Fear of hypoglycemia—An underestimated problem

Abstract

Introduction: Fear of hypoglycemia (FOH) is a phenomenon that affects people with diabetes experiencing hypoglycemia. On the one hand, FOH is an adaptive mechanism that helps to protect patients from hypoglycemia and its consequences. On the other hand, the non-normative level of FOH causes anxiety and tension, disturbs normal functioning, and makes normoglycemia maintenance difficult. Objective:The main objective of this review was to describe factors influencing FOH and methods of measurement of FOH levels. Moreover, we highlighted the impact of the new technologies used in diabetes therapy on FOH and different therapeutic possibilities helping patients cope with excessive levels of FOH. We also presented clinical cases of patients with high FOH levels met in clinical practice and discussed methods to better diagnose and assist people with this kind of problem. Methods:We searched for studies and articles via PubMed using the keywords fear of hypoglycemia, diabetes, and hypoglycemia. From screened documents identified from literature search, 67 articles were included in our review. Results:We divided results from literature screening into five parts: fear of hypoglycemia and hypoglycemia definition, risk factors for the FOH, methods of measuring levels of FOH, therapies for the FOH, and modern technologies. We also described clinical examples of abnormal fear of hypoglycemia in patients. Conclusion:The review highlights the importance of taking into consideration fear of hypoglycemia phenomenon in diabetic patients in everyday clinical practice. K E Y W O R D Sanxiety, diabetes, fear of hypoglycemia, hypoglycemia INTRODUCTIONAnxiety disorders are mental disorders that are not caused by organic injury to the central nervous system, and their symptoms relate mainly to emotional processes. These disorders might be rooted in past experiences that trigger anxiety despite the absence of actual threat at a certain moment (Kępiński, 2020). It is an anticipatory reaction to aThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

“…The existing researches regards hypoglycemic fear as a whole and studies the relationship between it and other variables (Nakhleh & Shehadeh, 2021;Przezak, Bielka, & Molęda, 2022) which will lead to spurious correlations among variables easily appear when there are more variables. We do not know how the items in the two dimensions of hypoglycemic fear, hypoglycemic worries and hypoglycemic avoidance, interact with each other.…”

From Zero to Hero: Type 2 Diabetes Mellitus Patients Hike on the Way of St. James—A Feasibility Study with Analyses of Patients’ Quality of Life, Diabetes Distress and Glucose Profile

“…Some participants showed higher values after the pilgrimage but were still under the cutoff point. The relatively low overall PAID scores can be rated as positive because physical activity can be stressful, especially for insulin-treated patients with diabetes, given their risk of hypoglycemia and the higher demands set on diabetes self-management to prevent exercise-induced hypoglycemia [ 25 ]. According to Finn et al [ 26 ], this may in fact be a reason for non-adherence to physical activity programs or for not following physical activity recommendations.…”

Psychological Care as an Interdisciplinary Approach in the Management of Diabetes: A Narrative Review of Literature

“…The most common symptoms of this state are: discomfort and anxiety, with concomitant feelings of shortness of breath palpitations or hand tremors. FOH disturbs normal functioning, lead to worsening metabolic control of diabetes and reduction the patient's quality of life [46]. People with FOH are willing to change their dietary behavior by increased caloric intake, lower the intensity of physical activity and insulin dosing.…”

“…When hypoglycemic episodes repeat regularly the patient doesn't experience symptoms of hypoglycemia despite low blood glucose levels. This state named hypoglycemia unawareness can lead to occurrence and intensification of FOH [46]. There are several tools for measuring the FOH such as: Hypoglycemia Fear Survey modified version (HFS-II), Quick Screening for Fear of Hypoglycemia (QSFH), the Fear of Hypoglycemia 15-item scale (FH-15), and the Children's Hypoglycemia Index (CHI) used in pediatric patients [46].…”

“…It can help reestablish awareness of hypogly-cemia, improve HbA1c level and improve psychological well-being [11]. Other psychoeducational interventions which are common worldwide include: hypoglycemia anticipation, awareness and treatment training (HAATT), blood glucose awareness training II (BGAT-2), and the hypoglycemia treatment program (HyPOS) [46]. These should be implemented by a qualified behavioral practitioner if they are not available within the practice setting [11].…”