title: Cross-cultural variation in symptom perception of hypoglycemia.
abstract: BACKGROUND
  Cross-cultural differences in attitudes and practices related to diabetes are well-known. Similar differences in symptom reporting of endocrine conditions such as menopause are well documented. Minimal literature is available on the cross-cultural variation in reporting of hypoglycemic symptoms.
  
  
  OBJECTIVE
  This cross-sectional study aimed to assess the symptoms of hypoglycemia encountered by diabetologists who deal with patients from different language groups from various states of North and West India and Nepal.
  
  
  METHODS
  Eighty three doctors from six Indian states and Nepal, attending a continuing medical education program were requested to fill a detailed, pre-tested, Likert scale based questionnaire which assessed the frequency and symptoms with which patients presented with hypoglycemia in their clinical practice. Data were analyzed based on geographic location of the diabetologists and language spoken by their patients (Hindi vs. Gujarati).
  
  
  RESULTS
  Gujarati-speaking patients tended to report to their doctors, a greater inability to work under pressure and a higher frequency of intense hunger during hypoglycemia. They were less likely to report specific adrenergic (inward trembling), neuroglycopenic (feeling down over nothing), and nocturnal (crumpled bedsheets upon waking up) symptoms.
  
  
  CONCLUSIONS
  Significant cross-cultural differences related to the symptomatology of hypoglycemia are noted. Indian diabetologists should be aware of the varying presentation of hypoglycemia based on language and ethnic background.
authors.affiliation: Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, Haryana, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kalra
authors.affiliation: Department of Psychiatry, AIIMS, New Delhi, India.
authors.forename: Yatan Pal Singh
authors.initials: YP
authors.lastname: Balhara
authors.affiliation: Department of Endocrinology, Medanta Hospital, Gurgaon, India.
authors.forename: Ambrish
authors.initials: A
authors.lastname: Mithal
keywords: Culture; India; diabetes; ethnicity; hypoglycemia