# Why is fasting hypoglycemia considered an early sign of type II diabetes **URL:** \ **Category:** Factual Questions\ **Created:** [September 25, 2016, 9:33pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886 "2016-09-25T21:33:46Z")\ **Posts on this page:** 18\ **Page:** 2
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 26, 2016, 7:18pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/21 "2016-09-26T19:18:53Z")
> [@Wesley\_Clark](#): > > What conditions fill the first two but fail the third? Symptoms of low blood sugar, diagnosis of low blood sugar but raising sugar levels does not relieve symptoms? Then we need to dig deeper to figure out what’s actually causing those symptoms. [quote=“Surreal, post:17, topic:766886”] > **[Do high fasting glucose levels suggest nocturnal hypoglycaemia? The Somogyi...](https://pubmed.ncbi.nlm.nih.gov/23672623/)** > > Our data indicate that, in clinical practice, the Somogyi effect is rare. Fasting capillary blood glucose ≤ 5 mmol/l appears an important indicator of preceding silent nocturnal hypoglycaemia. > **[In search of the Somogyi effect - PubMed](https://pubmed.ncbi.nlm.nih.gov/6105438/)** > > Insulin-treated diabetic patients may show a rapid swing to hyperglycaemia after episodes of hypoglycaemia. This rebound hyperglycaemia, or Somogyi effect, is thought to be caused by the unopposed actions of hormonal antagonists to insulin secreted... > **[The Somogyi phenomenon. Sacred cow or bull? - PubMed](https://pubmed.ncbi.nlm.nih.gov/6370162/)** > > Posthypoglycemic hyperglycemia (Somogyi phenomenon) occurs infrequently in insulin-treated diabetic patients. When it occurs it is often in children and adolescents, or patients with a short duration of diabetes. Marked hyperglycemia (greater than... [/QUOTE] Thank you. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 26, 2016, 8:01pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/22 "2016-09-26T20:01:13Z")
Right. Someone can have an anxiety disorder that presents with symptoms consistent with hypoglycemia and happen to run low sometimes and be checked at one of those times. But if the same symptoms exist when the blood sugar is corrected then it does not qualify. In old test taking mode, the third rules out “true-true-unrelated.” ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 26, 2016, 10:40pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/23 "2016-09-26T22:40:04Z")
> [@armedmonkey](#): > > Where do you get 55? It’s [70](https://www.uthsc.edu/endocrinology/documents/Protocols/Hypoglycemia_Treatment_Protocol.pdf). And I guess we’re going to have to agree to disasgree on our friend Dr Whipple. Not for healthy non-diabetics it’s not. As **Surreal** has already pointed out, there’s plenty of evidence that such individuals regularly run glucose levels well below 70 with no ill effects. So to diagnose hypoglycemia in a non-diabetic, we need to look for glucose levels below 55. ---
**Author:** ![armedmonkey](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@armedmonkey](https://boards.straightdope.com/u/armedmonkey)\ **Post date:** [September 27, 2016, 2:41am UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/24 "2016-09-27T02:41:01Z")
At tgis point, I’m not sure If there is ANY cite you will accept, but I will try one more time. This is from the department of Internal Medicine at the University of Michigan. It’s titled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes” > [@](#): > > In healthy people, fasting blood sugar levels are usually between 70 and 99 mg/dL. > > Mild hypoglycemia > > Symptoms of mild low blood sugar usually develop when blood sugar falls below 70 mg/dL [cite](http://www.med.umich.edu/intmed/endocrinology/patients/Hypoglycemia.html). And yes, I know it is entirely possible to have low blood sugar and be asymptomatic, but the threshold, again, is 70. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 27, 2016, 12:21pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/25 "2016-09-27T12:21:12Z")
> [@armedmonkey](#): > > And yes, I know it is entirely possible to have low blood sugar and be asymptomatic, but the threshold, again, is 70. Those cites do not address the issue being discussed. We are talking about making the diagnosis of the clinical disorder of **hypoglycemia in a non-diabetic**. To make that diagnosis, glucose levels need to be less than 55. From [UpToDate.com](http://UpToDate.com), which reports the medical standards. [Rapid overview of hypoglycemia in adults](https://www.uptodate.com/contents/image?imageKey=ENDO%2F73797&topicKey=ENDO%2F1798&rank=1%7E150&source=see_link&search=hypoglycemia&utdPopup=true) > [@](#): > > Rapid overview for hypoglycemia in adults, other than significant sulfonylurea overdose > Clinical features > Any patient with acute change in mental status or coma should undergo rapid assessment of blood glucose as a possible cause. > All findings of hypoglycemia are nonspecific, including the following: > • Autonomic response (tends to occur with blood glucose below 65 mg/dL) > > - Sweating > - Weakness > - Tachycardia > - Palpitations > - Tremor > - Nervousness > - Hunger > - Paresthesias > • Neuroglycopenia > - Irritability > - Confusion > - Uncharacteristic behavior > - Seizure > - Occasionally, transient focal neurologic deficits > - Loss of consciousness > - Visual disturbance > Diagnostic evaluation > ◾Obtain blood glucose concentration as soon as possible (usually with a meter and strips, if available): > > For symptomatic patient known to have diabetes and with a low glucose value, \<70 mg/dL [3.89 mmol/L], administer treatment. If a glucose test cannot be performed, do not delay. Treat as if hypoglycemia has been confirmed. > **If the glucose is low (\<55 mg/dL) and the patient is a not a diabetic**, draw blood for glucose, insulin, C-peptide, and an oral hypoglycemic agent screen and then treat, > ◾Do not delay treatment if symptomatic hypoglycemia is suspected but rapid blood glucose measurement is not available or blood for diagnostic studies cannot be collected. > > Treatment > ◾If the patient is conscious and able to drink and swallow safely (ie, alert enough to do so and with gag reflex intact), administer a rapidly-absorbed carbohydrate (eg, 3 to 4 glucose tablets or a tube of gel with 15 grams, 4 to 6 oz. fruit juice or non-diet soda, or a teaspoon of honey or table sugar).\* > ◾If the patient has altered mental status, is unable to swallow, or does not respond to oral glucose administration within 15 minutes, give an IV bolus of 12.5 to 25 gm of glucose (25 to 50 mL of 50 percent dextrose). > ◾Measure a blood glucose 10 to 15 minutes after the IV bolus. Readminister 12.5 to 25 grams of glucose as needed to maintain the blood glucose above 80 mg/dL. > ◾If glucose cannot be given by parenteral or oral routes, give glucagon 1 mg IM or subcutaneously. Response may be transient and should be followed by careful glucose monitoring and oral or intravenous glucose administration. > ◾Give additional maintenance glucose by mouth or IV. IV dextrose infusion should ensure delivery of 6 to 9 mg/kg per minute of glucose. Amounts needed vary depending upon the cause and severity of the symptomatic hypoglycemia. Once the patient is able to ingest carbohydrate safely, providing a mixed meal (including carbohydrates, such as a sandwich) is the preferred means of maintaining glucose levels. > ◾Measure a blood glucose 10 to 15 minutes after the initial IV bolus and monitor every 30 to 60 minutes thereafter until stable (minimum of four hours). The measurement method should provide rapid turnaround, preferably at the point of care. > ◾Admit patients with ingestion of a long-acting hypoglycemic agent, recurrent hypoglycemia during observation, and those unable to eat. > > IM: intramuscular; IV: intravenous. > > - Patients taking an alpha-glucosidase inhibitor (eg, acarbose, miglitol, voglibose) with symptomatic hypoglycemia should only receive pure glucose (dextrose) orally because digestion and absorption of other carbohydrates (eg, table sugar [sucrose]) will be delayed by these medications and will be less effective in raising blood glucose levels. ---
**Author:** ![armedmonkey](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@armedmonkey](https://boards.straightdope.com/u/armedmonkey)\ **Post date:** [September 27, 2016, 2:43pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/26 "2016-09-27T14:43:53Z")
> [@Qadgop\_the\_Mercotan](#): > > Those cites do not address the issue being discussed. > > We are talking about making the diagnosis of the clinical disorder of **hypoglycemia in a non-diabetic**. What?! My last site was entitled EXACTLY THAT. “Hypoglycemia (Low Blood Sugar) in People Without Diabetes”. I suppose there could be different policies at different places, but I would rather stick with what the University of Michicgan Recommends. This is an instance where UpToDate misses the mark. And possibly dangerously so. If a patient comes in diaphoretic, tachycardic, and nauseus, with a blood sugar 12 points bellow normal, but has no history of diabetes, I am still going to call that hypoglycemia. You can be irresponsible if you want and delay addressing the blood sugar because the glucose isn’t low _enough_ for you and therefore doesn’t meet your version of Whipple’s triad in a non-diabetic, but that’s not how I’m going to operate, and that’s not how you should, either. But I give up, I didn’t think you would accept a cite anyway, even if it was titled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes”. That’s how you were able to read the phrase “People Without Diabetes” and then post but… but… “We are talking about making the diagnosis of the clinical disorder of hypoglycemia in a non-diabetic”. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 27, 2016, 6:51pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/27 "2016-09-27T18:51:20Z")
> [@armedmonkey](#): > > What?! But I give up, I didn’t think you would accept a cite anyway, even if it was titled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes”. That’s how you were able to read the phrase “People Without Diabetes” and then post but… but… “We are talking about making the diagnosis of the clinical disorder of hypoglycemia in a non-diabetic”. No need to get nasty, I’ve been trying to keep it civil. You still don’t seem to appreciate the difference I’m trying to draw. Though I admit I could have been more clear on the difference the other physicians in this thread and I are referring to vs. what you are keying on. Recurrent hypoglycemia syndrome vs. an episode of low blood sugar which casually gets referred to as ‘hypoglycemia’. Normal people have fasting glucoses that range from 70-99. Some, and even most people may have symptoms if their blood sugars fall below 70. But symptoms reliably develop in most people once the blood sugar goes below 55. In order to diagnose someone with the syndrome of **recurrent** hypoglycemia, the accepted medical standard in the US is Whipple’s Triad, using a blood sugar value of 55. I’m not saying I don’t offer someone who feels wobbly and happens to have a glucose of 65 a glucose tab, or a Snickers bar. THAT is standard therapy. Even so, many experts argue that’s more of a comfort measure than truly medically necessary, as such folks rarely progress below 50, where permanent damage to the brain can occur. Me, I prescribe glucose tabs in that setting. I’m saying I’m not going to diagnose them with recurrent hypoglycemia syndrome unless they have a glucose below 55, plus the other two points in the Triad. Nor will I thus embark on a workup for insulinoma, insulin autoimmune syndrome, pituitary insufficiency, or adrenal failure, or other possible cause. Because working up people for causes of recurrent hypoglycemia when their glucose is greater than 55 _rarely_ proves fruitful. This article on [recurrent hypoglycemia](http://www.consultantlive.com/endocrine-diseases/recurrent-hypoglycemia-when-diabetes-not-cause) by an endocrinologist at the Cleveland Clinic suggests using 50 as the value before starting such a workup. Can you see what I’m saying now, and reply without accusations of irresponsibility, incredulity, and dismissing my assessment on how to diagnose and manage the over and improperly diagnosed syndrome of _recurrent hypoglycemia_? ---
**Author:** ![armedmonkey](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@armedmonkey](https://boards.straightdope.com/u/armedmonkey)\ **Post date:** [September 27, 2016, 9:34pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/28 "2016-09-27T21:34:45Z")
You are trying to change the goalposts. You did not once refer to recurrent hypoglycemia. The OP didn’t ask about recurrent hypoglycemia. No one was discussing anything chronic, and your reaction to a cite entitled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes” wasn’t to try to find common ground, it was to claim that it didn’t address non-diabetics. Just no, doc. Just no. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 27, 2016, 10:06pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/29 "2016-09-27T22:06:50Z")
Seems like it’s similar to the distinction between \*depression \*(“I’ve been really sad this week because my best friend died.”) and _Major Depressive Disorder_. We may call both of them “depressed,” but one is a temporary state of being that happens in healthy people, and the other a medical diagnosis. It’s not like you’ll ignore the feelings of depression in someone who’s best friend just died, but you know it’s likely to resolve on it’s own, without subjecting someone to the bother and expense of full testing for a diagnosis. I have to agree with **armedmonkey** ’s point, if not their tone, though. The OP was asking about hypoglycemia, the symptom, not E16.2 Hypoglycemia, Unspecified - the diagnosis. (I can’t find an ICD10 code for “recurrent hypoglycemia”) ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 27, 2016, 10:35pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/30 "2016-09-27T22:35:00Z")
The whole discussion started out about fasting hypoglycemia predicting diabetes. And to my medical mind, which has had to assess plenty of patients for complaints they feel must be hypoglycemia, that means the type of hypoglycemia as defined in [UpToDate.com](http://UpToDate.com) as I spelled out. My statements in subsequent threads were directed at expanding on that view of hypoglycemia. So I don’t feel I moved the goalposts; we perceived different goalposts from the start. And while your link was a very thorough overview of hypoglycemia and its symptoms and treatments, what I wrote was that it didn’t “address the issue being discussed”. And I’ll cop to being self-absorbed enough that I meant it didn’t address the issue that I was discussing at that point, how to use Whipple’s Triad to make a legit diagnosis of the type of hypoglycemia that requires detailed workup to rule out insulinomas, autoimmune disease, etc. So yes, it was relevant to the thread, relevant to what you and others were saying, but not what I was focusing on. My bad. But I still stand by my point. You should document glucose levels under 55, along with the other two points made by Dr. Whipple, before pursuing workup. And also plenty of healthy people can run glucose levels between 55 and 70, and be asymptomatic and have it be normal for them, and not need intervention or evaluation. ---
**Author:** ![armedmonkey](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@armedmonkey](https://boards.straightdope.com/u/armedmonkey)\ **Post date:** [September 30, 2016, 1:46pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/31 "2016-09-30T13:46:23Z")
First off, let me apologize for my tone. It started out as just very, very informal, but it turned angry as I started to believe other professionals weren’t even listening. I shouldn’t have let it do that. I should have just rationally stuck to my guns and upgraded my politeness and professionalism. Second, please believe that I don’t really discount Whipple’s triad, I was just making a joke. It may not be one that truly landed, but hey, it wouldn’t be the first time that happened. Whipple’s triad makes sense as a whole, but if you pick it apart, it can seem tautological. I found humor in that. Next, I respect your position, **Qadgop** , but I just can’t agree. My reasoning for not agreeing actually relies on Whipple’s triad, and it is this: If a patient does present with symptoms, has a blood sugar 12 points below normal, and those symptoms are relieved by raising the blood sugar, what _else_ are you going to call it? **DSeid** mentioned the “real world” up thread. In my mind, what I just described is the real world. It does not have to be below 55, it just has to be symptomatic and relieved by raising the blood sugar. But this whole thing is kinda dumb. I don’t believe for a second that Dr **the Mercotan** wouldn’t treat a patient for hypoglycemia just because their glucose was 58. Of course he would. He’s not going to whip out his Rx pad and prescribe zofran for nausea and toprol for the tachycardia while discounting the blood glucose; the first thing he’s going to do is see if the guy can drink some orange juice. That’s the real world. Lastly, this stupid argument about whether it is 55 or 70 isn’t helping the OP at all. To me the OP’s question should be this: “Is fasting hypoglycemia considered an early sign of type II diabetes.” And the short answer for that is no, it’s not. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [September 30, 2016, 3:26pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/32 "2016-09-30T15:26:54Z")
> [@DSeid](#): > > Right. Someone can have an anxiety disorder that presents with symptoms consistent with hypoglycemia and happen to run low sometimes and be checked at one of those times. But if the same symptoms exist when the blood sugar is corrected then it does not qualify… I didn’t see this post until now, but whatdya’know, I saw my endocrinologist yesterday to see how what my diabetes was up to, and I asked him the exact question, but with opposite premises from this cite, which I am curious about then, and with a different (vague but considered) response. Perhaps because of the different premise, but now I’m all confused: My understanding is that anxiety for some reason (something with adrenalin?) causes acute _hyper_glycemia. I distinctly remember being given orange juice by an annoyed doctor who told me “get a grip, stop crying, you’re just making the numbers stay high”–which I later interpreted as being more than just a temporary sounds-scientific-just-stop-crying statement. Fast-forward 25 years to yesterday. Me, with bipolar disease previously known occasionally as anxious-mania or or anxious-depression (two for one!) can go through chronic horrible anxiety, and asked if that might have been, or can be, contributory to hyperglycemia. His answer, FWIW, no, as to chronic. But he seemed therefore to agree with the answer in the acute scenario. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [September 30, 2016, 3:44pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/33 "2016-09-30T15:44:02Z")
Cx: not “anxious-mania,” but something like “melancholic-mania.” Or that might be just for the/my mixed-state symptom. [BTW, very roughly put, suicide from this disease is not for the nexus of symptoms commonly thought of “depression thoughts,” but to stop the merciless anxiety.] ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 30, 2016, 3:51pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/34 "2016-09-30T15:51:15Z")
> [@Leo\_Bloom](#): > > I didn’t see this post until now, but whatdya’know, I saw my endocrinologist yesterday to see how what my diabetes was up to, and I asked him the exact question, but with opposite premises from this cite, which I am curious about then, and with a different (vague but considered) response. Perhaps because of the different premise, but now I’m all confused: > > My understanding is that anxiety for some reason (something with adrenalin?) causes acute _hyper_glycemia. I distinctly remember being given orange juice by an annoyed doctor who told me “get a grip, stop crying, you’re just making the numbers stay high”–which I later interpreted as being more than just a temporary sounds-scientific-just-stop-crying statement. > > Fast-forward 25 years to yesterday. Me, with bipolar disease previously known occasionally as anxious-mania or or anxious-depression (two for one!) can go through chronic horrible anxiety, and asked if that might have been, or can be, contributory to hyperglycemia. His answer, FWIW, no, as to chronic. But he seemed therefore to agree with the answer in the acute scenario. Anxiety can cause acute hyperglycemia, yes. Flight or fight response releases glucose into the bloodstream, so you have energy with which to flight or flee. But in a person \*without \*diabetes, their body quickly shuttles all that glucose - and sometimes extra - into the cells on the back of insulin. So Anxiety without diabetes can cause a brief moment of hyperglycemia, and then by the time they decide it’s worth going to the ER, all that sugar is in the cells already and they are hypoglycemic. Give 'em sugar, and it corrects the hypoglycemia, but not the anxiety and those symptoms of anxiety. There’s a lot of overlap in symptoms between hypoglycemia, hyperglycemia, and acute anxiety, actually. This is why even diabetics can’t always tell if they’re hypo or hyper without testing (although I’ve had more than one tell me that hypo feels like you’re drunk, and hyper feels like you’re high on weed - feelings which I’m not entirely confident I could tell the difference between reliably.) Hypoglycemic symptoms, those shared with anxiety/panic attack in bold, and those shared with hyperglycemia in italics: \*\*Shakiness Nervousness or anxiety Sweating, chills and clamminess I\*rritability or impatience \* \*Confusion, including delirium \* Rapid/fast heartbeat Lightheadedness or dizziness \*\* Hunger and \*\*nausea \*\* \*Sleepiness \* \*\*_Blurred/impaired vision_ Tingling or numbness in the lips or tongue \*Headaches \*\*\* \*Weakness or fatigue \* \*\*Anger, stubbornness, or sadness \*\*\*Lack of coordination \*\*\* Nightmares or crying out during sleep \*\* Seizures \*Unconsciousness \* There are only so many alarm bells your body has to ring when something is wrong. Symptoms are a great start to figuring out what might be wrong, but they’re usually not enough all by themselves. That’s why we look for signs (objective measurements, like labs and blood glucose readings) as well as symptoms. ---
**Author:** ![armedmonkey](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@armedmonkey](https://boards.straightdope.com/u/armedmonkey)\ **Post date:** [September 30, 2016, 4:40pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/35 "2016-09-30T16:40:20Z")
> [@Qadgop\_the\_Mercotan](#): > > And to my medical mind, which has had to assess plenty of patients for complaints they feel must be hypoglycemia, that means the type of hypoglycemia as defined in [UpToDate.com](http://UpToDate.com) as I spelled out. I’m sorry, but I have to say this. Quit citing UpToDate. It’s on my computer at work, too, and it’s a good resource, but c’mon man, it’s just a subscription based encyclopedia. It ain’t the bible. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 30, 2016, 5:44pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/36 "2016-09-30T17:44:21Z")
> [@armedmonkey](#): > > I’m sorry, but I have to say this. Quit citing UpToDate. It’s on my computer at work, too, and it’s a good resource, but c’mon man, it’s just a subscription based encyclopedia. It ain’t the bible. No, it’s not the bible, and it’s not a source for cutting-edge information. But it is reliably referenced with decent supporting evidence, is regularly updated, and does reflect pretty well the generally accepted standards of US medicine these days. And practitioners who follow its guidelines _in general_ are practicing better medicine as a whole than those who practice based on what’s touted by drug reps, to be sure. 😉 And henceforth I will work harder to be less self-absorbed and focused on my own points when responding to knowledgeable input from other posters such as yourself. But I don’t guarantee I’ll be that much better that quick. I’m still not sure all of you are real. I know my patients are though, since I can see and _smell_ them. ---
**Author:** ![armedmonkey](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@armedmonkey](https://boards.straightdope.com/u/armedmonkey)\ **Post date:** [September 30, 2016, 6:57pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/37 "2016-09-30T18:57:42Z")
> [@Qadgop\_the\_Mercotan](#): > > And practitioners who follow its guidelines _in general_ are practicing better medicine as a whole than those who practice based on what’s touted by drug reps, to be sure. 😉 Oh don’t even get me _started_ on drug reps. Well, don’t get me started on device reps, because that’s probably the RN equivalent of an MD drug rep. I know this may come as a surprise, but I’m not always polite to them. 😃 ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [September 30, 2016, 8:58pm UTC](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886/38 "2016-09-30T20:58:46Z")
Since you’re an **armedmonkey** perhaps you could show them your other “devices”? There’s more than one way to get a pushy rep out the door. 😃 [Previous page](https://boards.straightdope.com/t/why-is-fasting-hypoglycemia-considered-an-early-sign-of-type-ii-diabetes/766886.md?page=1)