Significant Impact of Hypos on Daily Life
It is our experience here at Diabetes Insight that fear of hypoglycemia is singly the most important limiting factor in managing type 1 diabetes and that identifying the fear of hypoglycemia among people with diabetes may be of the greatest importance on the road to effective diabetes management.
On average, people with type 1 diabetes experience two symptomatic episodes of mild or moderate hypoglycaemia per week, and one or more episodes of severe hypoglycaemia (where the person with diabetes needs external assistance to recover from the hypoglycaemic episode) per year.
With progressive insulin deficiency, incidence rates of severe hypoglycaemia in people with type 2 diabetes are similar to those of type 1 diabetes patients. Therefore hypoglycaemia has a significant impact on how people with diabetes go about their daily lives.
Hypoglycaemia Avoidance Behavior
The associated risks of long-term complications may be overshadowed by short-term goals to avoid hypoglycaemia. This “hypoglycaemia avoidance behavior” may lead to poorer glycaemic control increasing the risk of long-term complications.
Quantitative scales have been developed, such as the Fear of Hypoglycemia Scale, to assess the psychological impact of diabetes. At Diabetes Insight we use such scales to help determine what are the specific issues that are leading to fear of hypoglycaemia and how this can be addressed. Difficulty in adhering to the complex and demanding self-care described above seems intuitively to be a major reason why many adults with type 1 diabetes fall short of reaching their goal for glycemic control.
The Science Behind Fear
Fear and anxiety are central in some of the avoidance behavior related to self-care in diabetes, for example fear of hypoglycemia. Fear is an innate response to a threat, i.e. a response that does not need to be learned. The purpose of the response is to prepare the person for fight or flight in order to increase chances of survival. With fear comes an impulse to escape and avoid, appropriate responses increasing the chance of survival when a threat actually exists. Fear is easily conditioned so that the fear response can be elicited in the presence of non-dangerous stimuli associated with the actual threat, for instance, fear as a response to the thought of hypoglycemia or the sight of a place where one has experienced hypoglycemia. A distinction sometimes made between fear and anxiety is that fear is a response to a dangerous stimulus being present, whereas anxiety is a fear response without the presence of a dangerous stimulus.
A problem with anxiety or phobic fear is that when the fear response is elicited, escape is the primary focus of our attention instead of evaluation of the real danger. Once frightened, we tend to avoid not only the specific fear stimulus but also conditioned stimuli. This avoidance of non-dangerous stimuli prevents the individual from experiencing and thus learning that the stimuli are not dangerous, creating a vicious circle in which anxiety may spread to other situations which limits the individual from taking part in certain activities.
At Diabetes Insight we look at your current self-management, and look at ways as to how to overcome the challenges, change what is not working and effectively problem solve. For many people this involves a shift of attitudes and perceptions that has been ingrained for years, often not from themselves, but by outside external influences. For many people, changing perceptions can often be an uncomfortable but liberating process. The realization that there are alternatives, that there is a different way of dealing with matters at hand, can give control back to the person, rather than the diabetes.