When Low Blood Sugars Cause High Anxiety: Fear of Hypoglycemia Among Parents of Youth With Type 1 Diabetes Mellitus

Abitbol, L; Palmert, Mark R.

doi:10.1016/j.jcjd.2020.08.098

Cited by 19 publications

(18 citation statements)

References 28 publications

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“…A key distinction emerged from studies in the current review between the threats, fears and concerns that parents had some control over (e.g., adopting protective behaviours such as limiting travel away from home, restricting child’s activity participation [ 44 , 49 , 50 , 54 , 55 ]) and ones where they had much less control (e.g., the child’s seizures [ 35 , 38 , 42 , 43 , 46 , 50 , 54 ] and the social implications of their child’s condition, such as bullying [ 36 ] and/or being treated differently [ 35 , 36 , 44 , 48 , 51 , 54 ]). Epilepsy-related fears about factors outside of parents/caregivers control commonly negatively impacted parents’/caregivers’ emotional and social well-being, as also seen in other studies of parents/caregivers of children with long-term conditions [ 19 – 21 , 76 , 77 ].…”

Section: Discussionmentioning

confidence: 63%

Parents’/caregivers’ fears and concerns about their child’s epilepsy: A scoping review

et al. 2022

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Background Childhood epilepsy is a serious and common neurological condition and can have life-long consequences and its impact can pervade all aspects of family life. Whilst the medical management of seizures is important, much of the day-to-day home management of epilepsy is invisible to people external to the family, including health care professionals, and parents’/caregivers’ fears and concerns can go unacknowledged and unaddressed by health care professionals. Objective This objective of this review was to examine parents’/caregivers’ fears and concerns regarding their child’s epilepsy, the impact of these fears and concerns on family life, the social and emotional well-being of parents/caregivers and any factors which mitigate these fears and concerns. Design Scoping review using a modified version of Arksey and O’Malley’s framework. Data sources Relevant studies were identified using key search terms in Scopus, Medline, CINAHL and PsychInfo databases in March 2021 with hand checking of reference lists. Search terms were developed using population (parents/caregivers of children aged ≤ 18 years with epilepsy, families); concept (parents’/caregivers’ fears, concerns, anxiety about their child’s epilepsy); and context (any setting). A further search was run in April 2022. Other inclusion criteria: English language empirical studies, 2010–2021. Study appraisal methods A minimum of two reviewers independently screened articles and undertook data extraction and decisions were consensually made. Methodological quality appraisal was undertaken using the Mixed Methods Appraisal Tool v2018. A data extraction table was created to chart all studies. The conduct and reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (S1 Table). There is no published copy of the review protocol. Main findings The search identified a total of 4077 papers (after duplicates were removed) of which 110 were assessed for eligibility. Twenty-four papers published between 2010–2021 were included in the review and each paper was treated as a separate study. The review findings indicate that parents’/caregivers’ fears and concerns stem from more than their child’s seizures and relate to many wider aspects of family life. These fears and concerns had far-reaching influences on their parenting/caregiving, and on the lifestyle and activities of their child and their family. What was less evident was what parents/caregivers wanted in terms of support or how they thought health professionals could acknowledge and/or allay their fears and concerns. The discussion is framed within the compassion-focused therapy model as a basis for generating new thinking about the impact of these fears and concerns and the need for a new agenda for clinical consultations in childhood epilepsy. Conclusions The review concludes with a proposal that a more compassionate agenda underpins the dialogue between parents/caregivers and clinicians to encompass and mitigate the wider emotional, psychosocial, and societal threats that impact on the parent/caregivers of children with epilepsy.

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Section: Discussionmentioning

confidence: 63%

Parents’/caregivers’ fears and concerns about their child’s epilepsy: A scoping review

et al. 2022

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“…Patients with FoH are likely to engage in avoidance behavior to prevent hypoglycemia 11 , for instance, reducing the insulin dosage, increasing food intake, and restricting activities, which may harm their glycemic control 11 , 12 . In addition, FoH was positively correlated with negative emotions such as psychological distress and anxiety in patients with diabetes 13 , 14 and reduced the quality of life 15 , 16 . Therefore, FoH is a critical psychological obstacle to metabolic control, negatively influencing the self-management and mental health of patients with diabetes.…”

Section: Introductionmentioning

confidence: 96%

Fear of hypoglycemia and associated factors in hospitalized patients with type 2 diabetes: a cross‑sectional study

Huang

Peng

Ding

et al. 2022

Sci Rep

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The present cross-sectional survey was performed to assess the prevalence and factors associated with fear of hypoglycemia (FoH) in hospitalized patients with type 2 diabetes (T2D). Between July and December 2020, 494 patients with T2D were evaluated via structured questionnaires containing sociodemographic information, clinical information, and the Fear of Hypoglycemia-15 scale (FH-15). Patients were divided into the FoH and non-FoH groups according to the FH-15 score. Univariate and multivariate logistic regression analyses were performed to determine factors associated with FoH. Variables with P values < 0.1 in the univariate model were included in the multivariate model. In this study, the prevalence of FoH was 17.4% (86/494). 247 (50.0%) patients experienced hypoglycemic episodes in the past year, and 15 (3.0%) patients experienced severe hypoglycemic episodes in the past year. The mean age was 60.04 ± 11.71 years old, and female patients accounted for 39.9% of the sample. The item with the highest average FH-15 scores was: how often are you afraid of having hypoglycemia while alone? Multivariate logistic regression analysis indicated that living alone (OR 2.48; 95% CI 1.20–5.14; P = 0.015), number of hypoglycemic episodes in the past year (OR 1.06; 95% CI 1.03–1.10; P < 0.001), number of severe hypoglycemic episodes in the past year (OR 2.61; 95% CI 1.20–5.69; P = 0.016), and duration of insulin use (OR 1.06; 95% CI 1.02–1.10; P = 0.006) were associated with FoH. The prevalence of FoH in hospitalized patients with T2D was high. FoH was associated with living alone, number of hypoglycemic episodes in the past year, number of severe hypoglycemic episodes in the past year, and duration of insulin use. These findings can contribute to early decision-making for preventing, identifying, and improving FoH in patients with T2D. In the future, interventions aimed at reducing FoH to improve the harmful effects of FoH are necessary, such as increasing diabetes-related knowledge and skills, increasing social support, reducing psychological fear, and minimizing risks for hypoglycemic episodes.

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“…Acute hypoglycemia that was produced by an insulin injection [8] or a low-glucose diet [9] decreased glucose concentrations in the ventromedial hypothalamus and increased norepinephrine levels in the amygdala [10], leading to the presence of anxiety. A current clinical hypothesis suggests that the fear of hypoglycemia, rather than acute hypoglycemia itself, produces anxiety [11][12][13]. Controlled experimental designs are needed to either prove or refute the hypothesis that hypoglycemia produces anxiety.…”

Section: Introductionmentioning

confidence: 99%

Anxiety Constitutes an Early Sign of Acute Hypoglycemia

García

Contreras

2022

Neuropsychobiology

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Introduction: Research in humans has identified a link between hypoglycemia and anxiety. The present study examined anxiety-like behaviors in rats that were subjected to hypoglycemia that was produced by an acute injection of insulin. Healthy female Wistar rats were subjected to a battery of tests to explore anxiety (elevated plus maze) and locomotion (open field test). Methods: The control (CT) group received 0.9% saline (3 mL/kg, p.o.). Three other groups received 50% glucose (3 mL/kg, p.o.), insulin (0.1 UI, s.c.), or insulin + glucose (normalized glycemia [NG] group). Results: Normal glycemic values were found in the CT and NG groups. Therefore, a single control (CT-NG) group was formed for statistical comparisons. The highest glycemic value was found in the glucose-induced hyperglycemia group. The lowest glycemic value was found in the insulin-induced hypoglycemia group. In the open field test, the most significant change was a higher number of rearings in the hypoglycemia group. In the elevated plus maze test, the CT-NG group and hyperglycemia groups exhibited similar behavior, whereas the hypoglycemia group spent a shorter time on the open arms and a longer time on the closed arms and had the highest Anxiety Index. Hyperglycemia is a typical characteristic of diabetes. Insulin normalizes glycemia. In the present study, insulin produced anxiety only when it produced hypoglycemia. Conclusion: The main effect of acute hypoglycemia is anxiety, which may be considered an early sign of hypoglycemia in an allostatic process.

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When Low Blood Sugars Cause High Anxiety: Fear of Hypoglycemia Among Parents of Youth With Type 1 Diabetes Mellitus

Cited by 19 publications

References 28 publications

Parents’/caregivers’ fears and concerns about their child’s epilepsy: A scoping review

Parents’/caregivers’ fears and concerns about their child’s epilepsy: A scoping review

Fear of hypoglycemia and associated factors in hospitalized patients with type 2 diabetes: a cross‑sectional study

Anxiety Constitutes an Early Sign of Acute Hypoglycemia

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