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Fear of hypoglycaemia fact sheet

PDF coverThis fact sheet is available in two formats.

You can download and print out the PDF version.

Or you can read it as a website page below.

Hypoglycaemia or ‘hypo’ (low blood glucose) is a common challenge for people managing their diabetes with insulin or other glucose-lowering medications. People with diabetes often worry or become fearful about hypos. If you feel this way, you are not alone. There are many things you can do to prevent hypos and ease your fears.

 “There’s nothing worse than having that fear at the back of your head that you’re going to be in a meeting or something and pass out from not treating a hypo quick enough—it’s never happened, touch wood.”

Melissa, 31, person with diabetes

What is fear of hypoglycaemia?

Fear of hypos is a specific and intense feeling brought on by the risk and/or experiences of having low blood glucose.

It is common to worry about:

  • losing consciousness
  • having an accident or injuring yourself
  • having a hypo while asleep
  • being embarrassed or attracting unwanted attention
  • relying on others for help who may not fully understand diabetes
  • losing independence or the ability to drive
  • being judged by others
  • others not knowing how to help.

Having concerns about hypos is natural. This keeps you alert to the symptoms of low blood glucose, which enables you to treat a hypo quickly when it happens. However, fear of hypos becomes a serious problem when it starts to affect daily life or the way you manage your diabetes. For example, if you are:

  • reducing insulin or overeating to avoid having a hypo
  • checking blood glucose levels excessively
  • avoiding social activities for fear of embarrassment
  • avoiding being alone due to worries about safety.

If you think you are experiencing fear of hypoglycaemia, talk to your health professional. They will assess the problem and help you work out strategies for preventing hypos and overcoming your fears.

What you can do

Whether or not you fear hypos, it’s important to look after your emotional well-being.

Some of the following strategies may work for you; others may not, and that’s okay. They may give you ideas about other things you could try.

Be informed

Many hypos can be prevented. The first step is to educate yourself about your actual risk and how to prevent, recognise and treat hypos. If you get the right information and support, you will find that you feel more confident to manage your risk of hypos, treat them before they become severe and reduce your fears.

A good place to start is by talking to your diabetes health professional. If you are unsure about who to contact, call the NDSS Helpline on 1300 136 588 and they can direct you.

Take care when searching the internet for medical advice. Make sure you consult reliable sources (e.g., professional organisations).

Have a hypo plan

Having a plan for how to manage a hypo can help reduce any anxiety or fears you may have about the experience. Keep your ‘hypo kit’ with you at all times so you can treat a hypo promptly (see box Managing a hypo).

Make sure your family, friends and other people that you spend a lot of time with know what to do when you can’t treat a hypo yourself. If you live alone, consider asking someone (e.g., a friend or neighbour) to check on you regularly.

Managing a hypo

If you have hypo symptoms (eg shaking, sweating, light headedness) or a blood glucose level of less than 4mmol/l (even if you have no symptoms), follow these steps:

  1. Have 15 grams of glucose (equivalent to 150ml fruit juice OR 4 large jelly beans OR 7 small jelly beans).
  2. Wait 15 minutes and then re-check your blood glucose level.
  3. If your blood glucose level is still less than 4mmol/l, have another 15 grams of glucose.
  4. Consider the need for a longer-acting carbohydrate if your next meal is more than 20 minutes away.

Note: This is the current recommendation of the National Diabetes Services Scheme. For individualised advice, please talk with your diabetes health professional.

Ask questions

It’s okay if you don’t have all the answers about hypos or managing your fear of them. Sometimes, people find that writing a list of questions and concerns is a useful way of processing some of their feelings.

  • Bring this list to your next diabetes appointment so you don’t forget the questions or concerns you want to discuss with your health professional.
  • Remember, there are no silly questions or concernsthey are all valid. Your health professional will appreciate anything you mention, as it will help them to offer you the best possible support.

Be aware of your symptoms

People who are less aware of their hypo symptoms often fear hypos the most. This is because they don’t know when their hypos are coming on. This leaves them feeling out of control.

  • Keep a record of your symptoms throughout the day (e.g., how you were feeling physically and emotionally, how you reacted).
  • After a hypo, ask yourself, ‘What do I think caused this hypo?’ (e.g., what you were doing at the time, when you last ate, or injected insulin). No one knows your body better than you.
  • Notice patterns in the days and times you have hypos and think about how you can avoid similar hypos in the future.
  • Ask yourself, ‘What concerns me the most about having a hypo?’. You may not be fully aware of what you are fearing. Thinking it through and writing it down can provide you with a lot of insight.

Getting to know your hypo symptoms better can prepare you to take action to prevent low blood glucose. This can make you feel more in control and less fearful of the unknown. Your health professional can also help you develop a plan to reduce your hypos and fears.

If you don’t have symptoms or don’t recognise them quickly enough to avoid a hypo, talk to your health professional. You may have ‘impaired awareness of hypoglycaemia’, which they can help with.

“I understand so much more about it now and I know how to get myself out of a hypo and I know how to adjust if I’m too high with my sugars, mainly because I’ve done the DAFNE* program, I think.”

Dave, 62, person with type 1 diabetes

* DAFNE is a structured type 1 diabetes training program (see following information).

Get connected

Talking things through with others can be a big help. You might like to talk to your family or friends about how you feel and how they can support you.

It may also help to talk to others who understand what it is like to live with diabetes. It can be reassuring to know that other people face similar challenges and to share ideas about how to cope with them. Join a support group or an online communityread on to find out where you can access ‘peer support’.

Talk with a professional

The strategies above may give you some ideas about how to prevent hypos and reduce your fears, but they can’t replace professional help. It’s always a good idea to talk about your concerns with your health care team.

Who can help?

Your diabetes health professionals

Man talking to a psychologistYour diabetes health care team is there to help you with all aspects of your diabetes, including how you feel about hypos. Share your feelings with them if you feel comfortable to do sothey will give you non-judgemental support and advice. You may want to talk to your:

  • general practitioner (GP)
  • endocrinologist
  • diabetes educator
  • nurse practitioner
  • dietitian.

Take this fact sheet to your appointment to help get the conversation started. You will probably feel relieved after sharing your feelings, and it will help your health professional to understand how you are feeling.

Together, you can make plans to reduce your fears. For example, your health professional can help you to safely make some small changes to the way you manage your diabetes so it feels less scary.

  • You might like to attend a structured diabetes education session. Learning more about hypos and how to best manage your diabetes could make it easier to prevent and treat hypos. You may feel more confident with your skills and reduce your concerns.
  • There may be group education sessions in your area.
  • Ask your health professional or contact the diabetes organisation in your state/territory for more information.

A psychologist

You might also like to talk to a psychologist. They can help you find ways to cope with your fear of hypos.

Ask your diabetes health professional if they know a psychologist in your area who is familiar with diabetes.

You can also find a psychologist near you by visiting the Australian Psychological Society website at psychology.org.au

Your GP can tell you if you are eligible for a Mental Health Treatment Plan to reduce the costs of seeing a psychologist.

More information and support

Dose Adjustment For Normal Eating (DAFNE)

dafne.org.au

DAFNE is a five-day structured type 1 diabetes training program. People attend in small groups with others who have type 1 diabetes to learn more about managing the condition. Studies have proven that DAFNE can help people with problematic hypos. On average, rates of severe hypos are halved following DAFNE training. Courses are available in approximately 20 centres in most states/territories across Australia.

Peer support

ndss.com.au
(search for ‘Publications and Resources’)

To find out what peer support is and how you can access it in your area, refer to the National Diabetes Services Scheme (NDSS) leaflet, Peer support for diabetes.

Diabetes Australia and the NDSS

diabetesaustralia.com.au
ndss.com.au
NDSS Helpline 1300 136 588

Through the NDSS, you can access a free national NDSS Helpline to obtain information about diabetes and to learn about education programs, peer support groups and other events.

The NDSS and you

A wide range of services and support is available through the NDSS to help you manage your diabetes. This includes information on diabetes management through the NDSS Helpline and website. The products, services and education programs available can help you stay on top of your diabetes.

This fact sheet is intended as a guide only. It should not replace individual medical advice and if you have any concerns about your health or further questions, you should contact your health professional.

Version 2 December 2018. First published June 2016.