The Link Between Hypoglycemia and Anxiety

Hypoglycemia is the medical term used to refer to low blood sugar levels in the blood. It is a common condition in people with diabetes. People with diabetes usually tend to worry about their blood sugar levels falling, but some people end up developing severe anxiety issues about having these hypoglycemic episodes. In fact, the fear of having hypoglycemia can become so intense that it often starts to interfere with their day to day life and affects their relationships, work or school, and even their family life. The fear can also begin to interfere with their ability to take care of themselves and manage their diabetes. This excessive worry about hypoglycemia is a type of anxiety disorder, but there are many ways to handle such anxiety that stems from hypoglycemia concerns. Here is everything you need to know about hypoglycemia and anxiety – the connection, symptoms, and more.

What is Hypoglycemia?

When you have diabetes, you are likely to be taking some form of diabetes medications, including insulin or medicines, to increase the insulin levels in the body.(1,2,3)

When you are on such medications, it is likely that your blood sugar levels will go down. In any case, decreasing the blood sugar levels after having a meal is important in treating diabetes. However, sometimes, blood sugar levels can fall too low. Low blood glucose or blood sugar levels are medically referred to as hypoglycemia.(4,5) Blood sugar levels are considered to be low when it falls below 70 mg/dL. If you have diabetes, your doctor is likely to recommend that you check your blood sugar levels regularly throughout the day, especially if you skip a meal or exercise.

Hypoglycemia needs immediate treatment to prevent any severe complications from developing. Some of the common symptoms of hypoglycemia include:

If left untreated, hypoglycemia may cause more serious symptoms, such as:

To prevent hypoglycemia, or if you already have low blood sugar, you will need to consume a small snack that has at least 15 to 20 grams of carbohydrates. Best examples include:

  • Juice
  • Hard candy
  • Dried fruit
  • In severe cases of hypoglycemia, you may need to be hospitalized for medical intervention.
  • Anxiety and its Symptoms

All of us have experienced anxiety at some point in our lives. Anxiety is described as a feeling of distress, uneasiness, or dread in response to an unfamiliar, dangerous, or stressful situation.(6) Feeling anxious before any important event in your life or when you feel unsafe is a normal response of the body.(7)

However, anxiety that is excessive, unmanageable, and continues till it begins to interfere with your daily life or occurs for an extended period of time is known as an anxiety disorder, and it may need to be treated medically.

There are several types of anxiety disorders, including:(8)

Anxiety symptoms tend to vary from person to person and can include both emotional as well as physical symptoms. These may include:

Connection Between Diabetes and Anxiety

It is essential to balance your food intake with your diabetes medications to keep your blood sugar levels under control. Not maintaining this balance can cause a variety of problems, including hypoglycemia. Hypoglycemia, as mentioned earlier, comes with a variety of uncomfortable and unpleasant symptoms, which can turn out to be severe enough to need medical intervention.

Once you have had a hypoglycemic episode, it is natural to start worrying about the possibility of having more such attacks. While some people are capable of managing such type of worry, for others, this fear and worry of having future episodes tend to become intense, and many times, they are unable to handle this anxiety.

This condition is actually known as a fear of hypoglycemia (FOH). It is similar to any other type of phobia people may have, including a fear of snakes or water.(9,10)

In people with severe fear of hypoglycemia, they tend to become overly cautious or even hyperaware about monitoring their blood sugar levels. In some cases, people with a fear of hypoglycemia may also try to maintain their blood sugar levels above the recommended levels and continue worrying about these levels round the clock till the time it becomes an obsession.

Studies have shown that there is a strong link between having diabetes and anxiety.(11) A study carried out in 2008 found that clinically diagnosed anxiety was 20 percent greater in Americans with diabetes as compared to Americans who did not have diabetes.(12)

A diagnosis of diabetes is bound to cause some anxiety. It is natural to worry about how the disease will require you to make certain, perhaps undesirable, changes to your lifestyle or that you now have lesser control over your health.

Additionally, following a strict schedule of medication, dietary changes, exercising routines, blood glucose monitoring, and possible smoking cessation are also some of the factors that are a common part of diabetes treatment that can make a person feel anxious.

How to Manage Anxiety with Diabetes?

There are many tried and tested treatment options for anxiety due to fear of hypoglycemia. If anxiety about having a hypoglycemia episode has started to affect your day to day life, you can discuss about the following treatment options with your doctor.

Psychological Counseling

Your doctor may recommend you to a professional mental health professional for help. A psychologist or psychiatrist can help make a proper diagnosis and provide the treatment you need. This can include cognitive-behavioral therapy and medications.(13)

An approach known as graduated exposure therapy has shown to be useful in helping confront fears related to hypoglycemia and diabetes in general. It has shown to be effective in managing patients’ anxiety. Exposure therapy gradually keeps exposing you to specific situations that you fear but in a safe environment.(14) For example, if you have been obsessive about monitoring your blood sugar levels, your therapist may suggest that you delay checking your blood sugar levels by one minute, to begin with. You would then gradually start increasing this delay to 10 minutes and more as you get comfortable dealing with your anxiety.

Getting Educated About the Hypoglycemic Risk

The better you understand the risk of hypoglycemia and the ways in which you can take care and better prepare for a potential episode, the easier it becomes to manage your anxiety and fears. Discussing with your doctor will help you assess your overall risk, and together with your doctor, you can develop a plan that enables you to prepare in case you have a hypoglycemic episode.

Many people like to purchase a glucagon kit in case of any emergency.(15) You can discuss this option with your doctor first. You can also teach your family members and friends about how to use the kit in case of severe low blood glucose levels. Knowing that there are others who can help you in an emergency often helps reduce anxiety related to hypoglycemia.

Undertaking Blood Glucose Awareness Training

Blood Glucose Awareness Training (BGAT) is a procedure designed to help people with diabetes manage their condition better by helping them understand how dietary choices, insulin, and physical activity can affect their blood sugar levels. This type of training helps you feel more in control of your blood sugar and your overall health. In turn, this can ease the anxiety related to hypoglycemic episodes.(16)

Conclusion

If you have diabetes, worrying about the possibility of having a hypoglycemic episode is normal. Experiencing a hypoglycemic episode can be frightening, which is why the fear of experiencing future episodes can make people anxious. However, if this fear starts to affect your day to day life and also impairs your ability to manage your diabetes, then you might be having an anxiety disorder known as a fear of hypoglycemia. Talking to your doctor can help you understand how to deal with your anxiety. They will be able to provide you with the required knowledge about how to manage your blood sugar levels to avoid having an episode of hypoglycemia.

References:

  1. Cryer, P.E., Davis, S.N. and Shamoon, H., 2003. Hypoglycemia in diabetes. Diabetes care, 26(6), pp.1902-1912.
  2. Boyle, P.J. and Zrebiec, J., 2007. Management of diabetes-related hypoglycemia. Southern medical journal, 100(2), pp.183-195.
  3. Anderson Jr, J.H., Blackard, W.G., Goldman, J. and Rubenstein, A.H., 1978. Diabetes and hypoglycemia due to insulin antibodies. The American Journal of Medicine, 64(5), pp.868-873.
  4. Cryer, P.E., 2008. The barrier of hypoglycemia in diabetes. Diabetes, 57(12), pp.3169-3176.
  5. Desouza, C.V., Bolli, G.B. and Fonseca, V., 2010. Hypoglycemia, diabetes, and cardiovascular events. Diabetes care, 33(6), pp.1389-1394.
  6. Beck, A.T., Emery, G. and Greenberg, R.L., 2005. Anxiety disorders and phobias: A cognitive perspective. Basic Books.
  7. Zung, W.W., 1971. A rating instrument for anxiety disorders. Psychosomatics: Journal of Consultation and Liaison Psychiatry.
  8. Craske, M.G., 1999. Anxiety disorders: psychological approaches to theory and treatment. Westview Press.
  9. Cox, D.J., Irvine, A., Gonder-Frederick, L., Nowacek, G. and Butterfield, J., 1987. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes care, 10(5), pp.617-621.
  10. Fidler, C., Elmelund Christensen, T. and Gillard, S., 2011. Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. Journal of medical economics, 14(5), pp.646-655.
  11. Smith, K.J., Béland, M., Clyde, M., Gariépy, G., Pagé, V., Badawi, G., Rabasa-Lhoret, R. and Schmitz, N., 2013. Association of diabetes with anxiety: a systematic review and meta-analysis. Journal of psychosomatic research, 74(2), pp.89-99.
  12. Li, C., Barker, L., Ford, E.S., Zhang, X., Strine, T.W. and Mokdad, A.H., 2008. Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System. Diabetic Medicine, 25(7), pp.878-881.
  13. Wild, D., von Maltzahn, R., Brohan, E., Christensen, T., Clauson, P. and Gonder-Frederick, L., 2007. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient education and counseling, 68(1), pp.10-15.
  14. O’Donnell, H.K., Berget, C., Wooldridge, J.S. and Driscoll, K.A., 2019. Graduated exposure to treat fear of hypoglycemia in a young adult with type 1 diabetes: A case study. Pediatric Diabetes, 20(1), pp.113-118.
  15. Kedia, N., 2011. Treatment of severe diabetic hypoglycemia with glucagon: an underutilized therapeutic approach. Diabetes, metabolic syndrome and obesity: targets and therapy, 4, p.337.
  16. Cox, D.J., Gonder-Frederick, L., Polonsky, W., Schlundt, D., Kovatchev, B. and Clarke, W., 2001. Blood glucose awareness training (BGAT-2): long-term benefits. Diabetes care, 24(4), pp.637-642.