Symptom awareness and blood glucose estimation in diabetic adults.

Abstract

Self-regulation of diabetes depends in part on common-sense models of symptoms and blood glucose fluctuations. Symptom perception and subjective estimation of blood glucose were studied in 52 adult, difficult-to-control, non-insulin-dependent diabetics using a structured interview and laboratory blood-glucose measurement. Most patients believed they could detect hyperglycemia. Symptoms linked by patients to hyperglycemic and hypoglycemic episodes did overlap with symptoms traditionally associated with those states. Some patients may experience dysphoria during glycemic swings to which multiple symptom labels are applicable, although prominent exceptions and idiosyncratic symptoms were evident. Estimation of current blood glucose using an ordinal scale suggested some capacity for discriminating blood glucose levels. Numerical estimates of Chemstrip values were correlated with actual values, but far too inaccurately for purposes of self-regulation. Research is needed to clarify whether subjective symptom perception and blood glucose estimation helps or hinders self-regulation of diabetes.

Accuracy in Discriminating Blood Glucose Levels in a Sample of Children with Type 1 Diabetes

“…Thus, many patients may focus on symptoms that are actually false signals while ignoring others that truly indicate variations in BGL and can involve serious clinical consequences (Diamond, Massey, & Covey, 1989;Gil Roales-Nieto & Vílchez Joya, 1993;Gonder-Frederick et al, 1986). Similar findings have also been reported in diabetic children and adolescents (Freund et al, 1986;Wiebe, Alderfer, Palmer, Lindsay, & Jarrett, 1994).…”

Factors Related to Perceived Diabetes Control Are Not Related to Actual Glucose Control for Minority Patients With Diabetes

“…Although fluctuations in glucose do not correspond well to subjective cues, subjective cues are salient and compelling to patients as indicators of health (14). Estimates of glucose control based on subjective cues will likely lead to overly optimistic estimates of control that are unlikely to motivate changes in self-management.…”

Perceived health status and perceived diabetes control: psychological indicators and accuracy

“…However, patients with diabetes also appear to have some personal ability to detect abnormal glucose levels [17,18], and the accuracy of detection of blood glucose abnormalities can be enhanced with blood glucose awareness training [19 -21]. Gonder-Frederick et al [22] have represented the complexity of blood glucose detection in their biopsychobehavioral model of hypoglycemia.…”