Top tips for managing fears, anxiety and worry about hypos

Hypoglycaemia (or hypo for short) is one of the aspects of living with diabetes that can cause enormous worry and anxiety day to day, plus fears in general about its effects.  Hypos are a side effect of insulin or insulin-stimulating tablets, rather than being connected to diabetes itself, so the problem many people find is that making efforts to get their blood glucose levels in the recommended range makes hypos more likely, presenting a down side to managing diabetes successfully.  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 about being asleep potentially making you less aware of your symptoms and being able to take action.  For parents of children with diabetes, the thought of a hypo in the night that they don’t know about can be extremely frightening¹.

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

• 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 annoying or inconvenient!
• Don’t just worry, take action! Start a log of your hypos (Click here to download the My Hypo Log Book) and then, or if you already have one, take a look at it analytically? What situations are they happening in?  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 to try to avoid it?  If you can’t see a pattern or can’t think what to do, would it help to talk it through with someone else, perhaps others 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’.
• Write down, or type 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.
• Seek professional help. If your fear of hypos or worry about them is preoccupying you, you’re getting anxiety symptoms about them 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, for example cognitive behavioural therapy.  You may need some strategies to reduce your anxiety, which will help you cope. There is nothing wrong with seeking or accepting this help - in fact it’s something everyone with diabetes should be offered in an ideal world!²
• Share your feelings with your health professional: Can you share how you’re feeling about hypos with your HCP, ask specific questions about them or discuss ‘scare stories’ you’ve heard, at your next consultation? It may even be that a change in your blood glucose monitoring method or your insulin type, dose or delivery method will make a difference to the likelihood of hypos while still keeping your blood glucose ‘numbers’ in range.  New products are constantly being developed and the consultation is a great way to learn about these. See also
• Being tempted to run your Blood Glucose (BG) high? It’s common to be tempted to ‘run your BG a little high’ if you are doing something where you really want to avoid a hypo e.g. a job interview, work presentation, or first date for example³or overnight⁴. Whilst this is understandable occasionally, and one way of coping with your anxiety, if you find you are doing this more regularly, it may be concealing a fear of hypos that you can get help with. A professional can help you prepare a strategy of how you would manage if you were to have a hypo in this sort of situation, so you’re prepared in advance if a hypo were to happen. As mentioned earlier, preparation is a great tool that helps relieve anxiety.
• How can you find out more for yourself?  It might be that learning more about the physical causes and progression of hypos, and how to take precautions against severe ones, will help to allay your worries and fears⁵. The Internet can be a great resource for trusted information from national diabetes organisations, and there are also a wide range of other resources. We’ve listed some for you below

References:

1. Children with Diabetes. Poll 2014.  http://www.childrenwithdiabetes.com/poll/poll20140409.htm
2. NICE. Guidelines 17, 18 and 28 (Type 1, Type 1 and Type 2 in Children and Young People, Type 2 respectively) (2015). www.nice.org.uk
3. Nash, J. Diabetes and Wellbeing: managing the psychological and emotional challenges of Diabetes Types 1 and 2. Chapter 5. Managing Fear, Anxiety and Worry. 2013P.82-90.
4. Diabetes Research and Wellness Foundation (DRWF). Diabetes and the testing block. Diabetes Wellness News, November 2015. P.7.
5. Diabetes UK pages about hypos: https://www.diabetes.org.uk/Guide-to-diabetes/Complications/Hypos-Hypers/