Counselor’s Corner: I’m so afraid of the complications from hyperglycemia I let my blood sugars go too low.

Many people worry about possible complications that can result from years of high blood glucose levels. This is completely understandable, but some people become so worried they go to intense efforts to avoid having high blood glucose at all costs, and that can lead to terrible turmoil in one’s life.

People in this situation may become intolerant of any elevated blood glucose numbers and prefer to deal with frequent hypoglycemia instead. They may become more and more impatient with blood glucose response time after an insulin injection, and as a result take sequential boluses and “stack” their insulin doses.  They may develop “reduced hypoglycemic awareness” from frequent hypoglycemia and may not seem to find these episodes particularly painful, disturbing, or problematic– even when there are serious consequences, such as family/marital conflict, car accidents, and/or frequent paramedic visits. For these people, this is a terrible trap, since this way of managing their diabetes may seem like the only rational way to avoid complications. We refer to this problem as “hyperglycemia fear syndrome”. It is an extremely difficult and scary problem for everyone involved.

Hyperglycemia fear is characterized primarily as an intense fear of high blood glucose levels and people with this problem may state they would “rather be low than high”.  Many people with this problem strongly believe that any high blood glucose is causing permanent damage. Making progress requires a willingness to admit that this fear is causing more harm to their lives than an occasional high blood glucose, and a willingness to tolerate the fear enough to address problematic behaviors with the following solutions:

1) Not over-correcting highs with too much insulin, but instead  trusting the insulin dosing recommendation (such as with a bolus calculator).

2) Not stacking insulin doses but instead waiting at minimum two hours between boluses/injections.

3) Treating hypoglycemia appropriately by always treating when blood glucose is at an agreed upon number (from an endocrinologist, CDE or other healthcare provider) and with the correct amount of glucose. Below 70 definitely needs treatment, and for some people below 80 is an area of concern as well.

CGM can help with accountability, but sometimes gives too much information that may become anxiety provoking in certain individuals. Progress requires patience, and relapses in fear and resulting behaviors are common. Successful treatment often requires a team approach – a person with diabetes willing to give treatment a chance, together with a caring and patient endocrinologist, diabetes educator and mental health professional.

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