Hands On Webinar | Fear of Hypoglycemia – Is It So Bad? | Recording-Fear of Hypoglycemia

Video Transcription

Video Summary

This webinar discusses fear of hypoglycemia (FOH) in people with diabetes—its prevalence, psychological impact, and management strategies—featuring experts Dr. Mark Heyman, a diabetes psychologist, and Dr. Alex Lin, a clinical endocrinologist. FOH is a specific and intense fear of low blood sugar, often leading to maladaptive behaviors such as intentionally running blood sugars high, skipping insulin doses, defensive snacking, activity avoidance, and obsessive glucose monitoring. While some anxiety about hypoglycemia is functional and protective, excessive fear impairs quality of life and diabetes management, sometimes resulting in higher A1C and complications.<br /><br />FOH affects about one in seven people with diabetes, and up to 30% of people with type 1 experience clinically significant FOH. It varies among individuals; some have high fear despite low risk, others low fear despite high risk. New diabetes technologies like continuous glucose monitors (CGM) and automated insulin delivery can reduce hypoglycemia incidence but may also increase anxiety due to constant data exposure and perceived lack of control.<br /><br />Assessment in clinical settings involves open conversations, use of tools like the Hypoglycemia Fear Survey, and recognizing signs such as persistent hyperglycemia or reluctance to take insulin. Interventions include patient education about hypoglycemia, cognitive restructuring to change unhelpful beliefs, distress tolerance skills, exposure therapy, and referrals to mental health professionals when necessary. Collaboration between primary care, endocrinology, diabetes educators, and mental health providers is essential.<br /><br />Importantly, fear is not necessary to prevent hypoglycemia; appropriate concern and knowledge suffice. Even with modern technology, hypoglycemia remains a challenge, highlighting the role of behavior and attitudes. Technology use should be tailored and boundaries set to reduce anxiety without losing its benefits. SSRIs may help when behavioral approaches alone are insufficient. Overall, addressing FOH can improve both diabetes management and quality of life.

Keywords

fear of hypoglycemia

FOH

diabetes management

hypoglycemia anxiety

continuous glucose monitors

automated insulin delivery

hypoglycemia fear survey

cognitive restructuring

diabetes education

mental health interventions