Dear Counselor’s Corner,
I’m so afraid of severe hypoglycemia, I let my blood sugars run high. How can I get over this fear?
If you are taking insulin and working to keep your blood sugar close to your target range, you are probably going to have low blood sugars sometimes. Low blood sugar can be scary and some people who have a fear of low blood sugar keep their blood sugar high in order to avoid lows. Fear of low blood sugar can also cause people to avoid activities that they think may make their blood sugar go low, like exercise, or where they think that treating a low could be challenging, like driving. Fear of lows can not only keep people’s blood sugar high, making them not feel well and putting them at higher risk for diabetes-related complications, but it can also have an impact on a person’s quality of life. Fear of hypoglycemia can also affect your relationships with others…including your spouse or partner.
People who have a fear hypoglycemia generally fall into a couple of different categories: people who have a fear of hypoglycemia because they have had a severe low in the past, and people who have never had a severe low, but worry that they might.
If you have ever had a severe low, then it makes sense that you would have anxiety about having another one. The first thing I would suggest is to look and see if there is a reason why this low happened. Did you take insulin when you started eating dinner and then got distracted and didn’t finish all your food? Or did you go for a long run that day and forgot to set a temp basal on your pump? Trying to understand why something happened, based on facts, can help you in a couple of ways. First, it can help you not do the same thing again. And second, it can help you put your fear in context. Fears tend to generalize, and if you can’t identify which situations are safe, and which are not, everything becomes dangerous and scary.
If you have a fear of low blood sugar, but have never had a severe low, you may keep your blood sugar high because you are worried that you won’t be able to treat a low blood sugar if you do have one, either because you won’t have enough low supplies or you won’t be able to think straight. In this situation, try bringing your blood sugar down a little bit at a time to show yourself that you can do it. For example, if you are anxious to have a blood sugar below 200mg/dl, try bringing it down to 180mg/dl before treating. A couple days later, bring it down to 160mg/dl. And eventually, bring it down, and keep your blood sugar in your target range. This will help you see that you can handle lower blood sugars and give you confidence that you can treat them. And eventually when you go low, you’ll be able to pop some glucose tabs and see you’ll come right back up without thinking twice.
If you have a fear of lows that’s really affecting your life, and that you’re having trouble dealing with on your own, you may want to seek treatment from a mental health provider with expertise in diabetes.