Selected Demographic Data (n =60)

S. No

Demographic

Variables

Level of Knowledge

Chi-square χ²

Inference

Inadequate

Moderate

Adequate

Cal. value

Tab value

Age in years

a) ≤30

b) 31 - 40

c) 41 - 50

d) 51 and above

0.88

12.59

Gender

a) Male

b) Female

0.93

5.99

Religion

a) Hindu

b) Christian

c) Muslim

d) Others

5.45

9.49

Marital status

a) Married

b) Single

c) Widow

d) Divorced

0.41

5.99

Educational status

a) Non literate

b) Primary education

c) Secondary education

d) Graduate and above

7.27

12.59

Occupation

a) Home maker

b) Unemployed

c) Employed

d) Business

3.62

12.59

Family income

a) Below 5000

b) 5001 to 10000

c)10001 to 15000

d)15001 and above

5.44

12.59

Treatment for diabetes mellitus

a) Yes

b) No

History of hypoglycemic attack

a) Yes

b) No

Table No 3 shows that the obtained post test mean value (20±4.8) of knowledge was higher than the knowledge of pre test value (11±4.01) respectively. The mean difference was 9. The obtained calculated “t” value was 28.7, which is greater than the tabulated value i.e., 2.00, “p’’value 0.0001. It shows that there was significant difference between pretest and posttest knowledge. Thus, indicating structured teaching programme was highly effective. Hence H1, There is a significant difference between pre-test and post-test knowledge scores regarding management of hypoglycemia among people with diabetes mellitus in selected rural areas was accepted.

Table No 4 reveals that in order to find out the association between the post test levels of knowledge with demographic variables, chi square was computed. The results showed that there is no significant relationship between the post test levels of knowledge with their Age, Gender, Religion, Marital status, Educational status, Occupation, family income, Treatment of diabetes mellitus and any history of hypoglycemic attack. Hence H2 there is a significant association between post test levels of knowledge with their selected demographic variables was rejected.

DISCUSSION:

The finding of the study revealed that structured teaching programme was being effective in enhancing knowledge of people with diabetes mellitus regarding management of hypoglycaemia as evidenced by score obtained in pre test and post test. In present study people with diabetes mellitus regarding management of hypoglycaemia the obtained post test mean value 20±4.8 is higher than pre test value 11±4.01.The obtained calculated “t” value was 28.7, which is greater than the tabulated value i.e., 2.00, “p’’value 0.0001. These findings were supported by a study was conducted by Faziya Manzoor, to assess the impact of structured teaching programme on knowledge and skills regarding self-monitoring of blood glucose level for prevention of hypoglycemia among type2 diabetes mellitus patients. In that study results revealed that mean post test scores 37.21 and 14.68 is higher than mean pre-test scores 25.8 and 4.72.⁹ In present study there was no significant association between post test level of knowledge scores with their selected demographic variables, these findings were supported by a study conducted to assess the awareness on management of hypoglycemia among diabetic clients in PSG Hospital, Coimbatore, the results shown no significant association between gender, religion, educational status, occupation, duration of diagnosis, treatment for diabetes mellitus and information on hypoglycaemia.¹⁰

LIMITATION:

The study was limited to diabetic people living in selected Rural areas.

RECOMMENDATIONS:

In the view of findings reported, following recommendations were made,

· The study can be replicated on a larger sample, there by findings can be generalized to a larger population.

· A study can be conducted in Rural and Urban areas.

· A follow up study for a longer period for more reliability and effectiveness of self management programme on diet, exercise, medication and preventing hypoglycemia complications.

ETHICAL CLEARANCE:

Ethical clearance was obtained from research and ethical committee of GSL College of Nursing and Medical Officer in PHC, Rajanagaram. Informed consent was obtained from the study subject who were willing to participate in the study. The subjects informed about the place of study and their personal information is ensured confidentially.

CONFLICT OF INTEREST:

None.

CONCLUSION:

Hypoglycemia is a major limiting factor in overall glycemic management of diabetes and may lead to loss of consciousness or even death. Recognition of hypoglycemia risk factors, symptoms, management, prevention and blood glucose monitoring and educational programme for peoples with diabetes mellitus can be maintain glycemic control.

REFERENCES:

1. BT Basavanthappa “Textbook of Medical Surgical Nursing”, 1^st edition, 2003, Jaypee Brothers Medical Publisher, page no. 693 to 707.

2. https:www:jagranjosh.com/general-knowledge/world-diabetes-day-1573639198.

3. Pouya Saeedi et al, Global and regional diabetes prevalence estimates for 2019 and projection for 2030 and 2045, International Diabetes Federation Diabetes Atlas, 9^th edition, September 2019, doi : 10.1016/j.diabres.2019.107843

4. ncbi.nlm.nih.gov/pmc/articles/PMC3784865/

5. Brunner and Suddarth’s “Textbook of Medical Surgical Nursing”, 13^thedition, 2014, Wolters Kluwer publishers, New Delhi, page no. 1417 to 1441.

6. Lewis’s “Textbook of Medical Surgical Nursing”, 3^rd edition, 2011, Elsevier Publication, page no. 1267 to 1269.

7. Javed Ansari “Textbook of Medical Surgical Nursing”,2015 edition, part B, PV Publication, page no 1390 to 1393.

8. endocrineweb.com/conditions/diabetes/normal-regulation-blood-glucose.

9. Faziya Manzoor, a study to assess the impact of structured teaching programme on knowledge and skills regarding self-monitoring of blood glucose level for prevention of hypoglycemia among type2 diabetes mellitus patients. Doi : 10.31690/ijnmi/45.

10. Prameela. A, a study to assess the awareness on management of hypoglycemia among diabetic clients in PSG Hospital, Coimbatore. URL: http://repository-tnmgrmu.ac.in/id/eprint/6890.

Received on 24.06.2022 Modified on 14.07.2022

Int. J. of Advances in Nur. Management. 2022; 10(4):415-419.

DOI: 10.52711/2454-2652.2022.00090