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Symptoms and Blood Glucose Levels in Diabetics FREE

Daniel J. Cox, PhD; Linda Gonder-Frederick, MA; Stephen Pohl, MD; William Carter, PhD; William Clarke, MD; Suzanne Bennett-Johnson, PhD; Arlan Rosebloom, MD; Clare Bradley, PhD; Jennifer Moses
JAMA. 1985;253(11):1558-1558. doi:10.1001/jama.1985.03350350052010
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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 studies5-10 conducted independently

REFERENCES

Krall L: Joslin Diabetes Manual . Philadelphia, Lea & Febiger, 1978;.
Guthrie NW, Guthrie RA: Nursing Management of Diabetes Mellitus . St Louis, CV Mosby Co, 1977;.
Balodimos MC, Root HF:  Hypoglycemic insulin reactions without warning symptoms . JAMA 1959;; 171:261-266.
O'Connell KA, Hamera EK, Knapp TM, et al:  Symptom use and self-regulation in type II diabetes . Adv Nurs Sci 1984;;6:19-28.
Pennebaker JW, Cox DJ, Gonder-Frederick L, et al:  Physical symptoms related to blood glucose in insulin-dependent diabetics . Psychosom Med 1981;;43:489-500.
Cox DJ, Gonder-Frederick L, Pohl S, et al:  Reliability of symptom-blood glucose relationships among insulin-dependent adult diabetics . Psychosom Med 1983;; 45:357-360.
Cox DJ, Clarke W, Pohl S, et al:  Accuracy of perceiving blood glucose in IDDM patients . Diabetes Care , in press.
Gonder-Frederick L, Cox DJ, Pennebaker JW:  The relationship of individual-specific symptoms to discrete physiological parameters . Health Psychol , in press.
Freund A, Bennett-Johnson S, Rosenbloom AL:  Subjective symptoms and blood glucose concentrations in adolescents with diabetes . Diabetes 1984;;33:70A.
Bradley C, Moses JL, Gillespie CR:  An examination of the possibilities of continuous blood glucose monitoring with minimal blood sampling . Diabetes 1983;; 32( (suppl) ):171A.

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Krall L: Joslin Diabetes Manual . Philadelphia, Lea & Febiger, 1978;.
Guthrie NW, Guthrie RA: Nursing Management of Diabetes Mellitus . St Louis, CV Mosby Co, 1977;.
Balodimos MC, Root HF:  Hypoglycemic insulin reactions without warning symptoms . JAMA 1959;; 171:261-266.
O'Connell KA, Hamera EK, Knapp TM, et al:  Symptom use and self-regulation in type II diabetes . Adv Nurs Sci 1984;;6:19-28.
Pennebaker JW, Cox DJ, Gonder-Frederick L, et al:  Physical symptoms related to blood glucose in insulin-dependent diabetics . Psychosom Med 1981;;43:489-500.
Cox DJ, Gonder-Frederick L, Pohl S, et al:  Reliability of symptom-blood glucose relationships among insulin-dependent adult diabetics . Psychosom Med 1983;; 45:357-360.
Cox DJ, Clarke W, Pohl S, et al:  Accuracy of perceiving blood glucose in IDDM patients . Diabetes Care , in press.
Gonder-Frederick L, Cox DJ, Pennebaker JW:  The relationship of individual-specific symptoms to discrete physiological parameters . Health Psychol , in press.
Freund A, Bennett-Johnson S, Rosenbloom AL:  Subjective symptoms and blood glucose concentrations in adolescents with diabetes . Diabetes 1984;;33:70A.
Bradley C, Moses JL, Gillespie CR:  An examination of the possibilities of continuous blood glucose monitoring with minimal blood sampling . Diabetes 1983;; 32( (suppl) ):171A.
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