7 Tips For Managing Fears, Anxiety And Worry About Hypoglycaemic Episodes

Hypoglycaemia (or hypo for short) is one of the aspects of living with diabetes that can cause enormous worry and anxiety day to day as well as general fears about its effects. Hypos are a side effect of insulin or insulin-stimulating tablets rather than being as a result of the diabetes itself. Many people find that trying to lower their blood glucose levels into the recommended range makes hypos more likely, presenting a challenge to successful diabetes management. Added to that, in the hustle and bustle of everyday life, hypos can make an unexpected appearance – at work, in the car, during a trip to the pub or theatre – and demand to be dealt with.

Night-times are a particular worry, specifically as being asleep potentially makes you less aware of your symptoms and able to take prompt action. For parents of children with diabetes, the thought of a silent hypo in the night can be extremely frightening¹.

Managing Your Anxiety

Here are some tips to cope with your concerns about hypos:

1. Remind yourself that it’s completely normal to be concerned about hypos and also to find them extremely annoying and inconvenient! Being aware of and naming your feelings about hypos can be very helpful in itself, as can letting off steam about them when they’ve been particularly bothersome!

2. Don’t just worry, take action! Keep a log of your hypos and then take a look at it analytically. In what situations do they happen? Are you able to make a change to any aspect of your routine or food, activity, or insulin next time you’re in those situations? If you can’t see a pattern or can’t think of what to do, would it help to talk it through with someone else living with diabetes, either online or in person? Learning relaxation techniques, e.g. deep breathing, mindfulness, or yoga could also help to cope ‘in the moment’.

3. Write down your fears and worries. Take each one and give it a ‘worry score’, e.g. 1 is low and 5 is very high. Take each one and consider how it’s affecting you and what needs to happen to reassure you or remove the worry.

4. Seek professional help. If your fear of hypos is preoccupying you, you’re getting anxiety symptoms, or you are starting to organise your life (or those of others, e.g. your child) around avoiding them, it’s time to seek professional help, such as cognitive behavioural therapy. You may need some strategies to reduce your anxiety to help you cope. There is nothing wrong with seeking or accepting this help - in fact, many national healthcare authorities advocate for awareness of the psychological impact of living with diabetes.^2,3

5. Share your feelings with your diabetes healthcare team. Can you share how you’re feeling about hypos, ask specific questions about them, or discuss ‘scare stories’ you’ve heard at your next consultation? A change to your blood glucose monitoring method or your insulin type, dose, or delivery method can possibly reduce your likelihood of hypos while still keeping your blood glucose ‘numbers’ in range, putting you at ease. New products are constantly being developed and your visits with your diabetes healthcare team are a great way to learn about these.

6. If you find you are frequently tempted to run your blood glucose high in an effort to avoid a hypo, it may be worth seeking professional counselling to help you work through this underlying anxiety and allow you to optimise your blood glucose management. Your diabetes healthcare team can also help you prepare a strategy of how you would manage if you were to have a hypo in various situations so you can be prepared in advance. Preparation is a great tool that helps relieve anxiety.

7. How can you find out more for yourself? Educating yourself about your actual degree of risk of a hypo, how to recognise one, and how to treat it will help to allay your worries and fears. It may also help for you to connect with others who can empathise with you.⁴ The Internet can be a great resource for trusted information from national diabetes organisations, and there are also a wide range of other resources.

Final Thoughts

It is entirely normal to feel some unease at the prospect of experiencing a hypo. However, there are tools, resources, and an abundance of support available if you feel this anxiety is beginning to overwhelm you. Never be afraid to reach out.

References:

1. Van Name MA, Hilliard ME, Boyle CT, et al. Night-time is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes. Pediatr Diabetes. 2018;19(1):114-120.
2. NICE. Type 1 diabetes in adults: diagnosis and management. www.nice.org.uk. 2020. Available at: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#aware ness-and-management-of-hypoglycaemia-2. (Accessed January 2022).
3. American Diabetes Association. Psychosocial Care for People With Diabetes: Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126-2140.
4. National Diabetes Services Scheme. Fear of hypoglycaemia fact sheet. https://www.ndss.com.au/. 2020. Available at: https://www.ndss.com.au/about-diabetes/resources/find-a-resource/fear-of-hypoglycaemia-fact-sheet. (Accessed January 2022).

*Editor’s note: This article has been adapted and reproduced from a post published on Medtronic Diabetes Australia.