Beverly S. Adler, PhD, CDE
Anxiety is a normal part of life for everyone. Symptoms of anxiety can include general feelings of worry, apprehensive expectation, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, and sleep disturbance. Physical reactions can include racing heartbeat, sweating, muscle tension, flushed cheeks and light-headedness.
Anxiety is also common among people with diabetes. Stress can disturb blood glucose control because the body’s release of stress hormones also produces extra glucose. When people with diabetes are stressed, the production of the stress hormones adrenaline and cortisol increases. In those without diabetes, these hormones help the body's stress response by prompting the liver to release more glucose for additional energy. However, for people with diabetes this action raises blood glucose levels and can be problematic.
Three common anxieties that affect people with diabetes are:
• Fear of blood glucose monitoring.
• Fear of hypoglycemic reactions (low blood glucose).
• Fear of long-term complications.
Fear of blood glucose monitoring and helpful coping strategies
People with diabetes can experience two different types of anxiety when it comes to blood glucose monitoring. The first type of anxiety related to glucose monitoring is a fear of pain when pricking your finger. Self-monitoring with a glucose meter requires a tiny drop of blood taken from your fingertip. The good news is that today's lancets are extremely fine, making checking virtually pain-free. Here are some tips to help avoid anxiety associated with repeated fingertip checking:
• It's important to have clean hands before checking. But, don't use rubbing alcohol for cleaning your fingertip because it will dry out your fingertip and make pricking your fingertip more painful. Simply wash your hands in warm, soapy water and dry them completely.
• Get your blood flowing before pricking your fingertip. Use warm water when washing your hands, and gently massage your finger from the base to the fingertip to improve blood flow. Prick yourself on the side of the pad of your finger toward the end for less pain.
• Use lancets only once. Reusing lancets will make them dull. If you have to reuse lancets because of their expense, limit each to four uses maximum.
• Use a lancing device that allows you to dial the depth of the puncture. Select the lowest setting that gives you an adequate blood sample. Rotate your fingers every time you check so you do not build up a callus.
The second type of anxiety related to glucose monitoring is the fear of getting a "bad" result when checking your blood glucose. The way you think about your result can affect your feelings. Checking blood glucose provides information at the moment you check. That information guides your next decision. First, you need to know your target range. The American Diabetes Association recommends a fasting blood glucose of 70mg/dL to 130mg/dL. 2 hours after a meal, the levels should be less than 180mg/dL. (The target ranges for children are usually a little higher). It helps to write down your numbers to track patterns of highs or lows. Check your blood glucose levels as often as needed. Remember this advice: check—don't guess!
Blood glucose numbers are not “good” or “bad”. Some people view their blood glucose readings as a judgment, especially when the numbers are not in the target range. Using words like “bad” or “undesirable” when thinking about your numbers can leave you feeling down on yourself, guilty, and discouraged. It’s important that you don’t let your blood glucose numbers affect your self-esteem. The next time you check your blood glucose, remember that it’s only a number – and you are much more than a number.
Fear of hypoglycemic reactions and helpful coping strategies
Sometimes, trying to maintain blood glucose in a safe range can feel like walking a tightrope. Hypoglycemia (low blood glucose) can occur in people with type 1 or type 2 diabetes.
Early symptoms of hypoglycemia can include:
• Feeling shaky
• Pounding heart; racing pulse
• Pale skin
Without treatment, you can get more severe symptoms, including:
• Poor coordination
• Poor concentration
• Numbness in mouth and tongue
• Passing out
• Nightmares or bad dreams
The effects of a hypoglycemic reaction can be frightening, embarrassing, uncomfortable, unpleasant, or in very rare cases, fatal. Some people try to avoid low blood glucose by keeping their blood glucose levels higher than recommended. This works for the short-term, but can lead to long-term problems. The standard treatment for hypoglycemia is to consume 15 to 20 grams of glucose or simple carbohydrates and then recheck blood glucose after 15 minutes. Once your blood glucose returns to normal, eat a small snack if your next planned meal is more than an hour or two away.
Injectable glucagon is an emergency medicine used to treat severe hypoglycemia in patients with diabetes who have passed out. In this case, someone else must take over. The medication works by stimulating the liver to release stored glucose into the bloodstream. It usually works within five to 10 minutes. A glucagon emergency kit is available by prescription.
Worrying about blood glucose levels does not make them better or worse. It just keeps you feeling anxious. Check blood glucose levels frequently and stop worrying. Do not feel guilty of mismanagement if you have a hypoglycemic reaction. Nobody is perfect and blood glucose management is not easy. Continue to do the best that you can do.
Fear of long-term complications and helpful coping strategies
If you manage your diabetes too strictly and worry obsessively about your future health, it can make you feel hopeless. An emotional consequence of obsessive worry about diabetes is called "diabetes burnout." If you feel like diabetes is a prison, I advise you to "break out before you burnout!" The good news is that, thanks to medical developments, people with diabetes are less likely to develop long-term complications than ever before.
Here are some additional actions you can take to help calm anxiety:
• Take a walk.
• Engage in regular exercise because it can manage stress, as well as blood glucose.
• Get enough sleep.
• Write in a journal.
• Learn to use some form of relaxation, such as deep breathing or yoga.
• Limit or eliminate alcohol.
Here are some ways you can change your thoughts to reduce your anxiety:
• If you can learn to approach diabetes with the mindset "it is what it is," then stress can be reduced.
• If you can accept your diabetes, you can feel empowered to manage it.
• If you can change your attitude from hopelessness to hopefulness, you can change your perspective to focus on long-term good health.
• Psychologists see humor as a character strength. People living with diabetes can improve their mood by approaching life with a sense of humor—LAUGH!
• Choose to have a positive attitude. As the saying goes, “you cannot live a positive life with a negative mind." If you default to a negative mindset, that will limit you. A bad attitude is like a flat tire—you don't get anywhere until you change it.
Final thoughts to cope with diabetes and anxiety
For people that feel that their anxiety is too difficult for them to manage on their own, they may be helped by talking to a diabetes psychologist or mental health provider who provides diabetes-focused therapy.
A person living with diabetes is not alone. It's really important to have a network of people that you can turn to who can help reduce feelings of stress: family, friends, support groups, outreach events, the diabetes online community, to name a few. Reminder: diabetes is just one aspect of a person, like eye color. It does NOT define people; their strength and courage does.
Have you had anxiety as a result of diabetes? How have you coped with that anxiety? Share with the community in the comments below.