Hypoglycaemic symptoms and hypoglycaemia threshold in older people with diabetes--a patient perspective

To investigate patients' views about their lowest tolerable blood glucose level and explore symptoms they may develop below that level.

A semi-structured patient interview.

Outpatient clinic for older people (≥75 years) with diabetes.

Patients attending an outpatient clinic over a six months period who are monitoring their blood glucose at home and able to participate in interview.

Sixty one patients gave answers to the interview questions. Mean (SD) age was 82.3 (3.9) years and 33 (54%) were females. All patients indicated that they were usually aware when hypoglycaemia occurs but the symptoms reported were mostly non specific. The threshold for hypoglycaemia was 5 mmol/L in 13 (21%) patients, 6 mmol/L in 14 (23%) patients, 7 mmol/L in 13 (21%) patients, 8 mmol/L in 17 (28%) patients and 9 mmol/L in 4 (7%) patients. There was no significant difference between patients who were symptomatic at a higher blood glucose level (>6 mmo/L) and those who developed symptoms at a lower level (≤6 mmol/L).

Older people with diabetes who seem to be aware of hypoglycaemia report mostly non specific symptoms. The threshold of experiencing hypoglycaemic symptoms appears to be higher than the usually defined <4 mmol/L.