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Managing hypo anxiety

Lots of people with Type 1 diabetes are nervous about hypos and will do what they can to avoid them.

We've spoken to clinical psychologist Dr Jen Nash who's got some great advice to help overcome anxiety around hypos.

What is hypo anxiety?

Hypo anxiety is when you're worried your blood glucose level (also called blood sugar) will go too low, usually below 4mmol/l. This is called a hypo. But if you worry about hypos then please be reassured - you’re completely normal. Worrying about hypos is very common – one study found that 25% of people with diabetes reported that worrying about hypos is a serious problem for them.

Running your blood sugar levels higher for a long period of time in order to avoid hypos isn't the answer. This will increase your risk of developing complications in the future. 

But there are things you can do to manage the anxiety and plan for hypos.

Why are people nervous about hypos?

So why do many of us worry about hypos, particularly when, in most cases, they can be treated with relative speed and ease by consuming a sugary drink or snack? Well, easy as it can be to treat, the effects of a hypo can be frightening, embarrassing, uncomfortable, unpleasant, or in their worst cases, fatal. Getting sweaty, having slurred speech, shaking, feeling tearful, or acting 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.

It’s important to realise that this anxiety actually makes sense when we look at it from an evolutionary point of view. We are hard-wired to engage in actions that ensure our survival, and ‘survival’ can be defined broadly: we want to avoid things that will lead to possible rejection from others, and acting oddly whilst in the midst of a hypo is one example of such things.

Managing the anxiety

The good news is that fear of hypos can be managed, here are some strategies to help:

  • What are you worried about specifically? Is it the actual hypo feelings, or the impact of having one will have eg, worrying what others may think? 
  • Try writing or typing out your fears and worries, and look at each of them in turn (perhaps with the support of a trusted healthcare professional or friend). 
  • Make a plan of options that you could take if this feared situation were to happen. For example, if you’re worried about having a hypo in a work meeting, would you prefer to quietly excuse yourself from the meeting to treat it (others would probably assume you needed to use the bathroom) or would it be appropriate to take a sugary drink/carton of orange juice out of your bag to drink?
  • Often having a plan that’s thought through in advance can help. You may even want to ‘try out’ the plan on an occasion when you’re not having a hypo, to reassure you that it’s one that works in practice! 
  • It is really understandable to be tempted to run your blood glucose 'a bit high’ on occasions where a hypo would be particularly difficult to manage (for example, a big day at work, an interview, a first date or first day at college or training course, or to avoid night time hypos). Whilst doing this now and then is a way of managing your apprehension, do keep track of how often you are thinking this way. It is easy to let the anxiety dictate this is the best thing for you in the short term, when the long term consequences can be damaging. It’s a sign that you would benefit from some help in this area. Working with a helping professional who is trained in techniques to manage anxiety can help you prepare ahead of time, so you have a ‘toolbox’ of anxiety management techniques to support you. 

Is your hypo anxiety a bit more severe?

Don't continue to struggle on your own if your fear of hypos is taking up a lot of your thinking time, causing anxiety symptoms (e.g. racing heart, sweaty palms, lightheadedness) or you are starting to arrange your life around avoiding them.

Professional help (from a psychologist, counsellor or their equivalents), using therapeutic approaches such as cognitive behavioural therapy (CBT), can offer you helpful anxiety management strategies. 

There is no shame around needing this help - in an ideal world this kind of emotional support for living with the demands of diabetes would be offered to everyone with diabetes. 

Some techniques to try

Relaxation techniques, such as mindful breathing and deep muscle relaxation are great skills to equip yourself so you can have strategies to manage when you’re in the midst of a hypo. 

If you feel able to, do share how you’re feeling about hypos with a member of your diabetes team. If you’re not satisfied with the way they respond to your concerns or you don’t feel able to assert yourself, you may want to think about who else is involved in your care who you could talk to. Perhaps talk to other people with diabetes, perhaps on our online support forum or if the anxiety of hypos makes it difficult for you to talk about it, our helpline may be able to guide you as to how you can have these kind of discussions.  

Do what you can to find out all you can about hypos – their causes, and the steps you can take to protect yourself against severe ones. Knowledge is power, and worries and fears can greatly reduce in the face of it. Ensure you are accessing trusted information from national diabetes organisations, to ensure you are getting the most helpful advice. 

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