A Study to Assess the Factors Hindering in self Insulin Administration among Diabetic Individuals

 

Mrs. Smita Sunil Gawade, Ms. Nikita, Ms. Varsha, Ms. Geetanjali, Ms. Mamata, Ms. Vaishali

Tulasi Angan, B-307, Purna Nagar, Chichwad, Pune 411019

 

ABSTRACT:

One of the greatest challenges faced by the modern world is Diabetes mellitus (DM). The physical, social and economic factors involved in the management of diabetes are a continuous strain for the health sector and the government agencies. It is expected that approximately 366 million people will be affected by Diabetes Mellitus by the year 2030¹. Due to the increased number of people with Diabetes Mellitus using insulin in recent years, more emphasis should be given to the standardization and improvement of insulin administration technique, focusing on properly teaching this technique so that people become aware of their responsibility and make less mistakes during insulin administration. In patients with diabetes, physicians are often concerned about increasing functional limitations that may impede a successful self-management. In particular, the correct handling of the insulin injection requires complex self-management abilities. Among these functional limitations, loss of visual acuity, loss of manual abilities and cognitive decline are of most importance. Considering all this it is decided to undertake study to assess the factors hindering in self insulin administration among diabetic individuals. A descriptive research design and purposive sampling technique was used. Sample size was 100. Structured checklist was used to assess demographic data, factors such as physical, cognitive, environmental, economic, emotional. Findings of the study shows that 61% are suffering with pain and 46% with bleeding due to injection. 54% samples are unaware about rotation of injection site and 48% samples are unaware about insulin drug temperature. 32% samples have skipped insulin due to more workload at workplace and 28% due to travelling. Majority 45% samples cannot afford new syringe, pen and needle tip for every injection. Comparison of factors hindering self insulin administration among temporary and permanent users shows that  temporary users, 43.8% have injection loading difficulties and 63% have injection carrying difficulties where as more number of (50%) permanent  users have experienced skin color changes at the site of injection. More number of temporary users fearful, anxious, embarrass and felt overburden for family because of insulin administration and have skipped insulin due to more workload and travelling than permanent users. The finding of the study will be helpful to create awareness related to safe self insulin administration practices by means of modern education technology.

 

 

 

 

INTRODUCTION:

According to W.H.O statistics, the global prevalence of diabetes in the year 2000 was 171,000,000 and it expected and approximated to be raised to 366,000,000 by 2030. Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the seventh leading cause of death in 2030².

 

Medical management for clients with diabetes includes restoring and maintaining blood glucose levels to as near normal as possible by balancing diet, exercise and the use of oral hypoglycemic agents or insulin.

 

The most used instrument among the several available in the market to inject insulin into the subcutaneous tissue is the disposable syringe due to its low cost, easy access, health professionals' familiarity with its use.

 

Due to the increased number of people with Diabetes Mellitus using insulin in recent years, more emphasis should be given to the standardization and improvement of insulin administration technique, focusing on properly teaching this technique so that people become aware of their responsibility and make less mistakes during insulin administration.

 

Self-care is a crucial element in prevention of complications of diabetes mellitus. There is need to improve knowledge and skill of diabetic persons about self insulin administration to prevent further complications and promote health.

 

MATERIAL AND METHOD:

1.     Research Approach: Quantitative

2.     Research Design: A descriptive exploratory

3.     Study Setting:  Selected hospitals

4.     Sampling Technique: Purposive sampling technique

5.     Sample size: 100

6.     Variables of the study: Dependent- Factors hindering by diabetic individual Independent- Self insulin administration.

7.     Tool:

The research tool includes 2 sections

Section A:

Demographic data (age, sex, education, site of injection, years of taking  insulin etc.)

Section B:

Structured checklist to assess factors hindering self insulin administration.

8.     Ethical considerations: Ethical committee approval is obtained from the Sadhu Vaswani College of Nursing. Participants were informed about the present study and verbal consent is obtained.

 

RESULTS:

The data was analyzed and presented in the following section:

Section A: Description of sample according to demographic characteristics (age, sex, education, occupation, year of diagnosis and self insulin administration, etc.) by frequency and percentage.

Section B: Data analysis to assess the factors hindering self insulin administration.

Section C: Data analysis to compare factors hindering self insulin administration among temporary and permanent users.

 

Section A: Description of sample according to demographic characteristics (age, sex, education, occupation, year of diagnosis and self insulin administration, etc.) by frequency and percentage.

Table No. 1- Description of Demographical variable by percentage              N=100

Sr. No	Demographic variables	Total	Percentage (%)
1	Age a) 25-35 b) 36-45 c) 46-55 d)above 55	46 24 14 16	46 24 14 16
2	Gender a) Male b) Female	51 49	51 49
3	Qualification a) 10th standards b) 12th standards c) Secondary d) Higher Secondary	39 25 20 14	39 25 20 14
4	Occupation a) Service b) House wife c) Own occupation d) Retired	21 32 40 06	21 32 40 06
5	Income a) Rs. 5000-10000 b) Rs.10000-15000 c) Rs15001-20000 d) Above  RS. 20000	69 17 05 09	69 17 05 09
6	Duration of Diagnosis a) 0-2 years b) 2-5 years c) Above 5years	11 21 69	11 21 69
7	Duration of Self Insulin Administration a) 0-2 years  b) 2-5years c) Above 5years	16 22 62	16 22 62
8	Site of Self Insulin Administration a) Thighs b) Abdomen c) Arms	27 68 66	27 68 66

 

Table No. 1 shows, out of 100 samples, Most of the samples (46%) are of age group of 25-35 yrs suffering with diabetes. 51% (51) samples are male, 49% (49) samples are female.  62% (62) are on self insulin administration more than 5 years. 22% (22) are on self insulin administration since 2-5 years and 16% (16) are oneself insulin administration since 0 -2 years. Majority of them that is 68% (68) samples use abdomen site, 66% samples use arm site and 27% (27) samplesuse thigh site for self insulin administration.

 

 

 

Section B: Data analysis to assess factors hindering self insulin administration.

Out of 100 samples, 61 (61%) samples have suffered with pain at the site of injection, 46(46%) have noticed bleeding and (29%) samples have noticed skin colour change at the site of injection. (24%) samples have lost sensation at the site of injection. (20%) samples have experienced itching and (18%) samples had swelling at the site of injection.

·       According to analysis of cognitive factors 54% samples are unaware about rotation of injection site and 48% samples are unaware about insulin drug temperature.

·       Environmental factors shows that 32% samples have skipped insulin due to more workload at workplace and 28% due to travelling.

·       Majority 62% samples cannot afford new syringe, pen and needle tip for every injection.

·       According to emotional factors, very less samples felt embarrass, anxious, fearful while administering insulin.

·       According to data analysis compare factors hindering self insulin administration among temporary and permanent uses.

·       According to physical factors, all the samples suffering with the pain at the site of injection.

·       Temporary users, 43.8% have injection loading difficulties and 63% have injection carrying difficulties where as more number of (50%) permanent users have experienced skin colour changes at the site of injection.

·       Assessment of cognitive factors shows that most of the samples aware about different sites, injection site rotation and temperature maintenance of insulin.

·       According to environmental factors, more number of temporary users have skipped insulin due to more workload and travelling than permanent users.

·       More number of permanent users are unable to afford insulin, syringe, insulin pen than temporary users.

·       More number of temporary users are fearful, anxious, embarrass and felt overburden for family because of insulin administration.

 

DISCUSSION:

Present study assessed that physical factors (tenderness, itching and color changes at the site of injection, fatigue) psychosocial factors (carrying insulin during travel, difficulty in taking insulin injections while travelling), financial factors (financial burden for the family), associated with insulin administration.

 

Present study also showed that self insulin injections were a serious burden, dissatisfaction with the way they took insulin, negative impact on quality of life.

 

 

Research studies to compare factors hindering self insulin administration among temporary and permanent users were not available, so present study findings may helpful to do further studies.

 

According to duration of use of self insulin administration, the present study categorized 100 samples into temporary users (less than 2 years) and permanent users (more than 2 years).

 

Majority of the diabetic patients (type 1 & 2) are suffering with the pain at the site of injection.

 

In comparison the findings showed that majority of temporary users have experienced physical factor (recognition of syringe loading marks/level, carrying difficulty), cognitive factors (unaware of different sites and temperature maintenance, environmental factors (more workload) emotional factor(fear full procedure, anxiety, feeling embarrass) that permanent users.

 

Majority of the permanent users have experienced physical factor (skin color changes). Most of them were unaware about injection site rotation, insulin temperature maintenance and un affordable to bear the cost of insulin, syringe, pen.

 

Thus above all studies are supporting study findings and shows that physical, cognitive, environmental, economical, emotional factors are hindering self insulin administration among diabetic individuals.

 

REFERENCES:

1.      Dr J P, Majra and Dr. Das Acharya. Awareness Regarding Self Care among Diabetics in Rural India. Middle eastjur of fam med.  [Serial online] Jul 2009 [cited on 2009 Nov 10]; 7(6). Available from URL:http://www.mejfm.com/mejfmJuly09_vol7-iss6/awareness.htm

2.      Prevalence of diabetes. Data and statistics by World Health Organization. Available from URL: http://www.who.int/research/en/

 

 

 

 

Received on 06.02.2019         Modified on 06.03.2019

Accepted on 31.03.2019      ©A&V Publications All right reserved