Symptoms in Children and Older People

Children often have difficulty in recognising symptoms of hypoglycaemia, and they show marked variability in symptoms between episodes of hypoglycaemia (Macfarlane and Smith, 1988). Trembling and sweating are often the first symptoms recognised by children. From interviews with the parents of children (aged up to 16 years) with type 1 diabetes, and with some of their children, more is known about the frequency of symptoms of hypoglycaemia in children (McCrimmon et al., 1995; Ross et al., 1998) (Table 2.4). The most frequently reported sign that parents observed was pallor (noted by 88%). The parents

Table 2.4 Symptoms of hypoglycaemia in children (derived from Ross et al., 1998)

Symptom

Frequency of rating (%) Parents' reports Children's reports

Correlation between parents' and children's intensity ratingsa

Tearful

73

47

0.40d

Headache

73

65

0.33d

Irritable

85

65

0.16

Uncoordinated

62

56

0.18

Naughty

47

31

0.23b

Weak

79

83

0.21b

Aggressive

75

62

0.26c

Trembling

79

88

0.25b

Sleepiness

63

69

0.27c

Nightmares

33

19

0.33d

Sweating

76

73

0.28c

Slurred speech

53

45

0.28c

Blurred vision

52

55

0.30c

Tummy pain

67

41

0.36d

Feeling sick

63

53

0.32c

Hungry

74

84

0.19

Yawning

48

45

0.20b

Odd behaviour

65

50

0.22b

Warmness

57

68

0.13

Restless

61

57

0.21b

Daydreaming

70

48

0.14

Argumentative

64

50

0.21b

Pounding heart

21

44

0.02

Confused

75

70

0.41d

Tingling lips

20

24

-0.01

Dizziness

66

87

0.28c

Tired

83

76

0.26c

Feeling awful

92

79

0.20

a Correlations: p of z (corrected for ties) 1.0 represents perfect agreement; 0 represents no agreement. b p < 0.05, c p < 0.01, d p< 0.001.

a Correlations: p of z (corrected for ties) 1.0 represents perfect agreement; 0 represents no agreement. b p < 0.05, c p < 0.01, d p< 0.001.

frequently reported symptoms of behavioural disturbance such as irritability, argumentativeness and aggression. This latter group of symptoms is not prominent in adults, although the Edinburgh Hypoglycaemia Scale includes 'odd behaviour' as an adult neuroglycopenic symptom. Others had previously noted the prominence of symptoms such as irritability, aggression and disobedience in the parents' reports of their children's symptoms of hypoglycaemia (Macfarlane and Smith, 1988; Macfarlane et al., 1989). Parents tend to under-report the subjective symptoms of hypoglycaemia, such as weakness and dizziness, but generally there is good agreement between parents and their children about the most prominent symptoms of childhood hypoglycaemia (McCrimmon et al., 1995; Ross et al., 1998).

Separate groups of autonomic and neuroglycopenic symptoms were not found in children with type 1 diabetes (McCrimmon et al., 1995; Ross et al., 1998). These symptoms are reported together by children and are not distinguished as separate groups, whereas the group of symptoms related to behavioural disturbance is clearly reported as a distinct group. In a refinement of the earlier study by McCrimmon et al. (1995), Ross et al. (1998) found that parents could distinguish between autonomic and neuroglycopenic symptoms.

People with insulin-treated type 2 diabetes report symptoms during hypoglycaemia that separate into autonomic and neuroglycopenic groups (Henderson et al., 2003). Elderly patients with type 2 diabetes treated with insulin commonly report neurological symptoms of hypoglycaemia which may be misinterpreted as features of cerebrovascular disease, such as transient ischaemic attacks (Jaap et al., 1998). The age-specific differences in the groups of hypoglycaemic symptoms, classified using statistical techniques (Principal Component Analysis), are shown in Table 2.5. Health professionals and carers who are involved in the treatment and education of diabetic patients should be aware of which symptoms are common at either end of the age spectrum.

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