Breaking down the fear of lows. The fear isn’t the problem, it’s the cycle of fear.
I am unfortunately one of those people who experienced about 4-5 seizures as a kid. (Early 1990s). I have small memories of being in the ambulance, or waking up in the hospital. All were in the overnight hours before CGM, before insulin that had no “peak time.” Glucagon was used.
Despite those traumatic experiences (mostly for my family) I don’t have a strong fear of lows. Is a little of that fear always there, sure. I know I’m contradicting myself here, but I am genuinely thanking myself for the years without constant monitoring and access to the data. I am strong, confident, and very aware of my symptoms of low blood sugar. I know that I need to rely on my body awareness and nothing else to advocate and treat.
So much of our anxiety today is triggered by the information or the “dopamine” we have access to. If diabetes had a best friend, it would be anxiety, right? Fear of hypoglycemia is hands down the number one concern I see in my practice with patients-both parents and adults with T1D, and it is 100% normal.
Let’s break it down.
Anxiety needs two things….
- Certainty – craving the need for knowing what’s next and the constant desire to control it.
- Comfort – if I don’t feel safe or comfortable, I need to fix it and find an exit strategy.
Cute right? So aren’t we all basically set up to experience anxiety immediately following a diabetes diagnosis? Awesome!
Not knowing what both the short and long-term future holds, AND also getting updates every 5 minutes. Definitely anxious. oooy
So how on earth can we manage the anxiety if we know it exists and is here to hang out for a while?
What usually happens is this….
- We sense a trigger: arrow on the CGM
- We reduce safety behaviors, things like:
- keeping glucose high
- Over-treating lows
- Constantly checking the CGM.
***These make sense and feel safe short term- but they’re keeping the fear stuck!
How do we get UNstuck? How do we break the fear cycle?
Here are my top 5 ways to manage (not eliminate) your fear of blood sugar lows
- Exposure: allow blood sugar/alarms to sit slightly lower (safely with support).
- Build a support plan: glucose in car, spouse/friend “following” you. Get really good at sharing your fears with your close peeps or a therapist. The offloading of thoughts releases endorphins.
- Practice sitting in discomfort (safely). Use the wait-and-see approach. Not every arrow or notification = ACTION.
- Probability vs possibility. Know the actual facts/likelihood of a sever low happening!
- Self-compassion: reframe your negative thinking. “I should be able to handle this, I shouldn’t have given so much insulin at lunch.” Positive self-talk will lead you to resilience, confidence and self trust!
As always, here as your IDS therapist, reach out to schedule anytime.
**Listen to my conversation on the Think Like a Pancreas — The Podcast, with renowned diabetes psychologist Dr. Bill Polonsky, founder of the Behavioral Diabetes Institute, to learn about the anxiety that comes with type 1 diabetes and low blood sugars.
