Hello!

This is my first post here, so I'm not sure if I'm breaking any of the etiquette rules or anything ;)

I've been a T1D for 14 years, and for a long time I was in a state of denial about my health. I pretty much just did the bare minimum to stay alive through my college years a few thereafter. Anyways, the past few months I've decided to regain control of my life and my diabetes. That being said, I'm experiencing lows once again since I'm managing my levels and insulin intake far better now but am still working out the kinks.

My question is: I have a (somewhat) irrational fear of lows. The panic that sets in during one is unbearable for me (and everyone else I'm sure), but it creates such fear in me, that I intentionally run high so that I don't experience them, which has already caused long-term complications in my body from this strategy. I live alone, and the only person that is involved in my life in any way is my boss (cause I work for him), so if something were to happen to me, it'd be several days before I was found (since he works part-time), and I fear it'd be too late by that point. How do I get over my fear of lows?

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Jack - Been there, done that! Yup I was the same in my 20s didn't really test that much and would have some crazy lows. Ok so first off the panic - make sure you always have something with you. I have always been able to tell they are coming on. My symptoms - which might be different from yours - were first hunger, then dizzy, not thinking clearly, feeling sleepy or weak. Anyway once you know the first symptom you can treat it before it goes too far.
BUT the better way is to not even get to the first symtom - to test and catch it before it happens is the best way to combat it. PLUS then you won't get the low and that fear will go away.
I lived alone for a bit when I was in my 20s, I get that if something happens no one will know for a while. The way to combat that is 1. get a roommate, 2. get a diabetic dog that senses when you are low, 3. have a friend or family member call you every 3 days to check in.
As for your fear of lows you need to know that under 4mmol is a low - living between 7-4mmol is ideal and you should not be constantly high just because you don't want to have a low. They will happen but if you test you can catch them early. I test 6 to 10 times a day. I test if I'm tired, hungry, have a head ache, don't feel right, and before every meal. Test and you will know if you are getting low. It's the only answer. Even if you have a CGM (Continuous Glucose Monitoring) I think that's what it means - you still need to know what is going on with your blood sugars. Lows are scary for sure but you can treat them early and not get low. :)

I've had roommates in the past, but I started devleoping extreme social anxiety during my college years and it has gotten worse ever year since, and my ability to seek out a roommate or have anyone close to me has greatly decreased. The only person I ever talk to or see is my employer, who is great, but he obviously has enough on his plate.

I've thought about getting a a dog. For selfish reason though (just cause I want one), but the cost of them put a halt to that real quick (insurance will not cover it). Maybe I should just start saving up :)

Maybe if you just got a gentle, attentive dog from the animal shelter, she would reassure you on a deep, primal level? I find dogs very comforting, especially a dog you know and love well. When I had my doggie, Rosa, if I was sad or worried, she'd come over and put her head on my knee and look up into my eyes with this very adorable concerned nurse look on her face. It was like she could speak and was saying, "Hey now, are you OK?"

I think even a dog who is not a trained diabetes assistant dog might be able to signal us when our diabetes needs attention just because they're so tuned in to us and ready to give us a woof, a knee-pawing, a whine or a very concerned once-over when we're not well or something is just not right.

Jack, I think perhaps you need to look at your anxiety as well as your diabetes. Have you tried to receive help on this issue? I get that some people don't like to have lots of people in their life but you need at least a friend or two - not just your employer. I think this issues needs to take precedence. Yes a pet is lovely but they can be expensive. I'm glad that you came on here to ask questions and I hope you aren't offended by my concern and suggestions. If something is getting worse over time it's only going to continue. I think you need to get some help on that issue. Please do. Hugs!

I am curious as to what you call "intentionally running high?" What numbers?

I am deathly afraid of hypos myself. I basically just stopped taking my fast acting because of it, and ended up gaining a lot of weight. (Around 30 lbs in 1 year!)

Now, I am slowly getting over my fear, and trying to keep the control as tight as possible. I don't fall in the high or low carb camp - both have not really worked for me. What I do is try and keep the meals I eat as a mainline so I can use the right amount of insulin.

I was recently put on Metformin to combat my insulin resistance (I am a LADA - but managed to muck up my IR over the last year..) That's one thing to look into - as it also curbs appetite - if you can stand the original side effects.

Once you have what you eat for breakfast/lunch/dinner standardized at first, you then can start to play a bit ewith the foods, adding in what you want and testing with the meter.

The reason I say this (and sorry if it seems like a lesson you don't need - I KNOW you've done this for 14 years already...) is because once you can prove to yourself that you are "okay" at the baseline foods - not going low, or even in a "normal" range, then you can gain the confidence to experiment a bit.

If you are all over the place with your injections, there is more room for error, and more room for highs/lows. (Especially when you are trying to figure what pizza+cake+salad would be for a bolus verses the night before when you had hamburger+salad+soup)

I actually went on the diabetic exchange diet to get back to a baseline. Once I get my stuff under control (and get over my fear of hypos,) then I will start experimenting with low carb again.

I hope my rambling has made a little bit of sense for you...

ALWAYS be afraid of this. It is a survival mechnanism. But do not let it control you or it will be too much.. CGM is a great start...

I am completely opposite of your fear, I may have smidge of fear in the back of my head but only when I am out of my routine (camping, traveling, staying with family overnight). I have had some pretty bad lows, and I am suprised I haven't passed out because of them but I always tell myself to stay calm even in those situations. The times I have felt like I was going to pass out were times I was already sick and having a very low BG, both times I sat down on the ground for a moment (luckily I was in front of a fridge both times) calmed myself down and I was able to help myself but both of those instances were rare occurences, I have had D for 20 years. I also always have glucose on my person and in my car. I think if you have those back up measures, it allows you to stay calmer.

I agree that having a pump and CGM also adds to the piece of mind that you are searching for. At least the CGM is something you can start right away if you are not certain you would like a pump. Good luck!

Experience is an EVIL teacher.

The problem with "tight" control is by definition it causes lows... the DCCT was painfully clear on that fact as well. Rarely mentioned, or even acknowledged by most white coats... and was blatantly and quite bluntly stated in the report itself.

Stop "fearing" them, and I offer we risk walking into the "tigers cage" and start slapping the tiger around (sic. stupidly). Not a bright idea, right? Zero wrong with your approach. Respecting lows is wisdom... if our fear stops us from living the life we wish to live, then action is required.

How high are we talking as being your "normal cruising altitude"?

Jack, I can so relate to your living situation. I also live alone (not even a pet) and I'm not working so the only person who expects to see me each week is my guitar teacher, and I go to him. I used to have friends over all the time, but after an assault and some other incidents, I've become socially phobic (although I've been working on doing better and may have a regular visitor here soon to work on guitar duets with me.)

Social anxiety and the fear of lows all go back to the same thing, oddly enough: those darn fight-or-flight hormones. When we go too low or drop too fast, our bodies dump out adrenal hormones -- the same hormones our bodies dump out when we are being chased by a bear or a tiger. The good thing is that these adrenal hormones cause our liver to dump out glucose which raises our blood sugar. The bad thing is that they also make us feel super anxious -- and "starving" -- for some time afterwards, until we metabolize them.

I'm not an expert, but based on my personal experience, I think this becomes one of those negative feedback loops. We start off by dumping fight-or-flight hormones because of a low, but then we start fearing normal meter readings as being "too close" to low (because in our minds we come to associate lower BG's with that terrible fight-or-flight feeling.)

I think it's a kind of post-traumatic stress (PTSD) reaction to the lows -- a fear of the fear, if you will -- where our brains give us this strong message to do ANYTHING to avoid another low in the future.

I know from my work with a PTSD counselor (after an assault two years ago) that with post-traumatic stress, a good way to get better is something called progressive desensitization or systematic desensitization, where one faces a bit of the fear in controlled situations until one is able to tolerate things that remind us of the trauma without freaking out again.

The way that systematic desensitization works in the blood glucose realm is slowly working your way back down to tolerating normal BG's until you can tolerate maintaining a normal-ish average blood glucose without experiencing terror. If you've been correcting to (for example) 180, try 170 for a while, then when you can do that without fear, try 160. Then after that's tolerable, try 150, and so on. I'm still working my way down, but I'm getting much better. I was at 106 tonight before dinner and I was OK with it, I felt a little shaky/fearful but I didn't freak out. I hope to be able to tolerate readings in the high 90's without fear...then I'll hold steady there.

What a wonderful thoughtful explanation , JeanV.. YOU are a winner , and I hope that Jack can use this info.

God Bless,
Brunetta

I have horrible anxiety due to my diabetes. Right now I am suffering big time every time I bolus. I have anxiety until I test my bloodsugar at the two hour mark, but do it sooner if I feel off. Other thing that does not help is having hypoglycemic unawareness. I have anxiety for lows and highs and I feel awful if bloodsugar is not close to normal, and for me normal is 100-135.

I would love to have my symptoms back for lows of sweating and shaking, but I have nothing, until it is way way low.

Hi Karen -

You might take comfort in the fact that your normal range gives you a nice cushion above the 68-70 that is the usual cutoff for hypoglycemia. If you start to feel "off" at 75 that provides a lot of protection.

Maurie

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