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The article discusses the management of hypoglycemia with a focus on a new management protocol to be followed by nurses. The authors explain the reason why it is important for nurses to properly manage an episode of hypoglycemia. It is stated in the article that lack of a proper protocol for managing hypoglycemia or other diabetes-related complications could lead to cardiovascular problems or serious infections. The authors are guided by the notion that the then existing protocol for controlling hypoglycemia was greatly flawed. The authors explain that the flawed protocol led to nurses’ delays in administering the proper medication and nutrition which subsequently led to lack of proper inpatient glycemia control. The protocol was also deemed inefficient because it only catered for hypoglycemia in acute care. This left out those suffering from hypoglycemia in post anesthetic situations, psychiatric and also ambulatory care. In the article, the authors explain the meaning, causes and symptoms of hypoglycemia in order to allow the reader to fully understand the basis of the topic. The authors also explain the importance of the evidence-based approach. It is explained that this approach is significant because through it the correct procedures for quality patient health care are developed. The authors who are all practitioners from the Portland, Oregon Veterans Affairs Medical Centre, came up with the idea that it was important to have an evidence-based protocol for management of hypoglycemia.  In developing the evidence-based protocol, a Hypoglycemia Workgroup was formed. The group consisted of diabetes educators, nutritionists, medicine professionals and pharmacists, among them the authors of the article. The article discusses the process that the group undertook in order to come up with the improved protocol.

The Workgroup conducted research on the existing protocol and its main provisions. The group identified the major flaws in the protocol including the fact that it did not have a definition of hypoglycemia. The group then came up with a definition from the American Diabetes Association (ADA). They adopted this definition for the new protocol. The article then explains that the group identified the major areas in which the new protocol would be used. These included areas such as ambulatory care which had not been provided for in the previous protocol. The group also added various treatments that had been missing in the then existing protocol. This included treatment for those patients who can swallow, those who have intravenous access only and those who require intravenous access but do not have it. The article also explains that the group also developed a method for ensuring adherence to the protocol. This meant that under the new protocol nurses had to document their use of the protocol in order to recognize its strengths and weaknesses and whether it was working efficiently. According to the article, the new protocol required nurses to document the number of cases of hypoglycemia, the symptoms, among other crucial pieces of information. The group also came up with a new one page hypoglycemia algorithm to replace the two page one which was viewed as lengthy and hard to follow.

The new algorithm is shown in the article. The workgroup ensured that the new protocol was approved by the relevant authorities; most importantly the deputy director of Patient Care Services. The article then stipulates that the workgroup also ensured implementation of the evidence based protocol by educating nurses and making treatment options readily available. The article also reports that implementation was tested. It was found that rates of severe hypoglycemia had considerably reduced after the new protocol was implemented. The article also provides the steps that are needed to ensure continued success of the new protocol. The authors conclude the article by restating why it is important to address the issue of hypoglycemia and most importantly the need for an evidence-based protocol for nurses.

The authors clearly state the major objectives of the article. The title of the article provides a clear portrayal of the main topic of discussion that is, an innovative protocol for managing hypoglycemia. The definition of hypoglycemia is also clear although the terms used for example dL cannot be easily understood by a layman. The authors rely on information from other authors who have conducted studies on hypoglycemia. The authors having been part of the workgroup were also able to relay first hand information that they obtained from the project. The data in the article is well laid out and one can easily follow the argument presented.  The data presented also supports the conclusions made by the authors. This is because it is clear that the authors wrote the article on the premise that an evidence based protocol was required to manage the cases of inpatient hypoglycemia. The article illustrates that there was enough evidence to show that the evidence based protocol devised by the workgroup was indeed functioning more efficiently than the previous one. This is the same conclusion reached by the authors.

The opinions presented in the article are thought provoking. The authors explain the importance of addressing the issue of a correct protocol for managing hypoglycemia. This prompts the reader to understand the gravity of the matter. For example, from the onset of the article the authors explain that over 17.5 million people in the US were suffering from diabetes in 2008. The authors also explain the devastating consequences of lack of the proper protocol for nurses for the managing of hypoglycemia. The research was well conducted but it could be improved by giving more evidence on the success of the new protocol. The most important thing that I learnt by critiquing the article is that hypoglycemia is very manageable if the right steps are undertaken by health care givers especially nurses. The article also clearly demonstrates that following the evidence based protocol cases of poor control of hypoglycemia are avoidable.

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