AAPB White Paper
Application of Biofeedback to Diabetes Mellitus in Baltimore, MD
Angele McGrady, Ph.D.

There are two major types of diabetes. Type I, insulin dependent diabetes (IDDM), accounts for approximately 20% of individuals with diabetes. In this type the pancreas makes little or no insulin and individuals require daily exogenous insulin injections to maintain control of blood glucose.In Type II, noninsulin dependent diabetes (NIDDM), the pancreas is producing insulin at reduced, normal or above normal levels but the tissues in the body have developed a resistance to insulin. Glucose is prevented from entering the cells and blood glucose levels increase. Oral medications are used to stimulate the pancreas and to decrease insulin resistance.NIDDM accounts for 80% of individuals diagnosed with diabetes.Heredity and obesity increase the chances of an individual developing NIDDM.

Besides using the hypoglycemic agents (insulin and sulfonylurea) individuals with diabetes must engage in health maintenance behaviors. Weight control, adequate nutrition, physical exercise and regular monitoring of blood glucose are critical components of self management.

Stressful life events and daily hassles cause blood glucose to increase, consequently increasing the requirements for insulin. During stress, cortisol is released from the adrenal cortex and sympathetic adrenal medullary activity increases, promoting high blood glucose levels and interfering with the actions of insulin. may omit their regular exercise, not pay attention to their diet, or fail to take the hypoglycemic medications.

Biofeedback is a technique by which persons learn to be aware of and control specific physiological processes. Biofeedback is usually coupled with relaxation training to reduce the arousal mediated by the nervous and endocrine systems. Since the effects of stress on blood glucose are clear, treatment directed to the reduction of the arousal response or to improve coping abilities can benefit individuals with diabetes. Thus, biofeedback has the potential to be an effective adjunct to hypoglycemic agents in individuals with IDDM and NIDDM.

A 12 to 15-session treatment plan comprised of diaphragmatic breathing, electromyograph and thermal biofeedback, autogenic and progressive relaxation is recommended. The treatment should be implemented gradually with knowledge of the individual's blood glucose values. Home practice of relaxation is recommended at times of the day when patients are unlikely to be experiencing hypoglycemia (low blood glucose). Multiple daily measurements of blood glucose for 2-3 weeks are necessary to establish an accurate pretreatment average. Regular monitoring of blood glucose should continue during treatment so that the individual's progress and any changes in blood glucose can be tracked. A clinical nurse specialist or diabetes educator is a valuable part of the treatment team since this individual has expertise in assessing the effects of diet, exercise, illness and other factors on blood glucose. Since blood glucose levels may fluctuate dramatically with exercise or illness, particularly if the individual's glucose values are usually erratic, surveillance of blood glucose by patients and staff must be maintained. Blood glucose numbers are expressed in mg/dl or mM/ 1 (milligrams per deciliter or millimoles per liter).

After treatment is completed, a two-week period of data collection is used to compare the average pretreatment values to posttreatment of daily blood glucose. Other valuable indices of progress are percent of blood glucose values above 200 mg/dl, percent of fasting blood glucose values at target (80-120 mg/dl) and dosage of the hypoglycemic agent. The patient's physician should be contacted for any changes in dosage or for any serious unresolved glycemic problems.

In summary, biofeedback and relaxation can be very effective in assisting individuals with diabetes to maintain better control over their blood glucose and to decrease the requirement for hypoglycemic agents. This treatment, however, cannot be used as a substitute for hypoglycemic agents and must be carried out in conjunction with regular self monitoring of blood glucose.

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