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Contents lists available at ScienceDirect

Collegian
journal homepage: www.elsevier.com/locate/coll

Patient reported experience of blood glucose management when

undergoing hyperbaric oxygen treatment
Carol Baines ∗ , Geraldine O’Rourke, Charne Miller, Karen Ford, William McGuiness
Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Liverpool Street 7053 7000, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: Patients who have diabetes and require hyperbaric treatment for wound healing are an
Received 1 August 2018 increasing population. Hyperbaric oxygen treatment (HBOT) has been shown to reduce a patient’s blood
Received in revised form glucose level during an individual treatment. Anecdotal evidence suggests patients with diabetes are
16 September 2018
concerned about suffering a hypoglycaemic episode during HBOT. It is suspected that patients who have
Accepted 18 November 2018
diabetes undertake protective health behaviours by intentionally increasing their blood glucose levels
Available online xxx
prior to HBOT.
Aim: To explore the emotional and physical experiences of patient self-management behaviours of
Keywords:
Hyperbaric oxygen
their blood glucose levels during a course of hyperbaric oxygen treatment.
Blood-glucose Method: The use of semi-structured in-depth interviews, each interview was audio recorded and
Diabetes transcribed verbatim. Participants (n = 15), were prior patients living with diabetes who had undergone
Interviews HBOT at a tertiary hospital in an Australian state during 2014–2017. Interpretive description along with
Interpretive-description thematic analysis of all interviews was undertaken.
Thematic analysis Findings: Four themes emerged from the interviews, each deriving from the participants’ experiences
1.Varying recognition of self-management requirement of diabetes; 2. Hypoglycaemia fear; 3. Treatment-
based adaptation; and 4. Ownership / monitoring. Participants reported that they altered their diabetic
regime/blood glucose management to undertake a course of HBOT.
Discussion: Patient engagement throughout HBOT, leads them to elevate their blood glucose, although
not advocated, to above normal levels, adopting these behavioural changes as a self-protective mecha-
nism.
Conclusion: Improving the patient experience of hyperbaric oxygen treatment is multifactorial and
often dependant on the relationship between the clinician and the patient. Consistent monitoring of
blood glucose during HBOT, may ameliorate negative feelings that are often associated with this treatment
option.
© 2018 Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd.

Problem What this paper adds

There is little known about the self-management of blood This paper provides commentary on the experiences and per-
glucose levels, in people living with diabetes, when undergoing ceptions of people with diabetes who have undergone hyperbaric
hyperbaric oxygen treatment (HBOT). oxygen treatment; describing the impact of individual self-
management behaviours on their blood glucose levels.

What is already known?

Currently it is observed that people living with diabetes who
undergo HBOT experience a decrease in their blood glucose level.
∗ Corresponding author at: Department of Diving and Hyperbaric Medicine, Royal
Hobart Hospital, Liverpool Street, Hobart, Tasmania 7000 Australia.
E-mail address: carol.baines@ths.tas.gov.au (C. Baines).
1. Introduction
Amongst the most common, costly, and preventable of all health
problems faced worldwide are those related to obesity, heart
disease, stroke, cancer, arthritis and diabetes. Diabetes is a well
acknowledged cause of long-term health complications, as evi-
denced by the 13point diabetes complication severity index (DCSI)
developed by Young et al. (2008)) and modified by Chang, Weiner,

https://doi.org/10.1016/j.colegn.2018.11.004
1322-7696/© 2018 Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd.

Please cite this article in press as: Baines, C., et al. Patient reported experience of blood glucose management when undergoing hyperbaric
oxygen treatment. Collegian (2018), https://doi.org/10.1016/j.colegn.2018.11.004
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Richards, Bleich, and Segal, (2012). The World Health Organisa-
tion (WHO, 2016) reports that long-term consequences of diabetes
impact significantly on quality of life, leading to complications
including heart attack, stroke, kidney failure, leg amputation, vision
loss and nerve damage which can increase the overall risk of dying
prematurely.
Hyperbaric oxygen treatment is an established treatment
modality, prescribed for patients who concomitantly have diabetes
and a wound (break in their skin integrity), that is non-responsive
to healing over a conventional timeframe (Heyboer, Sharma,
Santiago, & McCulloch, 2017). HBOT has been identified as use-
ful in the promotion of wound healing, thereby reducing the risk
of amputation (Jain, 2017). Previous studies have documented an
inconsistent and unpredictable impact on blood glucose levels
(BGL) in patients with diabetes during HBOT (Peleg et al., 2013;
Ekanayake & Doolette, 2001). All patients, regardless of primary
diagnosis and co-morbidities, who undergo hyperbaric oxygen
treatment, demonstrate a drop in their blood glucose level (McIIroy
& Banham, 2013). The magnitude of the blood glucose reduction
associated with HBOT is slightly amplified in the population of
patients who also have diabetes (Ekanayake & Doolette, 2001). One
regular, risk reduction strategy for patients who have diabetes and
receive HBOT is to undertake increased point of care blood glucose
testing (Heyboer et al., 2017).
2. Literature review
2.1. Diabetes as a chronic condition
Diabetes is a chronic illness, that affects the long-term health
of people in a number of ways, with the resulting need for multi-
disciplinary approaches to ongoing care within hospital and com-
munity settings (AIHW, 2018). In 2014-15, more than 11 million
Australians (50%) were reported as requiring highly complex health
needs arising from multiple chronic diseases, and many in this
group will need to access acute care services to receive treatment
(AIHW, 2018). Based on self-reported estimates from the Aus-
tralian Bureau of Statistics 2014–15 National Health Survey, more
than 1 in 20 (6.1%, or 1.2 million) Australian adults had diabetes
(AIHW, 2018). Diabetes was recorded as the principal and/or addi-
tional diagnosis in around one million hospitalisations in 2015–16,
accounting for 10% of all hospitalisations in Australia (AIHW, 2018).
A chronic complication of diabetes is micro and macrovascular
complications causing poor peripheral circulation, resulting in skin
wounding and ulceration (Chawla, Chawla, & Jaggi, 2016). Hyper-
baric oxygen treatment is one option available to the diabetic
population as an adjunctive treatment to assist in wound healing,
it should be noted work by Katarina, Magnus, Per, and Jan, (2009)
indicates that patients who have diabetes consider a high technol-
ogy treatment such as HBOT to be both burdensome and stressful.
2.2. What is hyperbaric oxygen treatment?
HBOT involves individuals breathing 100% oxygen, while inside
a hyperbaric chamber that is pressurised to greater than sea
level pressure (1 atmosphere absolute, or ATA), usually for a 110-
minute timeframe, for repeated episodes. Treatment regimens are
delivered using either a mono-place hyperbaric oxygen chamber
which accommodates a single patient only, or a multi-place hyper-
baric oxygen chamber which accommodates two or more people
(patients, nurses) (Jain, 2017) (see Fig. 1). Each hyperbaric chamber
is a pressurised vessel / chamber, therefore, once the door is closed
and treatment has commenced there is potential cause for tech-
nical, psychological and physical complications, which could pose
a need for intervention. HBOT has been demonstrated to increase
tissue oxygenation, stimulate angiogenesis and restore stem cell
Please cite this article in press as: Baines, C., et al. Patient reported experience of blood glucose management when undergoing hyperbaric
oxygen treatment. Collegian (2018), https://doi.org/10.1016/j.colegn.2018.11.004
mobilisation from the bone marrow, thus contributing to wound
healing (Prabowo et al., 2014; Peleg et al., 2013).
2.3. Hyperbaric treatment and measurement of blood glucose
levels
Monitoring blood glucose levels during HBOT is always per-
formed using the intermittent finger-prick method which is
standard clinical practice (point of care) and is recognised as safe
and normal for the patient (American Diabetes Association, 2018;
International Diabetes Federation, 2017; WHO, 2016). It has been
identified in previous studies, that HBOT patients have experi-
enced a hypoglycaemic episode at depth (McIIroy & Banham, 2013;
Wilkinson, Noting, Mahadi, Chapman, & Heilbronn, 2015). Hypo-
glycaemia itself is not viewed as a contraindication to HBOT, but
is a situation requiring ongoing medical management and clinical
support. There is potential for a multitude of physiological changes
that present with similar clinical symptoms to hypoglycaemia, in
patients receiving HBOT. Close monitoring of BGL allows for the
rapid recognition of hypoglycaemia as a potential cause of these
symptoms and establishes a practice standard for patient safety
(Trytko & Bennett, 2003; Stevens et al., 2015).
2.4. Hypoglycaemia fear
International consensus defines hypoglycaemia as a blood glu-
cose level of less than 4.0 mmol (ADA, 2018; IDF, 2017; & Diabetes
Australia, 2018). Personal experience with symptomatic hypo-
glycaemia can vary and symptoms may can include sweating,
faintness, rapid heart rate, shakiness, anxiety, or irritability (Dia-
betes Australia, 2018). A hypoglycaemic event can be a frightening
and medically serious situation. If not recognised and treated
quickly, the BGL can continue to fall, which is linked to poor
attention and cognitive function, potentially resulting in fit-
ting, unconsciousness or coma. Patients often self-manage these
unpleasant and harmful physical manifestations through non-
adherence to their medication regimes. (Walz et al., 2014; Bron,
Marynchenko, Yang, Yu, & Wu, 2012; Leiter et al., 2005).
This paper reports findings from an interpretive descriptive
study that aimed to explore individual patient experiences and
develop an understanding of the self-management initiatives peo-
ple with diabetes take to prevent hypoglycaemia whilst undergoing
hyperbaric oxygen treatment.
3. Methods
A qualitative method of interpretive description (Thorne,
Reimer, Kirkham, & O’Flynn-Magee, 2004) was adopted to allow
the construction of inductively derived understandings of the
participant’s experiences. The qualitative research methodology
interpretive description as described by Thorne, Reimer, Kirkham,
and MacDonald-Emes, (1997) is founded in the smaller scale quali-
tative investigation of an area of clinical interest for the purpose of
capturing themes and patterns within the subjective experiences
and the generation of an interpretive description that can inform
clinical practice (Thorne et al., 2004). Interpretive description is an
inductive method that informs the research design, data collection
and analysis (Thorne et al., 2004). Interpretive description acknowl-
edges the clinical expertise and experience of the researcher, and
this provides a stepping off point for the research design (rather
than providing an overarching structure) (Hunt, 2009). Individ-
ualised interviews are frequently the primary data source and
findings provide clinically applicable insights, which ultimately
inform clinical practice (Thorne et al., 1997).
Data for this study were gathered using individual semi-
structured, in-depth interviews. Each interview took place at the
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Fig. 1. Illustrated picture of Mono & Multi-place Hyperbaric Oxygen Chamber Reprinted with permission Bird Medical Devices. (2018, May 9).
participant’s chosen time and was conducted in a private, confiden-
tial manner. Interviews were audio recorded and supplementary
field notes were taken and later consulted to characterise any non-
verbal nuances. Each audio recording was transcribed verbatim. All
interviews were transcribed by the interviewer within five days of
the interview taking place. The computer software program NVivo,
was employed to manage and store data. Thematic analysis as
described by Braun & Clarke, 2006, underpinned by the principles
of interpretive description (Thorne et al., 2004) was undertaken.
The first two interviews were analysed by a second member
of the research team and regular meetings were held to discuss
the preliminary codes and developing themes; this support is an
acknowledged methodological core activity of supervision sessions
and team meeting in support of this approach to the research
(Barbour, 2001).
3.1. Research team
The team was responsible for the study design. The first
author undertook recruitment and data collection. Members of the
research team were involved in the thematic analysis
The interviewer is female, a Registered Nurse with over thirty
years’ experience, of which eighteen years, are in the specialist
field of hyperbaric and diving medicine. The interviewer adopted
a highly reflexive approach to engagement with participants with
careful consideration of the (previously) established clinical rela-
tionship when the participant was receiving HBOT. No participants
were receiving HBOT care at the time of interview.
3.2. Setting
The study setting was The Department of Diving and Hyperbaric
Medicine at a tertiary hospital in a state of Australia from 2014
to 2017. The tertiary hospital provided hyperbaric oxygen treat-
ment to a total of 112 patients during this period of which 70 have
diabetes, each patient undertook up to forty separate treatment
sessions over a period of eight weeks. This study involved a subset
of 15 people who consented to audio recorded in-depth interviews.
Please cite this article in press as: Baines, C., et al. Patient reported experience of blood glucose management when undergoing hyperbaric
oxygen treatment. Collegian (2018), https://doi.org/10.1016/j.colegn.2018.11.004
3
Thorne (2008) suggests that interpretive description can be applied
to small studies ranging from 5 to 30 participants.
3.3. Recruitment
Potential participants were purposively selected and were pre-
vious adult patients living with diabetes (Type 1 or Type 2), and
who had completed a course of HBOT in the preceding three years
at the study hospital. Patients were invited via a letter sent to their
home address to participate in an audio recorded, in-depth inter-
view. A consent form was included and if they wished to participate,
they were asked to return the signed consent form, in the reply-
paid envelope that was provided. Due to the retrospective nature
of the project, those patients who had most recently finished HBOT
were the first invited to participate as these were considered to be
‘closer’ in time to their experience. Letters were mailed out in clus-
ters of five, and responses were received within 14 days of initial
contact. At interview, the researcher verbally confirmed with the
participants their willingness to take part in the study prior to com-
mencing any recording, and it was reiterated that all reported data
would be used under a pseudonym.
Recruitment ceased when the researchers were confident that
no additional relevant knowledge was being obtained from new
participants, and thus data sufficiency had been reached. Thorne
(2008) advises that in smaller interpretive description studies, the
findings can be justified with the recognition that there will always
be more to study.
It was acknowledged that there may be occasions of emotional
discomfort, as a result of re-living the hyperbaric experience. The
offer of professional support from a Diabetes Nurse Practitioner was
made at the close of each interview. This support was not required
by any participants.
3.4. Ethics
This study received ethics approval from the University of Tas-
mania, Human Research Ethics Committee (HREC) (H0016456), La
Trobe University and site approval was obtained from the hospital
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Table 1
Demographic characteristics of study population.
Characteristics Value
n = 15
Gender 13 males / 2 females
Diabetes type /number of participants T1DM (1)
T2DM (5)
T2DM on insulin (9)
Age (mean) 61 years
Interview duration (mean) 45 minutes
Time since last HBOT (mean) 10 months
HBOT sessions (average) 35 sessions
Reason for HBOT Diabetic wound
Radiation proctitis
Radiation cystitis
Note. T1DM type 1 diabetes mellitus; T2DM type 2 diabetes mellitus; HBOT hyper-
baric oxygen therapy.
concerned. Written participant information was provided to each
participant. Each participant consented to the inclusion of their data
in the study were informed that they could withdraw at any time.
3.5. Findings
Of the 17 patients identified as meeting the inclusion criteria, 15
agreed to participate (see Table 1). The duration of the interviews
ranged between 25–65 min.
The four themes generated from analysis of the interviews and
derived from the participant’s subjective experiences, were varying
recognition of self-management requirements of diabetes; hypogly-
caemia fear; treatment-based adaptation; and ownership / monitoring
(see Fig. 2).
3.6. Theme 1 – varying recognition of self-management
requirements of diabetes
Individual participants were able to describe some aspects of
their diabetes management regimes, however, further discussion
revealed that their willingness to participate in the ongoing man-
agement of their diabetes varied. One participant, in explaining
their prescribed oral medication schedule, stated that ‘I only take
my medication when l felt like it’ (participant three). Several partici-
pants glossed over the issue of daily management and monitoring
with answers such as, ‘it has been out of control for a long time’ (par-
ticipant one), and ‘I am a slack diabetic’ (participant four). When
asked about their individual management strategies, and if they
experienced any unusual blood glucose readings, participant four
explained ‘It wasn’t because of the treatment (hyperbaric) l don’t
manage my diabetes properly’. From the responses given the require-
ment to self-manage their diabetes and understand the long-term
health implications was not foremost in the daily routines for these
participants.
Incidentally, participants two and eight, who were newly diag-
nosed with diabetes (six-months prior to HBOT), demonstrated the
greatest engagement with their disease process. They knew their
medication doses, regularly monitored their blood glucose, and
understood the subtleties and requirements of a controlled diet
and how this impacted their diabetes.
However, the majority of participant responses indicated a gen-
eral deniability of the long-term chronic effects of diabetes. This
was particularly evident in participants who could not identify the
relationship between poor management of their diabetes, and their
chronic non-healing wound issues, (the reason they were having
hyperbaric treatment). One participant said, ‘I suppose if you con-
trol your blood sugar it must be better for your wound’ (participant
one), but this insight was not shared by all. Participant nine sug-
gested that diabetes ‘is a silent disease’, the medical significance only
Please cite this article in press as: Baines, C., et al. Patient reported experience of blood glucose management when undergoing hyperbaric
oxygen treatment. Collegian (2018), https://doi.org/10.1016/j.colegn.2018.11.004
becoming evident when a serious complication occurs. Participants
did not seem to be able to draw a direct correlation between their
blood glucose management; the chronicity of their diabetes illness;
their chronic wound and the need for HBOT.
3.7. Theme 2 – hypoglycaemia fear
All participants voiced the fear of a reduction in their blood glu-
cose, resulting in a hypoglycaemic event, when undergoing HBOT.
Some voiced this fear more specifically, with participant four saying
‘I didn’t want to be low in the chamber’, and participant five stated
‘it just lowers it – quite significantly’ and perhaps most significantly,
participant six clearly articulated concern, saying ‘you come in here
it’s gonna drop more points while you are in the chamber – mine got
to 3 once’. Participant eleven described their experience, ‘it drops in
the chamber under pressure – it can drop in the reading – by up to
4 points, so if l go in with a reading of 5 that drops to 1, – well l’ m
stuffed!’ Participant seven said ‘I just hate being low so much, l will
do anything to avoid getting to such a helpless situation.’
As a result of repeated exposure to the hyperbaric environment,
study participants could articulate a clear association between the
blood glucose level required to have HBOT safely and the BGL
required to prevent a hypoglycaemic event whilst in the chamber,
‘well l came up here with my sugars somewhere near where they should
have been, of course they were too low – we had trouble’ (participant
one).
Respondents gave examples of the individual strategies they
employed to raise their blood glucose to what they perceived to be
a ‘safe’ level, in order to undergo HBOT and avoid a hypoglycaemic
event. Participants fourteen and nine, described the fear associated
with an ‘in-chamber hypo’ as being so serious, they deliberately
chose to reduce their diabetic oral medication and increase their
glucose intake, knowing this would push their blood glucose to
abnormally high levels. This indiscretion was not reported to the
hyperbaric practitioners, due to a concern that the doctor would
be ‘cross’ with them, and not allow HBOT to go ahead on that
occasion. The relationship between patient and HBOT clinician was
not openly discussed, but participant seven voiced they were con-
cerned about a hypoglycaemic event only because the practitioners
were concerned ‘you (practitioners) are worried about a hypo – so l
was too’.
3.8. Theme 3 - treatment based adaption
Participants described multiple strategies they employed to
adapt behaviours to forward manage the risk of ‘going low’ dur-
ing a hyperbaric treatment. Participant five reported adapting their
insulin regime, without medical support or supervision, ‘I had to
take less insulin Monday to Friday coz I was down low at 7–8 and
it has to be higher, I had it up in the week and down at the week-
end’. Adaptation of normal diabetes treatment was also described
by participant three, ‘a couple of times l came for treatment and had
some high ones – sort of 20, 22 I was a little concerned, but l didn’t
show it – I knew l was eating too much fruit’. When further explored,
participant three confirmed that ‘it is better being high than low with
the sugars, your treatments hardly ever stopped with a high’.
Participant thirteen explained, that following their first treat-
ment, they had quickly learned that the potential for a decrease in
blood glucose was an issue that they needed to manage. Participant
eleven stated, ‘I have not been able to go into the chamber a few times
lately because my sugar has been too low – they sit me out and I have
to wait for it to go up to get in the chamber’. To combat this from
repeatedly happening, participant eleven states ‘I eat my Weetbix
for breakfast –and l have sugar on them, this should push my sugars
up far enough and I can have my scheduled treatment’.
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Fig. 2. Thematic map four main themes.
Participant five said ‘you blokes said l needed to be higher for treat-
ment, so l made sure l arrived for treatment full of sugar’, indicating
acceptance of the increase in blood glucose as a ‘new normal’. Con-
versely, participant twelve, who having lived with diabetes for 20
years, voiced a clear annoyance that their ‘careful control was lost
for the entire day’. Participant fourteen, expressed frustration - ‘I am
sick of artificially raising my blood sugar just to have a dive’.
3.9. Theme 4 – ownership/monitoring
According to some participants it was important that they
retained control of their blood glucose management, during HBOT.
Participant ten indicated ‘you lose control at the beginning of a treat-
ment schedule – you accept the risk and start to learn a new normal’.
To comply with the clinical and safety requirements for hyper-
baric treatment, increased finger prick testing of blood glucose is
a necessity. Several participants indicated the additional monitor-
ing during HBOT was a nuisance and not necessarily an action they
undertook outside of the bounds of this clinical treatment, partic-
ipant four complained that their fingers were sore and enquired if
‘all of this testing is really necessary?’ This gave substance to the idea
that clinician driven activities (i.e. increased monitoring) can alter
normal routines of the patient.
Self-management initiatives were driven from the perspective
that each person with diabetes can and should manage their own
disease. Participant fifteen explained, ‘when living with a chronic
disease such as diabetes, you are aware of your body’s responses, you
learn to control those responses, you don’t hand over control once you
have mastered this because it is a risk that may change your life – so
you manage the risk, you eat the foods you know, take the drugs in the
dose you can predict their action, you control as much as possible’.
Individual engagement with diabetes monitoring decisions,
along with clinician expertise, can help promote ownership by cre-
ating a patient-centred approach to diabetes care, with participant
thirteen stating, ‘the first few treatments were daunting – we didn’t
know how I was going to behave, but once l was in control of the sugar
level it was fine’. Throughout the interviews it was noted that as
the familiarity with HBOT improved, the responsibility for blood
glucose control improved, this behaviour became accepted as an
Please cite this article in press as: Baines, C., et al. Patient reported experience of blood glucose management when undergoing hyperbaric
oxygen treatment. Collegian (2018), https://doi.org/10.1016/j.colegn.2018.11.004
5
individual norm, participant eleven stated ‘I know when l am going
to hypo so l just sort myself out in the chamber – it’s my responsibility’.
4. Discussion
The participants in this study who required HBOT to assist in
wound healing, intentionally altered their diet or adjusted their
diabetes medication regime to elevate their blood glucose. One of
the main drivers of this behaviour was the fear associated with a
hypoglycaemic event.
The hyperbaric clinician is required to safely manage each
patient’s glycaemic condition on an individual basis to facilitate
HBOT. This is usually done in collaboration with the patient thus
acknowledging the clinical relevance of a hypoglycaemic event
during HBOTand how this may affect their overall well-being. How-
ever, participants in this study voiced that they independently
altered their normal glycaemic regulatory behaviours, deliberately
elevating their blood glucose levels. This could considered ‘new
normal’ demonstrate a lack of understanding of how a persistently
high BGL might affect their chronic wound.
The relationship between clinician and patient oscillated
between trust in the knowledge the clinician would keep them
safe in the HBOT environment and the individual need to stay in
control, even if this was having a BGL directly outside of the figure
the clinician had discussed with them. The participants articulated
they were willing to manipulate their BGL to be artificially higher
than prescribed by the clinician, or what would be considered nor-
mal safe levels, to ensure they could complete hyperbaric treatment
without the threat of a hypoglycaemic event. This behaviour is sim-
ilarly demonstrated by Katarina et al. (2009), who reported both
hypoglycaemic and hyperglycaemic events in patients undergoing
HBOT. The self-reported management strategy of this cohort was
to either consume sugar or self-adjust their insulin dose.
The interview findings are consistent with the published litera-
ture with respect to patients fearing hypoglycemic events. Weiner
and Skipper (1979), reported over 30 years ago, that the patients’
fear of having a hypoglycaemic episode is ‘one of the major limita-
tions in achieving and maintaining satisfactory blood glucose control’.
This fear remains prevalent today; ‘hypo anxiety’ is recognised as
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a major limiting factor in glycaemic control (Cryer, 2002; Leiter
et al., 2005). In managing diabetes and blood glucose levels people
have an acknowledged fear of recurrent hypoglycaemic episodes
and confess to manipulating their diabetes treatment by changing
the dose and time of insulin administration; by altering the type
and duration of physical activity and varying their oral medicines
(Polonsky, 1999).
HBOT exacerbated hypoglycaemic fear leads to the protective
behaviour of increased point-of-care blood glucose testing. The
HBOT clinician drives additional monitoring, changing it from a
patient/personal control and preventative strategy into a tool that
the clinician employs as an overarching diabetes management
strategy. Thus, point of care testing (finger-prick) may present as
an imposition to a positive patient-clinician relationship.
The hyperbaric clinician is regularly collaborating with the
patient, to create an acceptable situation where the risk of a hypo-
glycaemic event is minimalised. If a person has a greater knowledge
base from which to make decisions, this may translate into an
increased motivation to better self-manage their chronic illness, the
significance of which is often played down by both parties (Norris,
Lau, Smith, Schmid, & Engelgau, 2002). In the HBOT environment,
blood glucose monitoring is a clinical requirement, this is often not
the practice in the greater diabetic population. The interview data
indicated that participants were frustrated with the long-term self-
management requirements of their diabetes and the fact that they
choose not to monitor their blood glucose with any regularity is
their choice.
Johansson, Osterberg, Leksell, and Berglund, (2015) note the
process of living with diabetes involves a responsibility that is
imposed on an individual and is constantly present; taking own-
ership and accepting change is paramount for the lifelong health
and well-being of the patient. It may be possible, that through the
continued trust of the HBOT practitioner, (both doctor and nurse),
patients learn to embrace risk, but the responsibility of daily man-
agement stays with the patient. Recognition of the dynamics of the
patient / clinician relationship in treatment decision-making is vital
to the ongoing self-management of chronic conditions, including
diabetes.
This research offers an insight into the heightened awareness
around blood glucose self-monitoring and overall diabetes self-
management initiatives in patients undergoing HBOT. The impetus
for this behaviour change, can be attributed to hypoglycaemic fear,
however, the clinician requirements for hyperbaric treatment may
be a concomitant driver.
5. Limitation
This study was able to provide some new insight into this issue,
but the relatively small number of participants (15) may diminish
the transferability of the findings. Although providing a unique per-
spective on blood glucose management in HBOT, further research to
ascertain if this behaviour is replicated in hyperbaric units across
Australia and internationally, would enhance collaborative man-
agement strategies.
6. Conclusion
These findings support the anecdotal data that patients who
have diabetes and undergo HBOT are adjusting their diet and med-
ication regime while developing their own self-management plan
to lessen the potential of having a hypoglycaemic event in the
hyperbaric chamber. In previous literature it has been demon-
strated that HBOT influences glycaemic control. It has not been
widely reported that patients are adjusting their own diabetes
management to undertake a medical intervention; however, this
Please cite this article in press as: Baines, C., et al. Patient reported experience of blood glucose management when undergoing hyperbaric
oxygen treatment. Collegian (2018), https://doi.org/10.1016/j.colegn.2018.11.004
work demonstrates that individualised adjustments are occurring
to receive HBOT. Hypoglycaemic fear is central to diabetes man-
agement as a chronic disease; this study adds another dimension
to our understanding of the phenomena.
Conflict of interest
The authors wish to state there is no known conflict of interest.
Disclosures
The authors have no funding acknowledgements or disclosures
concerning this project.
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