April 20, 2001 -- People with diabetes must keep their blood sugar levels under control if they want to lead long, healthy lives. New research shows that completing a structured, organized program designed to help them understand when their blood sugar is too high or too low is an effective way to help diabetic individuals maintain the control they need.
Diabetes affects 15.7 million Americans, or about 6% of the U.S. population. It is a condition in which the body is either not making enough or isn't responding well enough to the hormone insulin, which is necessary to use the sugar in the blood.
If you'd like to discuss different ways to control diabetes, go to WebMD's Diabetes board moderated by Gloria Yee, RN, CDE.
There are two main types of diabetes. Type 1, which accounts for about 5-10% of cases, usually becomes evident in early adolescence when the body's own immune system, for reasons that are not well understood, attacks the cells in the pancreas that produce insulin. These individuals must take daily injections of insulin in order to live.
Type 2 diabetes usually starts around middle age and is caused by the gradual wearing out of the cells that produce insulin combined with an overall reduced ability of the body to respond to insulin in the blood. Sometime type 2 diabetes can be controlled with diet and exercise, but often these individuals must also take medication and/or insulin injections.
Serious problems occur in diabetics when levels of sugar in the blood get too high or too low. Low blood sugar, called hypoglycemia, can occur as a result of taking too much insulin and causes a drunken-like state that quickly progresses to unconsciousness and death if not treated quickly by eating pure sugar or sugar rich food. High blood sugar, or hyperglycemia, is usually not immediately life-threatening but can cause damage to the organs of the body and circulatory system over time.
Keeping blood sugar at an optimal level, therefore, is crucial, and the Blood Glucose Awareness Training, or BGAT, program was designed to help diabetic individuals do just that. The designers of the program called it a biobehavioral intervention because it helps people with diabetes pick up on the subtle cues their bodies give off when blood sugar levels get too high or too low.
William Clarke, MD, and colleagues completed a study showing that the latest version of BGAT, called BGAT-2, helped 73 adults with type 1 diabetes improve their ability to detect when their blood sugars were too high or low.
The program also helped these individuals to worry less about the risks of their condition. Importantly, the benefits attained from completing this program were long lasting. Clarke is a professor of pediatrics at the University of Virginia Health Sciences Center in Charlottesville. The research is published in this month's issue of the journal Diabetes Care.
"This is not a quick fix; it's not easy," says Clarke about BGAT. "... This is not the McDonald's of improving glucose control. ... In order for it to be effective, you have to take the eight-week program, and there is homework that has to be done throughout the week. Without doing those sorts of things, you can't really improve your own awareness [of your blood glucose levels]. But once you've improved that awareness, it's something that seems to carry over for a long period of time."
Lois Exelbert, RN, MS, CDE, is a diabetes nurse educator. They use BGAT at the Diabetes Education Center at Baptist Hospital of Miami, where she is administrative director. She says it is extremely effective for helping individuals with diabetes recognize when their sugar levels are off, so they can fix the problem immediately in the short term and make changes to diet, exercise, and/or medication in order to prevent these ups and downs in the long term. Importantly, the program also teaches crucial safety strategies such as not getting behind the wheel of a car unless you've checked your blood sugar levels.
"The misconception is that everybody with diabetes is going to be subject to passing out from low blood sugar and just expect it," she says. "But not everybody has to have low blood sugar where they're passing out. ... It 's not an automatic function of having diabetes, and there's absolutely ways to prevent it."
One of Exelbert's patients, who prefers that her name not be used, has had type 1 diabetes for 27 years. She took the BGAT program in 1997 because she found, like many people who have had type 1 diabetes for several years, that she no longer experienced the obvious signs of low blood sugar, such as sweating and tremor. She found that the program was well worth the considerable effort and time required and recommends it to anyone interested in better understanding their disease and preventing long-term complications.
"It was very intense," she says about the program, "... but it worked for me because now I know when I'm going into a low [blood sugar state] by reactions my body is giving me now. ... I always talk about to people that I meet [with diabetes] who have had some bouts with 911 calls because this might help them learn about themselves before they get to that 911 call [state]. ... There was so much information in the program that I never knew [even] after having diabetes for such a long time."
Endocrinologist Philip A. Levin, MD, director of The Diabetes Center at Mercy Medical Center in Baltimore, Md., says the difference between this and other training programs for handling diabetes is that it is far more organized and structured. More and more data like this study is emerging to demonstrate that such a structured program does help people control their blood sugar.
"For a person to just assume that they can [test their blood sugar] a few times, get it right, and assume they have a handle on their own body's awareness of blood sugar changes, could be misleading and a little dangerous" he says. "If you're going to [determine your blood sugar level based on your body's subtle cues], you need to take a continuous program over a number of weeks or months where you get feedback in order to get a good feel for how often you're right and how often you're not right."