May 1, 2006

Blood Glucose Awareness Training

by



Monday, May 1 – 9pm est.
Linda Gonder-Frederick, Ph.D.
Topic – Blood Glucose Awareness Training

Linda Gonder-Frederick, Ph.D. is an Associate Professor of Research in Psychiatric Medicine at the University of Virgina. She is also the Division Head for the Division of Behavioral Medicine, which is part of the Department of Psychiatric Medicine at the University of Virginia Health System in Charlottesville, Virginia. Her clinical Interests are helping adults cope with chronic or life-threatening illnesses, anxiety disorders, stress disorders, insomnia, and depression. Her research Interests are behavioral and psychological issues in diabetes, hypoglycemia, predictors of outcome of weight reduction surgery, and development of patient interventions. Perhaps her best-known contribution to the diabetes community was the development of a training program called Blood Glucose Awareness Training, better known as BGAT, which was co-authored with several other researchers, including Dr. William Polonsky, who joined DiabetesTalkFest in December 2005. BGAT has proven especially valuable for patients with longstanding type 1 diabetes who suffer from hypoglycemia unawareness, a physiological problem that has few effective treatments. BGAT has also been critically acclaimed worldwide, as diabetes treatment centers from the Netherlands to Japan now offer translated-versions of this program.

[sstrumello] 6:02 pm: First, introductions … [sstrumello] 6:02 pm: Tonight, I am delighted to introduce you to a special guest, Linda Gonder-Frederick, Ph.D., who is an Associate Professor of Research in Psychiatric Medicine at the University of Virgina. Linda is also the
Division Head for the Division of Behavioral Medicine, which is part of the Department of Psychiatric Medicine at the University of Virginia Health System in Charlottesville, Virginia.

[Acroyear] 6:03 pm: Hi Dr

[sstrumello] 6:03 pm: Her clinical Interests are helping adults cope with chronic or life-threatening illnesses, anxiety disorders, stress disorders, insomnia, and depression. Her research Interests are behavioral and psychological issues in diabetes, hypoglycemia, predictors of outcome of weight reduction surgery, and development of patient interventions. Perhaps her best-known contributions to the diabetes community was the
development of a training program called Blood Glucose Awareness Training (aka BGAT).

[Linda Gonder-Frederick] 6:03 pm: Hello everybody. Welcome. It is a pleasure to be here.

[reese] 6:04 pm: hi linda saw hypoglycemic unawareness in you bio and had to be here

[sixuntilme] 6:04 pm: I second that.

[Acroyear] 6:04 pm: and then some

[sstrumello] 6:04 pm: Linda, thanks for joining us tonight. Can you give us a 5-second overview of BGAT for those who aren’t familiar with it?

[Linda Gonder-Frederick] 6:04 pm: It is one of our major areas of interest. A major problem for people living with diabetes that does not get enough attention.

[Jon] 6:05 pm: Linda, what can you do to help hypo unawareness?

[Linda Gonder-Frederick] 6:05 pm: BGAT was originally designed to help people recognize early warning signs better, and the research shows that it is often very helpful. We also study the “emotional” aspects of hypoglycemia.

[Heidi] 6:06 pm: how long did it take to develop BGAT?

[Linda Gonder-Frederick] 6:06 pm: Hypo Unawareness. Research shows that one of the best ways to increase symptom awareness is to try to avoid BGs less than 70 whenever possible. For many people, symptoms start coming back.

[Acroyear] 6:06 pm: How does one train to become aware again of the hypoglycemia
once it has been lost?..or can it ever be gotten back without putting ones health at risk ie high glucse levels?

[sstrumello] 6:06 pm: Blood Glucose Awareness Training (BGAT-2)
An overview of blood glucose awareness training (BGAT) has been shown to help improve awareness of blood glucose (BG) fluctuations among adults with type 1 diabetes. This study investigates the long-term
(12-month) benefits of BGAT-2.<a href=”http://care.diabetesjournals.org/cgi/content/full/24/4/637″>http://care.diabetesjournals.org/cgi/content/full/24/4/637</a>

[Linda Gonder-Frederick] 6:06 pm: It took several years to develop BGAT, and it is still being tested. There are now versions in Germany, Japan, Switzerland, and Holland.

[Linda Gonder-Frederick] 6:07 pm: Yes, it is possible to avoid lows without being high too much of the time. That’s one of the goals of BGAT. But as you probably know, it’s sometimes not easy…

[reese] 6:07 pm: i have symptoms they are just way different than they use to be and very very mild

[sstrumello] 6:08 pm: What was the genesis of BGAT?

[Acroyear] 6:08 pm: how does the psycology of a person affect the gluscose levels? The reason I ask is I do have depression due to the hypoglycemia and am actually going for the first time to a psycologist tomorrow. What can I expect?

[Linda Gonder-Frederick] 6:08 pm: Yes, symptoms change over time due to a variety of factors. And they also become much more mild. Most people do not become completely hypo unaware. We like to use the phrase “reduced hypoglycemic awareness.”

[Linda Gonder-Frederick] 6:09 pm: Acro – I actually see people in your situation quite frequently. Hopefully you have a psychologist who knows something about hypoglycemia as well as depression. You can usually expect to get a great deal of understanding for just how difficult it can be.

[Acroyear] 6:10 pm: hopefully..It has kicked me the you know what for too long

[ms] 6:10 pm: Is there any data on higher incidences of anxiety among individuals with diabetes on the whole?

[reese] 6:10 pm: i am on meds to help with my anxiety/depression, did wonders for me not sure counseling could help me, if they have not lived it

[Linda Gonder-Frederick] 6:10 pm: There is data showing that people with diabetes have more anxiety and more depression. And it doesn’t help if you have to deal with frequent hypoglycemia.

[Acroyear] 6:10 pm: thanks reese

[Ellen] 6:11 pm: I’d like to know if you’ve seen correlative data that shows reduced anxiety/phobias/depression surrounding the diabetes when people are better able to detect oncoming lows and high blood sugars so they can treat before a reaction happens either way.

[Linda Gonder-Frederick] 6:11 pm: Meds can be extremely helpful. Research shows that meds and counseling together sometimes work best.

[sixuntilme] 6:11 pm: Do medications such as blood pressure medications contribute to reduced awareness?

[ms] 6:11 pm: do anti-anxiety/depression medications (which I believe can be in different classes) tend to have an effect on individual’s diabetes management?

[Acroyear] 6:12 pm: I don’t know about the rest of you but i have been hypoglycemic unaware for yrs..been dead one..been paralyzed for 3 days..been in a coma for 5 days..all because of hypoglycemia

[reese] 6:12 pm: you need to post acroyear on the board if it helps you πŸ™‚

[Acroyear] 6:12 pm: I don’t understand “post”..I am new to this chat thing

[Linda Gonder-Frederick] 6:12 pm: Yes! Definitely! One of the things we study is anxiety about hypoglycemia, and what makes it worse. Being confident that you can handle the situation greatly reduces anxiety.

[Linda Gonder-Frederick] 6:13 pm: I’m trying to read all of the questions…I’ll catch up in a minute.

[reese] 6:13 pm: i hope one day the knowing of our bgs at all time will help immensely and what medtronics is offering but a bit too pricey for me

[sstrumello] 6:13 pm: OK, thanks. If we can hold off on questions until Linda has a chance to address outstanding ones, that would be appreciated.

[Linda Gonder-Frederick] 6:13 pm: Six – Some blood pressure meds do reduce symptoms – they are called beta blockers — but this is an area that is somewhat controversial

[Linda Gonder-Frederick] 6:14 pm: Am I caught up? If not, just ask again…These are all important questions!

[sstrumello] 6:14 pm: It looks like it, but if someone asked something that did not get addressed, please ask again now!

[Linda Gonder-Frederick] 6:15 pm: Reese – Yes, the continuous glucose monitors (CGMs) could make a huge difference in people’s lives…Currently though they are often not as accurate for hypoglycemia as they need to be.

[captkirk] 6:15 pm: Type 1 48 years and I do not have hypo unawareness, I have had to relearn symptoms many times. I have had to listen to my body very closely to relearn new symptoms. I am worn out by all these years of 24/7 awareness. What do you suggest?

[reese] 6:15 pm: Linda is doing great she has a great understanding are you diabetic?

[Heidi] 6:16 pm: how soon do you think the internet trials (of BGAT) will be completed/and available to everyone?

[Linda Gonder-Frederick] 6:16 pm: Cap – I suggest that you teach other people how to do what you have learned! It sounds like you are “naturally” blood glucose aware!

[Linda Gonder-Frederick] 6:16 pm: Reese – No I am not diabetic. But I have been doing research and working with people who are for over twenty years…

[reese] 6:17 pm: ahhh good to know linda

[captkirk] 6:17 pm: I just have learned with testing what indicates a low as old feelings went awry.

[reese] 6:17 pm: and like capt I have relearned the symptoms, but I liked the old strong ones and yes the 24/7 is wearing as well

[sstrumello] 6:18 pm: Linda, is the online version of BGAT still in trials? (<a href=”http://webcenter.healthsystem.virginia.edu/bmc/bgathome_temp/index2.htm”>http://webcenter.healthsystem.virginia.edu/bmc/bgathome_temp/index2.htm</a>)

[sstrumello] 6:18 pm: <a href=”http://webcenter.healthsystem.virginia.edu/bmc/bgathome_temp/index2.htm”>http://webcenter.healthsystem.virginia.edu/bmc/bgathome_temp/index2.htm</a>

[Linda Gonder-Frederick] 6:18 pm: Okay…the internet version of BGAT. We are in the final stages of testing it and will be presenting our results at this year’s ADA meeting. We have a website where people can go to put their names if they are interested in being notified as soon as we are “up and running.” It has taken us a long time…the address is <a href=”http://www.interest.bgathome.com”>www.interest.bgathome.com</a>. My computer savvy colleague said that he needs to update it, and he will get to it this week. But you can enter your name now.

[Acroyear] 6:19 pm: I don’t know about the rest of you, but I never recognize the “symptoms”..everyone else sees it and tells me..I just think they have no clue what they are talking about, and I go into a fight or flight mode..I wanna be left alone and if they try to force sugar on me, I fight them off..much to my regret afterwards as it uses more sugar to fight them off to leave me alone than it does to just have some sugar..its like I am scared of sugar or something, or I am scared that I may be wrong, and don’t

[reese] 6:19 pm: how does counseling help?? as they cannot fix lows and highs? I know help dealing with it, but truly…….

[Acroyear] 6:19 pm: wanna admit to it

[Ellen] 6:19 pm: I wonder if I could get my 18 year old son to try the online version. How many hours of work does it take?

[Linda Gonder-Frederick] 6:20 pm: Acro – This happens to a lot of people. It’s because your brain is not getting enough glucose and is having trouble functioning right. It’s also a control thing. It’s your body and it’s natural for you to want to know more about what is going on than other people. Nobody likes to be told “how they are feeling.”

[captkirk] 6:20 pm: Over the years I have learned that those feeling of obstinance are a signal of being low; I have learned those “new” signals

[Linda Gonder-Frederick] 6:21 pm: Ellen – BGATHome is a lot of work. We tell people that it is not the “McDonald’s” of diabetes education.

[Acroyear] 6:21 pm: thanks captain and linda

[Wendy12571] 6:21 pm: Ellen..that means it will cost you greatly…

[Ellen] 6:21 pm: Well he hates McDonalds and calls it McGarbage, so maybe there’s hope LOL

[reese] 6:21 pm: plus low bgs cause a lot of these feelings as well. Acroyear to you test enough?

[sstrumello] 6:22 pm: Ellen, having attended the live version at Joslin in Boston, there is something to be said for attending a class with others who experience the same thing. But not everyone has access, which is why the online version will be a tremendous benefit.

[Linda Gonder-Frederick] 6:22 pm: Cap _ you are exactly right. When people lose their “old” symptoms (caused by hormonal releases in response to lows), the major symptoms are the “brain” symptoms. We try to help people become more aware of these.

[Acroyear] 6:22 pm: I have just gotten back into the testing 5 times a day

[Acroyear] 6:22 pm: soon to go on the Medtronic 24/7 glucose sensor

[Linda Gonder-Frederick] 6:22 pm: Yes, Scott. Getting BGAT out to people has been a real struggle for us, and we are hoping that the internet version will make it available to many, many more people.

[captkirk] 6:23 pm: I have also found the old symptoms, pre testing were often very very wrong

[Acroyear] 6:23 pm: I just got the sensor and the insulin pump on Friday

[Wendy] 6:23 pm: I am in the internet trial of BGAT, most of the work is recording every bg, food, dose, EVERYTHING (not the actual reading of the
chapter)

[reese] 6:23 pm: that will help you a lot acroyear testing helps a lot with the not knowing

[ms] 6:23 pm: Today I found that I could not tell between lows and being tired and a bit under the weather. Not a good situation to be in when you are in a situation where testing frequently is not optimal.

[Linda Gonder-Frederick] 6:23 pm: Acro – You are exactly the type of person who needs to use these sensors first, and test as often as you can stand it.

[Wendy12571] 6:23 pm: very true ms

[Acroyear] 6:24 pm: I will get better..I figure god doesn’t want me and the devil thinks I will take over, so I have to make the best of everyday here on this planet..lol

[ms] 6:24 pm: does someone review each persons input with the bgat?

[Acroyear] 6:24 pm: I will Linda

[reese] 6:24 pm: man I don’t log a thing hmmmm?????

[Linda Gonder-Frederick] 6:24 pm: ms – there is a lot of confusion between hypo symptoms and others…this is because a lot of the low symptoms are things folks (even without diabetes) feel all the time – tired, sweaty, fatigued, jittery, trembly, hot, hungry, etc.

[Wendy12571] 6:25 pm: I would never want to do that Wendy.,….I hate RECORDING

[ms] 6:25 pm: unfortunately I know … : )

[ms] 6:26 pm: I would not mind if I could get valuable feedback often

[Linda Gonder-Frederick] 6:26 pm: That’s why BGAT teaches people to pay more attention to other BG “cues” like insulin, food and physical activity. The program does involve recording these things to give people a better understanding of how they personally are affected…Everybody is different.

[reese] 6:27 pm: does it help at all with the always hungry syndrome πŸ˜‰

[Acroyear] 6:27 pm: The scary part is too..even on the odd time that you know your low (rare), I am actually scared to test..I don’t wanna see the numbers on the machine..I am scared of the machine and the numbers it shows..is there any way around this..or do I just try to actept it and do it just because I have to ??

[Linda Gonder-Frederick] 6:27 pm: We are still trying to figure out how to do the personal “feedback” piece on the internet system. Right now we have an email system set up so people can send us questions, issues, etc. There are a lot of complications – time and money are major…We think the personal feedback is important but there are issues…

[ms] 6:28 pm: reese, are you hungry when low?

[reese] 6:28 pm: yes ms

[reese] 6:28 pm: starving

[reese] 6:28 pm: but even on a low normal

[Linda Gonder-Frederick] 6:28 pm: Reese – I’m not sure the “always hungry” syndrome just applies to people with diabetes (haha). I also work with nondiabetic folks who have this…

[lemonthyme] 6:28 pm: Does anyone get hungry before getting low and then the hunger subsides when you are low?

[reese] 6:28 pm: I truly am

[Acroyear] 6:29 pm: yes

[reese] 6:29 pm: I have had it all lemon

[Acroyear] 6:29 pm: My only sign that I see is slurred speech

[ms] 6:29 pm: I get an always hungry syndrome more when I am on the higher side – I crave food – like a crazy cycle!!

[lemonthyme] 6:29 pm: So have I

[Linda Gonder-Frederick] 6:29 pm: We wrote a short article on hunger as a
symptom once. It does sometimes correlate with low BG but not all of the time…People can be hungry when their BG levels are above 300…Hunger is caused by lots of changes other than blood sugar levels.

[ms] 6:29 pm: and the cycle leads to me being more tired – sheesh

[Ellen] 6:30 pm: Someone needs to make a bgat video game for teens

[sixuntilme] 6:30 pm: I don’t often get hungry when I’m low.

[JoeC] 6:30 pm: Whenever my 5 year old says, “I’m hungry”, I check right away. That’s his signal, and he may be 105, but he gets a snack.

[Wendy12571] 6:30 pm: roflmao Ellen

[Linda Gonder-Frederick] 6:30 pm: People can feel hungry as a cue that they are low, but then get so low they don’t feel it anymore.

[sixuntilme] 6:30 pm: But crying? Yeah, I’ll do that when I’m low. Almost every time. πŸ™‚

[reese] 6:30 pm: would love not to be diabetic for a day to see what a normal person feels with hunger and if I could fight it any better

[ms] 6:30 pm: ellen, or… adults : )

[Acroyear] 6:30 pm: cheers to that one reese

[Linda Gonder-Frederick] 6:30 pm: A lot of people cry when they get low…That’s the brain not getting enough glucose…

[lemonthyme] 6:30 pm: Double Cheers reese

[reese] 6:31 pm: I get very emotional when low

[Wendy12571] 6:31 pm: I get overly silly when low

[Acroyear] 6:31 pm: Linda could that not also be part of the depression as
well..the crying..how does one know???

[Linda Gonder-Frederick] 6:31 pm: Reese – That’s really common, and something we try to make people (and their families) more aware of…People can’t help the emotional changes.

[lemonthyme] 6:31 pm: My parents used to say that they could tell I was low by looking at my eyes. I never understood what they meant by that.

[JoeC] 6:31 pm: “A lot of people cry when they get low..” &lt;– is that true for children, too?

[Linda Gonder-Frederick] 6:32 pm: Okay…catching up again. I’m glad I took typing in high school many years ago.

[Heidi] 6:32 pm: hunger is different when I’m low, its more survival instinct
then true hunger

[sixuntilme] 6:32 pm: My boyfriend says the same thing about my eyes – like I look lost. It’s his cue, so he says.

[sstrumello] 6:32 pm: Linda, can I ask what you are doing to get the word out about BGAT among diabetes educators (CDEs)? I was surprised and troubled that not one of my CDEs had even heard of it, to me, it seems like something they should at least hear about in their training to become certified.

[lemonthyme] 6:32 pm: JoeC- I would cry when I was a child.

[Acroyear] 6:32 pm: They say I am looking through people..not at them

[Linda Gonder-Frederick] 6:32 pm: Wow…these are such good comments. Some people get silly or giddy instead of sad or angry. Same thing – low glucose in the brain.

[Wendy12571] 6:33 pm: the eyes are a family sign here…
[reese] 6:33 pm: I read on another site that we should inform our coworkers of this happening so that they don’t think you are an emotional nut but I have never done that, but sometimes I know my reactions to a work situation was because I was low, grrrrrr

[Linda Gonder-Frederick] 6:33 pm: And the eyes are often a dead giveaway for others…a glassy look

[ms] 6:33 pm: I start talking more freely when low

[JoeC] 6:33 pm: what about math? I ask my son a math question. If he’s right, he’s not low.

[Acroyear] 6:33 pm: Linda could that not also be part of the depression as well..the crying..how does one know???

[Linda Gonder-Frederick] 6:34 pm: I did my dissertation on moods and BG because of an experience early in my career when a very nice person in one of our studies was low, and starting cursing me out! It was fascinating…And I wanted to know what was happening.

[Linda Gonder-Frederick] 6:34 pm: Acro – Good question. Thanks for asking again. Yes, you would have to sort out the negative moods caused by low BG and what is caused by depression.

[Acroyear] 6:35 pm: Isn’t that hard too do when the diabetes low sugar is making you feel so bad?

[Linda Gonder-Frederick] 6:35 pm: Joe – I just did a study where I had children do math problems on a PDA several times a day, then measure their BG levels. There was a significant drop in performance during lows…I’m reporting this at ADA next month, and hope to publish it soon.

[Ellen] 6:35 pm: So does blood sugar drop when women are in the delivery room cursing their husbands? :kiss:

[Acroyear] 6:35 pm: lmao

[Linda Gonder-Frederick] 6:36 pm: Acro – what you would have to do is “record” (sorry about that) your moods and BG levels, then see if there is a correlation.

[Wendy12571] 6:36 pm: roflmao Ellen

[Acroyear] 6:36 pm: ok

[Acroyear] 6:36 pm: I’ll try

[ms] 6:36 pm: linda, have you done any studies on the effects of high on performance? or moderately high bg readings on performance?

[Linda Gonder-Frederick] 6:37 pm: If you feel really bad whether your bg is high or low, then it is the depression.

[reese] 6:37 pm: my golf game suffers when dealing with lows, makes me so mad

[Linda Gonder-Frederick] 6:38 pm: ms – Yes! We just published a study this year…Highs do interfere with performance for about one half of folks…I’m analyzing data now to see if this happens in children. The “cognitive” effects of BG levels tend to be somewhat idiosyncratic, and we don’t know why yet…individuals vary in how vulnerable they are…

[ms] 6:38 pm: I would have been/would be a great study LOL
[Linda Gonder-Frederick] 6:39 pm: It might have something to do with what BG levels people are used to having…but it’s probably much more complicated than that.

[Wendy] 6:39 pm: well ellen, they need some excuse….

[lemonthyme] 6:39 pm: Linda, do you know of any studies of the after effects of lows? I get terrible headaches and sometimes call them my “low hangover”.

[Ellen] 6:39 pm: Those studies would be helpful for teachers to read when they think parents or the children are making excuses for inability to concentrate after highs or lows

[ms] 6:39 pm: I feel I am one of those who missed out due to varying bg over the years -and from the anxiety that came with anticipating lows and “working hard to fit in”

[lemonthyme] 6:39 pm: I agree Linda

[Linda Gonder-Frederick] 6:39 pm: Gotta get back to Ellen – I’ll bet bg does drop during labor…Talk about exercise! But for hubby, it’s probably the blood pressure going up!

[Acroyear] 6:41 pm: Lemon..are the paramedics giving you glucagon?? if so those headaches are like 500x a migraine..its a proven fact..too much sugar in a concentrated amount

[reese] 6:41 pm: well I gotta go do my two hour test, thank you linda and acroyear post on this message board how counseling helps you bye all tc πŸ™‚

[Linda Gonder-Frederick] 6:41 pm: Lemon – We don’t know much about the aftereffects at all – except that people feel just terrible and have lots of negative symptoms.

[Acroyear] 6:41 pm: thanks reese

[Linda Gonder-Frederick] 6:41 pm: Bye Reese.

[Heidi] 6:41 pm: I found that BGAT improved my ability to sense oncoming highs(my lows I already feel pretty good)

[sstrumello] 6:41 pm: Thanks for joining us reese, we’ll have the transcript up for you to review soon!

[lemonthyme] 6:41 pm: No glucagon- just “regular” lows

[Ellen] 6:41 pm: Just because the bg on the meter reads in target, doesn’t mean the person isn’t recovering from rapidly dropping bg or rapidly rising bg. For how long after a severe low does it take until a person can think clearly?

[lemonthyme] 6:42 pm: Good Question Ellen

[Linda Gonder-Frederick] 6:42 pm: Ellen – Good question. Some people seem to recover quickly and others don’t. Again, people are different. And it also depends on how low people go and how long they stay low (and how rapidly they fell).

[Linda Gonder-Frederick] 6:43 pm: Back to the school issue – I am very interested in finding out about these cognitive effects in children and one of the reasons is school performance…

[Linda Gonder-Frederick] 6:43 pm: Just read Heidi’s comment. Wish she was still here…She’s actually done BGAT!

[ms] 6:44 pm: linda, obviously you need to find you point of focus, but… wish that could extend to college age and adults

[Ellen] 6:44 pm: I know the highs take a long time for my son’s bg to come down to target – several hours – no idea how long he’s impaired. He’s never used it as an excuse in school but there were times he probably should have.

[Acroyear] 6:44 pm: heres a question..now how many of you here can perform and talk and function while severely low (ie 1.0mml/L canadian measurement)..because I am still walking and talking and making jokes this low

[lemonthyme] 6:44 pm: I had an experience in college when I nearly failed an exam (not my typical performance). The Professor asked what was wrong. I told him that I had had low blood sugar. He didn’t say anything else.

[Acroyear] 6:44 pm: while others are passed ot at 2.9 mmol/L

[Linda Gonder-Frederick] 6:45 pm: Symptoms for highs (especially only moderate highs) are much more subtle and come on slower than low symptoms…Ellen – I suspect there are a lot of children going through this and no one knows…

[ms] 6:45 pm: many times i can acroyear … like i said earlier, thats when i have some of my best conversations –

[Acroyear] 6:45 pm: lol me too

[sstrumello] 6:46 pm: Acroyear, I find my lows vary. Sometimes, I am fully cognizant at lows in the neighborhood of 35 mg/dL (1.94 mmol/L), other times I am not functional at much higher levels!

[Linda Gonder-Frederick] 6:46 pm: Acro – It’s probably because you are low so often and your brain has learned to adapt better than most people…But this isn’t necessarily a good thing! I’m hoping that you will be able to reduce the frequency…

[Acroyear] 6:46 pm: me too..and yes I have at least 1 a day currently

[Acroyear] 6:47 pm: thanks sstrumello

[Linda Gonder-Frederick] 6:47 pm: Acro – good observation. People can respond differently to the same BG level at different times and we don’t know why. This is why it is not good to assume that just because they could function fine at 40 last week, the same thing will happen again this week. They could be much more affected.

[Ellen] 6:48 pm: Doesn’t it have to do with the rate at which one is dropping too…not just the actual bg at one point in time?

[Linda Gonder-Frederick] 6:48 pm: Ellen – We THINK so (at least I do) but surprisingly enough research hasn’t been able to document this. But I think we just haven’t designed the right study yet.

[Linda Gonder-Frederick] 6:49 pm: Checking to see if I missed anybody…Let me know if you didn’t get a response.

[Ellen] 6:49 pm: What about mistaking children’s behavior as ADD or ADHD when in fact behaviors are really due to vacillating bg?

[captkirk] 6:49 pm: Linda I have learned after thousands of lows that my anxiety skyrockets when I am dropping fast.

[Acroyear] 6:50 pm: with that type of study..do you let the studied person live their life..ie do things they normally would..or do you impose a low on them which would really show how or why that person reacts the way that they would normally??

[Linda Gonder-Frederick] 6:50 pm: Yes, that could happen. I did a quick study a few years ago to see if more children in our diabetes clinic were diagnosed as ADD than the general population. Didn’t find it.

[Jon] 6:50 pm: Just a reminder, 10 minutes left so get your questions in everybody

[Linda Gonder-Frederick] 6:50 pm: Cap – Anxiety is one of the major symptoms of lows for a lot of people…Caused by the adrenalin your body is releasing…almost like a panic attack

[ms] 6:51 pm: how can one distinguish between the distraction and anxiety that come along with diabetes to that of ADD?

[Ellen] 6:51 pm: Do you do any of these studies in patients with type 2?

[Linda Gonder-Frederick] 6:51 pm: Acro – To do these studies in a “controlled” way, we bring people into the hospital and, yes, we make them low…and do all kinds of tests.

[captkirk] 6:52 pm: You got that right. You stated earlier that everyday can be different I have always said with D somedays 1+1=2 but other days 1+1=78. Always a moving target

[ms] 6:52 pm: or with adults?

[ms] 6:52 pm: with type one
[Linda Gonder-Frederick] 6:52 pm: To tell the difference between ADD and diabetes symptoms, you would have to do the same thing I told Acro about his depression…Keep a record of symptoms and BG levels and see if they correlate or not…

[Acroyear] 6:53 pm: I wpuld like to see a study done on a person who “lives the life” rather than in a controlled place..It would show more as to how and why in my opinion..there is just something missing in a controleld state..

[Linda Gonder-Frederick] 6:53 pm: We’ve done one study with type 2 folks – a “field study” not a hospital one…where they used a PDA and did cognitive tests then measured BG. Found the same things…Lows and highs can affect performance.
[Linda Gonder-Frederick] 6:53 pm: ACro – You are right. Science is so limited. But it’s pretty hard to follow people around all of the time, measuring everything…

[lemonthyme] 6:54 pm: Good night everyone!

[Acroyear] 6:54 pm: lol you should come over to me for a bit..you would get more data than you would know what to do with ..lol

[JoeC] 6:54 pm: Is the jury still out as to whether interstitial fluid or blood is the best when trying to determine lows? Sorry if this topic was already discussed.

[Linda Gonder-Frederick] 6:55 pm: Acro – You definitely sound like an interesting guinea pig who could teach us a lot

[Acroyear] 6:55 pm: lol and then some

[Acroyear] 6:55 pm: I am one of those “been there done that types”

[Acroyear] 6:56 pm: actually how does one find out about and get to partake in these studies?

[Linda Gonder-Frederick] 6:56 pm: Joe – Blood is the best but it requires an IV line. That’s why the folks use interstitial fluid instead…People will not want to walk around with an IV line all of the time.

[Ellen] 6:56 pm: Good night all…thank you Dr. G-F. You’ve been great.

[Acroyear] 6:56 pm: l8r ellen

[Linda Gonder-Frederick] 6:56 pm: Acro – Go on websites on major university’s pages. They often have advertisements for clinical trials and other types of studies. NIH has the same thing.

[Acroyear] 6:57 pm: k

[ms] 6:57 pm: Thank you for hosting tonight and for the valuable information.

[JoeC] 6:57 pm: Thank you.

[Acroyear] 6:58 pm: yes thanks very much..i has given me some things to take with me tomorrow to the Dr’s office

[Linda Gonder-Frederick] 6:58 pm: This was a real blast for me. You folks are absolutely great. Best questions I’ve had in a long time…

[Linda Gonder-Frederick] 6:58 pm: I’ll be happy to come back again some time.

[Jon] 6:58 pm: Dr. GF, do you have any contact information if anybody wants to get a hold of you?

[Linda Gonder-Frederick] 6:59 pm: Acro – Good luck with your appointment. If your doc doesn’t know about diabetes, educate him or her.

[sixuntilme] 6:59 pm: Thank you!

[Acroyear] 6:59 pm: oh i will..don’t worry πŸ˜‰

[Linda Gonder-Frederick] 6:59 pm: I’m on the University of Virginia website. Email is [email protected]

[Jon] 6:59 pm: Thanks for being here!

[Jon] 7:00 pm: Come back any time!

[Acroyear] 7:00 pm: thanks again..see you all next chat

[Linda Gonder-Frederick] 7:00 pm: Good night everyone. Hope this was helpful. I know I learned a lot from you.

[Jon] 7:01 pm: Thanks again Dr!

[Linda Gonder-Frederick] 7:02 pm: My pleasure…But my fingers are numb! Thanks for the opportunity.

[Jon] 7:02 pm: The transcript for this chat will be posted up for those who missed any part of it

[Linda Gonder-Frederick] 7:02 pm: Good night Jon and Cap – Take care.

[Jon] 7:03 pm: Good night!

[captkirk] 7:03 pm: Adios