Hypoglycemia Worry and Anxiety

Up to 25% of people with diabetes are anxious about hypoglycemia
Up to 25% of people with diabetes are anxious about hypoglycemia

Many people with diabetes are anxious or worry a lot about hypoglycemia - in one study 25% of people with diabetes reported that anxiety about hypoglycemia is a serious problem for them.

Hypoglycemia is a frequent occurrence among many people with diabetes, with mild to moderate episodes (those that you can treat on your own) occurring about twice a week on average for the person with type 1.

Why do you worry about hypoglycemia?

So why do people worry about hypoglycemia, particularly when, in most cases, they can be treated with relative speed and ease by eating a sugary snack? Well, its often because the effects of a hypo can be frightening, embarrassing, uncomfortable, unpleasant and, in their worst cases, fatal.

Getting sweaty, having slurred speech, shaking uncontrollably or being confused may not seem too bad in the whole scheme of things, but having them occur in a job interview or important work meeting, whilst driving home at night or on a romantic date may not be so pleasant!
 
Having just one episode of hypoglycemia that was unpleasant can lead to increased anxiety of it happening again.

This can lead to other behaviours which may lead to further difficulties with managing diabetes:

  • Running blood sugars high to avoid hypoglycemia
  • Eating more than needed to keep blood glucose levels elevated
  • Restricting activities such as driving, exercising, travelling on public transport etc.

In addition to a particularly bad experience of hypoglycemia, there are three further factors that may contribute to excessive worry:

  • You may be experiencing a weakened ability to feel the warning signs of hypoglycemia
  • The warning signs of hypoglycemia, such as sweating and shaking occur because of the associated release of the body’s stress related hormones, epinephrine. However for some people with diabetes, their warning signs are less obvious, and so by the time they do notice the problem, their blood glucose level has dropped so low that taking reparative action becomes even harder. This is known as reduced hypo awareness.
  • You may not be able to distinguish the feelings  of hypoglycemia from the feelings of fear

Many symptoms of hypoglycemia, such as sweatiness or an increased heart rate are the same as signs you would experience if you were fearful. This may lead to a spiral of confusion:

  • You may notice your heart beating a little faster
  • You may think: “This could be hypoglycemia”.
  • This makes you nervous, so your heart therefore beats even faster.
  • Thinking, “Oh no, this is a symptom of hypoglycemia”
  • You feel even more nervous and reach for a snack to raise your blood sugar levels

When actually what you really were experiencing was nervousness!

You may find predicting or estimating your blood glucose level challenging

Everyone’s experience of hypoglycemia is unique, therefore although you have likely been taught to be alert for certain signs of hypoglycemia, your own response may be totally different - e.g. a particular taste in your mouth or an unusual feeling in your legs.

Top 5 strategies for helping you to overcome your difficulties with hypoglycemia

Tell your healthcare team

If you frequently experience low blood glucose levels, the first thing that may be needed is a change to your diabetes regime - medication type, the dosage, or the timing of medication and/or food. Your doctor will be able to help with this.

Also, if you are experiencing less warning signs than previously, there are ways of recovering these, through avoiding all hypos for as little as a few weeks. This needs careful planning to avoid the opposite problem of overly high blood glucose levels, but is very possible with guidance.

Immediately before checking your blood glucose, guess what the number will be

Increase your confidence in your hypoglycemia awareness by estimating what yours is before you actually test. Write down what your guess is, then test and write down the actual result. If you often guess incorrectly, then use the following strategies to help you.

Learn your unique ‘alarm bells’ that are your own warning signs of hypos

Everyone has their own individual ‘alarm bells’ that is their body’s way of telling you that you are low. Keep track of what you notice going on for you when you have a hypo (obviously best thought about after you have recovered from one!). Is it a physical symptom (heart racing, tingling in a certain part of your body, sweating, shaking, heart palpitations) or a change in your mood or in your ability to think clearly?

Find out what works best for treating your hypoglycemia

Experiment! Some people like to try chocolate, but because of the high fat content, it can be slow to raise blood glucose levels.

Fast acting sugars contained in glucose tablets and glucose drinks can act more quickly. There’s nothing worse than eating a snack and it not working so try a variety of foods and see what works best for you.

Once you’ve found what works best for you, always carry some of this with you. You may also want to try:

If you tend to think you are having reactions even when you are not, try a breathing exercise

If you think you may get yourself into the anxiety cycle described earlier, then a quick relaxation exercise can help control your panic so that you can discover whether or not you are experiencing hypoglycemia.

Try the following quick exercise:

  • Sit comfortably in a chair
  • Close your eyes
  • Take a slow, deep breath in so your lungs are full
  • Hold this breath for the count of 3 seconds
  • Breathe out as fully as possible for a count of 5 seconds
  • Repeat this sequence for two more breaths
  • Open your eyes and notice any subtle differences in how you feel, both in your body and your mind
  • With a bit of practice, over time you will be able to notice a feeling of relaxation
  • Once you feel comfortable with the technique, begin to practice this when you are having hypoglycemic symptoms that you are not sure whether or not are real
  • If they weaken it is likely it is a false alarm, but in the beginning always test your blood glucose level to see if you are correct
  • With frequent practice, over time you can expect the false alarms to occur less frequently

This is one of series of Psychology articles by Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.