Anticipating High and Low BGs with BGAT

Training program teaches inner detective skills

By Daniel TrecrociDaniel Trecroci

Several years ago, in an effort to teach people how to better recognize blood glucose symptoms, avoid highs and lows, and treat themselves accordingly, Daniel Cox, PhD, ABPP, came up with a concept called Blood Glucose Awareness Training (or, as it is more popularly know—"BGAT"). Cox, who is a professor in the Departments of Psychiatric Medicine and Internal Medicine and director of the Center for Behavioral Medicine Research at the University of Virginia Health System in Charlottesville, Virginia, developed BGAT along with colleagues.

Since then, it has developed a popularlity in teaching people how to better recognize blood glucose (BG) symptoms and keep them out of harm's way.

According to a 2006 article that appeared in Diabetes Spectrum (19:43-49), BGAT was defined as a "psychoeducational intervention" that, in part, addresses an individual's need to know where their blood glucose is in the daily juggling of taking insulin, eating food and exercising. Citing data from 15 studies from around the United States and Europe, Cox and his University of Virginia colleagues stated that "BGAT has been consistently demonstrated to improve the ability to detect and diminish both hypoglycemia and hyperglycemia" while reducing the episodes of severe hypoglycemia and driving mishaps that are the result of such episodes.

Paying Attention to Internal Cues

dLife recently interviewed Dr. Cox about BGAT. Cox states that BGAT is a "systematic program" that teaches individuals with type 1 diabetes how to be more attentive to a variety of internal cues," such as physical symptoms, disruptions in cognitive and motor function, and shift in mood that might relate to extreme BGs.

"Then BGAT teaches individuals how to discriminate whether these internal cues signal high or low BG for them personally," says Cox. "This requires participants to fill out daily diaries each time they measure their BG, at which time they record any internal cues, estimate their BG and then measure their BG to determine how accurate their estimate was."

In addition, BGAT teaches individuals about their insulin kinetic, their carbohydrate utilization and the effects of physical exertion on their BG in order to anticipate when their BG might go high or low, and when to look for symptoms of high or low BG.

"This training enables individuals to avoid some extreme BGs and to better recognize when extreme BGs are occurring. As a result, BGAT leads to fewer episodes of severe hypoglycemia and diabetic ketoacidosis [while improving] quality of life and [causing] less fear of hypoglycemia."

A Skill That Can Be Developed

BGAT espouses the belief that hypo- and hyperglycemia symptom perception is a skill that can be developed. However, if a person does not recognize his or her individual signs of hypo- or hyperglycemia awareness, how can something like that be taught?

Cox states that extreme BGs can frequently be anticipated when considering insulin that is injected, food that is eaten and exercise that is performed, allowing individuals to know when to look for symptoms of high BG.

"No one recognizes all of their high or low BGs, and everyone has some symptoms of high and low BG much of the time," states Cox. "The trick is to better recognize those symptoms and occurrences of extreme BG. The goal is to improve detection of extreme BG from, say, 40 percent of the time to 70 percent of the time."

Not a Replacement for Frequent Testing

Cox emphasizes that BGAT cannot replace frequent measurement. In fact, BGAT requires that an individual measure his or her BG in order to get feedback of their BG estimates.

"Whenever a person feels low or high, they should always measure their BG," he says. "But we cannot measure our BG all of the time, sometimes because it is not convenient or possible," says Cox. "In these cases, people have to rely on their estimates. Additionally, measurements of BG only tell you where BG is, not where it is going. BGAT can help individuals better anticipate where BG is going."

Who is Most Likely to Benefit From BGAT Training?

Cox says that many people benefit from BGAT. These individuals include:

  • Individuals who have recurrent, severe hypoglycemia or hypoglycemia-related negative consequences like car accidents
  • Individuals who are initiating intensive insulin therapy
  • Individuals who have significant fear of either hypo- or hyperglycemia, or
  • Individuals who suffer from hypoglycemia unawareness

How can people learn about BGAT?

BGAT is now available as an interventional tool for clinicians to use with their patients and for individuals with type 1 to pursue as a self-directed tutorial. " is an interactive personalized Internet program that can either be done in a self-paced manner or done within a class format directed by a diabetes educator."

Read Daniel Trecroci's bio.

Read more of Daniel Trecroci's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.


Last Modified Date: May 29, 2013

All content on is created and reviewed in compliance with our editorial policy.

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