It is already well-established that hypoglycemia limits full realization of glycemic control’s long-term benefits in type 1 diabetes, and these are not simple fears. Unfortunately, diabetes education routinely shifts the blame back on the patient, rather than acknowledging physiological issues which contribute to the problem, or when educators are aware of the problem, they are ill-prepared to properly address the issue.
At the very least, an episode of hypoglycemia is a nuisance and a distraction. It can be embarrassing and cause social ostracism. The psychological morbidity of hypoglycemia includes fear of hypoglycemia, guilt about that rational fear, high levels of anxiety, and low levels of overall happiness. In her book about her life with type 1 diabetes Lisa Roney wrote, "[T]hese episodes [of hypoglycemia] shame and haunt me, the most apparent shadow on my semblance of a normal life."
Part of the problem is that the medical profession and the pharmaceutical industry have done woefully little to address the limitations of current treatment modalities.
Deb Butterfield, in her book about life with type 1 diabetes ("Showdown with Diabetes") once wrote: "Knowing what dose of insulin to take was not then, and is not now, a precise science. It is not a simple analog of food, exercise, and insulin; rather it is a complex and seemingly random theory of chaos with a few discernable known variables."
BGAT is an excellent means to address this problem, but awareness among CDE's remains incredibly low (as of 2006, it was not even covered in training, leaving CDE's to investigate for themselves), as the focus on issues specific to type 1 are dwarfed by the issues related to the Metabolic Syndrome, leaving most nurse educators ill-prepared to address these issues. Its high time that the American Association of Diabetes Educators incorporate this into their curriculum, but instead, they spent the most recent conference addressing issues that have been covered repeatedly in preceding years.
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Dr. Bill,
One huge problem that rarely gets discussedd is how people with Type 2 diabetes who have been running high for a long time will experience a counterregulatory response when they approach normal blood sugars which will make them feel hypo.
I have run into a lot of Type 2s online who felt hypo at normal numbers: 80-100 mg/dl and had ignorant medical professionals tell them to raise their blood sugars higher to "solve" this non-problem.
People need to know that they are not experiencing a hypo until the blood sugar goes below 70 mg/dl, and that if they feel hypo at normal levels, it's a transient phenomenon that will gradually fade away as the body adapts to normalcy.
But sadly, quite a ew doctors and dietitians don't seem to know this.