The symptoms of hyperglycaemia in people with insulin-treated diabetes: classification using principal components analysis.

Abstract

People with insulin-treated diabetes commonly experience symptoms of hyperglycaemia, but the nature of these symptoms and their origins are poorly understood. The aims of this study were (1) to identify and classify the symptoms of hyperglycaemia experienced by people with insulin-treated diabetes and (2) to identify patient characteristics associated with intensity of, and glycaemic threshold for, glycaemic symptoms. Common hyperglycaemic symptoms were identified from preliminary interviews. Eighteen symptoms were used in a questionnaire. Four hundred participants estimated the intensities with which they experienced these symptoms during hyperglycaemia. Principal components analysis (PCA) was used to examine correlations between symptoms. Associations between symptom intensity, glycaemic threshold, and other characteristics were examined with multiple regression. In total, 361 participants (90.2%) reported experiencing hyperglycaemic symptoms. PCA suggested four symptom groupings: (1) feeling tense, irritability, restlessness, poor concentration (agitation) (2) thirst, dry mouth, need to urinate, not feeling right, sweet/funny taste, weakness (osmotic) (3) dizziness, blurred vision, light-headedness, weakness (neurological) (4) headache, nausea (malaise). Mean symptom intensity was associated with younger age. The median (range) estimated blood glucose threshold for symptom onset was 15 (8-30) mmol/L; there was a weak tendency for this threshold to be elevated in people who had impaired hypoglycaemia awareness. People with insulin-treated diabetes commonly reported symptoms associated with hyperglycaemia. PCA separated these into four groups. Osmotic symptoms appear to be specific to hyperglycaemia; symptoms in the other groups may suggest underlying physiological mechanisms, but are relatively non-specific. Symptoms are more intense in younger people and may be reported at lower blood glucose concentrations in people with normal awareness of hypoglycaemia.