| Hypoglycemia is the major limiting factor in Type 1 Insulin-Dependent Diabetes Mellitus (IDDM). It can lead to serious cognitive impairment and significant morbidity and mortality. People rely on direct blood testing and autonomic symptoms to detect hypoglycemia. Blood testing is precise, but requires invasive techniques that are cumbersome, costly, painful, and socially uncomfortable. Many people develop impaired counterregulation, which reduces the intensity of autonomic warning symptoms. This can prevent a person from detecting hypoglycemia.;Cognitive performance testing may be an effective alternative to autonomic symptom monitoring and can be done more frequently than direct blood testing. Previous research shows that choice reaction time (CRT) is reliably and consistently impaired during moderate to severe hypoglycemia. This exploratory small-n intensive study was designed to assess the practicality and accuracy of using CRT as a proxy measure of neuroglycopenia and low blood glucose (BG) levels.;Participants used the Psion Organizer II-LZ-64 hand-held computer (HHC) to do a Psion Test, i.e., check CRT to detect hypoglycemia. Eight adolescent subjects with IDDM (ages 15--17, two male and six female) completed a two-week home monitoring protocol during naturally fluctuating BG intervals. They first estimated BG, then rated symptoms, checked CRT, and did direct blood testing. The MC recorded this data and information on sleep, drug, alcohol, and caffeine use. Seven subjects experienced hypoglycemia during the study. The Psion Test detected 66% of all 53 hypoglycemic events below 80 mg/dl (Sensitivity 0.59--0.77 for six of the seven subjects). Adolescents detected only 41% of their lows. They misinterpreted hypoglycemia as hyperglycemia during 23% of the low events. The Psion Test confirmed 75% of the 128 normal BG events. Adolescents detected only 47%. Percent Accuracy was greater for the Psion Test, compared to adolescent estimates (p = .02, .05 alpha).;Results from this study show adolescents can use HHCs to track self-management data and are interested to use Psion testing as a detection strategy. Adolescents want and need more education about neuroglycopenic symptoms of hypoglycemia. The Psion HHC shows potential as a diagnostic test for hypoglycemia and may be helpful as a biofeedback tool in BG awareness training. |
