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Abstract
Management of type 1 diabetes requires a continual balancing of insulin, fuel intake, and metabolic demand (e.g., exercise). This can only be accomplished with knowledge of where one's blood glucose is and where it is going and knowledge of how to manipulate insulin, fuel, and exercise to manage it. Blood Glucose Awareness Training (BGAT) is a psychoeducational intervention that in part addresses these needs. Fifteen research studies from the United States and Europe, involving single-site and multicenter projects, are reviewed. BGAT has been consistently demonstrated to improve the ability to detect and diminish both hypoglycemia and hyperglycemia while reducing the sequelae of extreme blood glucose levels (e.g., episodes of severe hypoglycemia and driving mishaps). BGAT has recently been transformed for internet delivery, making it available both for clinicians to use with their patients and for individuals with type 1 diabetes to pursue as a self-directed tutorial.
The management of diabetes is a balancing act. For individuals with type 1 diabetes, it is like balancing a three-armed teeter-totter, with one arm supporting fuel consumption (e.g., food), a second supporting metabolic demand (e.g., physical activity), and a third supporting insulin. If there is relatively too much insulin, the teeter-totter tips into hypoglycemia, exposing the individual to unpleasant counterregulation symptoms,1 the impact of neuroglycopenia disrupting performance of routine tasks,2 and even death as in the case of the dead-in-bed phenomenon.3 Conversely, if the imbalance is in the direction of a relative lack of insulin in relation to metabolic demands for it, the teeter-totter will tip toward hyperglycemia and the short-term negative effects of cognitive dysfunction,4 lethargy,4,5 diabetic ketoacidosis,6 and possible chronic complications such as cardiovascular disease.7
Although health care providers can write insulin prescriptions and dietitians and diabetes educators can make recommendations about nutrient intake and exercise on a periodic basis, it is left to patients to make hourly, weekly, and lifelong decisions that lead to balance or imbalance of metabolic control. These decisions are made more difficult by the fact that these three elements and other unknown factors are dynamic and interacting. One must consider the dose, timing, and type of insulin; duration and intensity of physical activity; and amount and type of food consumption to correct extreme blood glucose or maintain euglycemia. However, because...