Older people with Type 2 diabetes have been shown to have a lower intensity, and more limited perception, of autonomic symptoms of hypoglycaemia than age-matched non-diabetic elderly subjects (Meneilly et al 1994b). In a descriptive study of 45 elderly patients with Type 2 diabetes who were receiving treatment either with insulin or a sulphonylurea, the symptoms of hypoglycaemia that were recognized most commonly were nonspecific in nature and included weakness, unsteadiness, sleepiness and faintness (Thomson et al 1991). In a retrospective study of people with Type 2 diabetes treated with insulin (Jaap et al 1998), the hypoglycaemia symptoms that were reported with the greatest frequency and intensity were mainly 'neuro logical' in nature and included unsteadiness, lightheadedness and poor concentration (Table 10.5). Trembling (71.2%) and sweating (75%) also featured prominently, contrasting with a Canadian study in which it was claimed that the autonomic symptoms of hypoglycaemia in the elderly were attenuated (Meneilly et al 1994a). However, the latter study did not use an age-specific symptom questionnaire, and differences in symptom questionnaires and in scoring methods of inducing hypoglycaemia may account for the differences in symptom profiles that have been described.
Using the statistical technique of principal components analysis, the hypoglycaemia symptoms of elderly people with Type 2 diabetes could be separated into neuroglycopenic and autonomic groups, but the typical symptoms of a 'general malaise' group of symptoms such as headache or nausea were rare (Jaap et al 1998). However, symptoms such as impaired motor coordination and slurring of speech were prominent. In elderly people, these symptoms may be misinterpreted as representing either cerebral ischaemia, intermittent haemodynamic changes associated with cardiac dysrhythmia, or vasovagal and syncopal attacks. Healthcare professionals should be aware of the age-specific differences in hypoglycaemic symptoms (Table 10.1), both from the need to identify and treat hypoglycae-mia, and for educational purposes.
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