Ahmed AT, Karter AJ, Liu J. Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours. Diabet Med. 2006; 23:(7)795-802

Alsahli M, Gerich JE. Hypoglycemia, chronic kidney disease, and diabetes mellitus. Mayo Clin Proc. 2014; 89:(11)1564-1571

Barron E, Bakhai C, Kar P Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabet Endocrinol. 2020; 8:(10)813-822

Battelino T, Danne T, Bergenstal RM Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabet Care. 2019; 42:(8)1593-603

Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The fallacy of average: how using HbA1c alone to assess glycemic control can be misleading. Diabet Care. 2017a; 40:(8)994-999

Beck RW, Riddlesworth T, Ruedy K Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA. 2017a; 317:(4)371-378

Choudhary P, Rickels MR, Senior PA Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabet Care. 2015; 38:(6)1016-1029

Edelman SV, Blose JS. The impact of nocturnal hypoglycemia on clinical and cost-related issues in patients with type 1 and type 2 diabetes. Diabetes Educ. 2014; 40:(3)269-279

Forum for Injection Technique UK. Optimising diabetes care: the UK injection and infusion technique recommendations. 2020. (accessed 13 October 2021)

Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabet Care. 1994; 17:(7)697-703

Heinemann L, Freckmann G, Ehrmann D Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet. 2018; 391:(10128)1367-1377

Hessler DM, Fisher L, Polonsky WH Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes. Diabet Med. 2017; 34:(9)1228-3129

Holt RIG, DeVries JH, Hess-Fischl A The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2021; 1-44

International Hypoglycaemia Study Group. Understanding hypoglycaemia in diabetes definition. 2021. (accessed 13 October 2021)

Joint British Diabetes Societies for Inpatient Care. Inpatient care of the frail older adult with diabetes. 2019. (accessed 16 October 2021)

Krist AH, Devoe JE, Cheng A, Ehrlich T, Jones SM. Redesigning primary care to address the COVID-19 pandemic in the midst of the pandemic. Ann Fam Med. 2020; 18:(4)349-354

Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Fard HH, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. 2020; 10:(2)98-115

NHS Digital. National Diabetes Audit report 1: care processes and treatment targets. 2020. (accessed 13 October 2021)

NHS Digital. Quality and outcomes framework. 2021a. (accessed 13 October 2021)

NHS Digital. National Diabetes Audit, 2019-20: type 1 diabetes. 2021b. (accessed 13 October 2021)

National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. NICE guideline NG17. 2020. (accessed 13 October 2021)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 13 October 2021)

Rabbone I, Schiaffini R, Cherubini V, Maffeis C, Scaramuzza A Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?. Diabet Care. 2020; 43:(11)2870-2872

Thomas NJ, Lynam AL, Hill AV. Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes. Diabetologia. 2019; 62:(7)1167-1172

TREND. Alcohol, smoking and illicit drugs: what you need to know if you have diabetes. 2020. (accessed 13 October 2021)

World Health Organization. COVID-19 dashboard. 2020. (accessed 13 October 2021)

Yardley JE, Sigal RJ. Exercise strategies for hypoglycemia prevention in individuals with type 1 diabetes. Diabetes Spectrum. 2015; 28:(1)32-38

Nursing interventions for people with type 1 diabetes and frequent hypoglycaemia

02 November 2021
Volume 26 · Issue 11
Figure 1. Questionnaire to determine people's awareness of hypoglycaemia
Figure 1. Questionnaire to determine people's awareness of hypoglycaemia


Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing β-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS.

Over the past decade, the incidence of all types of diabetes has been increasing rapidly around the globe. Although the incidence of type 1 diabetes peaks in puberty and early adulthood, it affects all age groups, with a global prevalence of 5.9 per 10 000 population (Mobasseri et al, 2020). Within the UK, the NHS National Diabetes Audit or ‘NADIA’ (NHS Digital, 2020) estimated the figures for type 1 diabetes to be approximately 400 000, including around 29 000 children (NHS Digital, 2021a). Around half of newly diagnosed cases of type 1 diabetes are those of people over the age of 18 years (NHS Digital, 2021b). The incidence of new diagnoses of type 1 diabetes is increasing by about 4% each year.

The latest NADIA data for type 1 diabetes in the UK (NHS Digital, 2021b) highlighted that people with confirmed type 1 diabetes at an adult specialist service was low (78 585, which is 35.9% of the total number of people with type 1 diabetes (218 670). This means that a proportion of these patients are seen within primary care or in the community setting. Specialist care for those with type 1 diabetes is accessed locally when specific specialist care input is needed, such as in cases of frequent hypoglycaemia or impaired awareness of hypoglycaemia, complex long-term complications, insulin pump therapy, recurrent secondary care admissions, pre-conceptional care and pregnancy.

Register now to continue reading

Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month