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Program may help diabetics head off low blood sugar

By Anne Harding

NEW YORK (Reuters Health) - A six-week behavior-modification program helped people with diabetes overcome anxieties and prevent plunging blood sugar in a small UK study.

Dr. Stephanie Amiel of King's College London and her colleagues evaluated a program specifically for people with type 1 diabetes who had difficulty recognizing episodes of low blood sugar, or hypoglycemia, despite having undergone training in how to adjust their insulin use.

People with type 1 diabetes who need insulin to survive are at risk of hypoglycemia, but this can be a problem in patients with type 2 diabetes too, especially if they use insulin or a sulfonylurea drug, according to Dr. Jane Chiang, of the American Diabetes Association.

Signs of low blood sugar include shaking, confusion, sweating and blurred vision, Andrew Keen, a health psychologist specializing in diabetes at the University of Aberdeen, told Reuters Health.

"These signals mean that people can take action early before blood glucose levels drop very low when they are effectively unable to self-treat," said Keen, who did not take part in the new study.

However, some people lose the ability to recognize these signs, he added.

Untreated hypoglycemia can lead to seizures and unconsciousness.

Many people with diabetes are so concerned about their blood sugar getting too high that they don't pay as much attention when their blood sugar drops too low, noted Chiang, who was not involved in the study.

"People need to be aware that hypoglycemia is just as dangerous, even more so, than hyperglycemia, and that it is treatable and avoidable," she said.

"Hypoglycemia is particularly concerning in young adults and older adults because they are vulnerable," Chiang said.

The program Amiel's team devised included instruction on signs of hypoglycemia and how to reduce hypoglycemia risk. Program leaders also focused on helping participants identify their own emotional and motivational barriers to recognizing low blood sugar episodes.

The training consisted of three weekly full-day group sessions and individual follow-up in person and by telephone during weeks four and five, with a final full-day group session focusing on relapse prevention.

Amiel and her colleagues followed the patients for a year after the end of the program.

Among the 23 participants who completed the program, 14 reported having passed out in the year before the study began as a result of low blood sugar episodes, three said they'd been taken to an emergency room (one individual, 24 times) and three had been admitted to the hospital, Amiel's team reports in the journal Diabetes Care.

After the program, the average annual number of episodes of severe hypoglycemia - meaning patients required assistance from another person - fell from three to zero.

The average number of episodes of moderate hypoglycemia, meaning patients were able to treat the episode themselves, fell from 14 to zero per six-week period.

While patients were significantly less worried about avoiding high blood sugar after the program, and somewhat less worried about low blood sugar, blood markers of their overall long-term blood sugar control did not change.

It's not surprising that a targeted program was able to improve patients' ability to cope with hypoglycemia, Chiang said in an interview.

"Even if you spent a little bit of time and you are aware of it and could identify a few triggers, you can still address it, and I think you can make a difference," she said.

SOURCE: http://bit.ly/1m0SUWQ Diabetes Care, online December 6, 2013.

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