Symptoms and Blood Glucose Levels in Diabetics

To the Editor.— Textbooks and professional associations have long advocated teaching patients with diabetes to look for symptoms such as sweating, headache, trembling, and hunger as indicators of hypoglycemia and to interpret symptoms such as increased thirst, need to urinate, weakness, and nausea as indicative of hyperglycemia. 1,2 Patients so instructed are then encouraged to eat, avoid insulin and exercise, test their blood glucose levels when they feel the standard symptoms of hypoglycemia, and test their blood glucose levels and avoid carbohydrates when they feel the standard symptoms of hyperglycemia. 3 Recent surveys have shown that patients given these instructions do in fact attend to and act on such physiological cues. 4 These accepted guidelines for patient education and self-monitoring are founded on the assumption that certain symptoms consistently correlate in a standard fashion with blood glucose levels for all persons with diabetes. Recently, however, six studies 5-10 conducted independently