BLOOD-GLUCOSE ESTIMATION AND SYMPTOMS DURING HYPERGLYCEMIA AND HYPOGLYCEMIA IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

PURPOSE: To investigate hypoglycemic and hyperglycemic symptoms, accur acy of estimating blood glucose, and their relation to glycemic contro l and counterregulatory hormone levels in insulin-dependent diabetes m ellitus. PATIENTS AND METHODS: During randomly ordered stepped hypogly cemic and hyperglycemic insulin clamps on two separate days, 42 patien ts with insulin-dependent diabetes mellitus rated the intensity of 40 moods and symptoms when glucose was 8.9, 5.6 and 2.2 mmol/L, and 8.9, 14.4 and 21.1 mmol/l. The subjects were blinded to their actual glucos e levels and asked to estimate them at each step. Epinephrine, norepin ephrine, cortisol, growth hormone, and glucagon were measured at each glucose plateau. RESULTS: Cluster analysis yielded five symptom groups during hypoglycemia: autonomic symptoms, negative moods, positive moo ds, feeling weak/dizzy, and feeling relaxed. At 2.2 mmol/L, mean score s for all five symptom groups and 11 of 17 unclustered symptoms differ ed from those reported at the baseline glucose of 8.9 mmol/L (P <0.05) , but 34% of patients reported no awareness of autonomic symptoms. The intensity of autonomic symptoms correlated positively with HbA(1) (r =.43, P <0.01), epinephrine (r = .59, P <0.001), norepinephrine (r =.4 5, P <0.01) and cortisol (r =.62, P < 0.001), and negatively with gluc ose estimation error (r = -.45, P = 0.01). Six patients (15%) were una ware of both autonomic and neuroglycopenic symptoms during hypoglycemi a. At 21.1 mmol/L, only 5 of 40 symptoms differed (P <0.05) from basel ine. Seventeen percent of subjects made potentially serious errors whe n estimating glucose at 2.2 mmol/L, and 66% at 21.1 mmol/L. Many patie nts experienced symptoms different from those they reported as their u sual manifestations of changing glucose levels. CONCLUSIONS: Since the majority of patients made clinically serious errors in glucose estima tion, and many used symptoms that did not discriminate hyperglycemia a nd hypoglycemia, individualized training to increase awareness of gluc ose-related symptoms and glucose levels may help patients reduce the f requency or severity of hyperglycemic and hypoglycemic events.