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Type 1 Diabetes And Anxiety

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Anxiety Over Low Blood Sugar

Stress and Type 1 Diabetes

A low blood sugar episode, which can include anything from confusion and shakiness to nausea, loss of consciousness, and seizures, can be very scary. It therefore makes sense that some people with diabetes also experience anxiety related to possibly having a low blood sugar episodeand not just as a physiological reaction to low blood sugar levels.

This anxiety is so common that the term “fear of hypoglycemia” is commonly used among healthcare providers and researchers. Research has found that a history of experiencing mild hypoglycemia increases FoH in people who have diabetes.

What Are The Symptoms Of Anxiety When You Have Type 2 Diabetes

Trying to determine whether anxiety is psychological or due to blood sugar fluctuations can be tough because both hypoglycemia and hyperglycemia symptoms mimic symptoms of anxiety, Bereolos says.

But unlike blood sugar fluctuations, signs and symptoms of an anxiety disorder persist.

  • Restlessness or feeling on edge
  • Difficulty concentrating or mind going blank
  • Irritability

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Next Steps: Assist Or Assign

The decision about whether you support the person yourself or involve other health professionals will depend on:

  • the needs and preferences of the person with diabetes
  • your qualifications, knowledge, skills and confidence to address elevated anxiety symptoms
  • the severity of the anxiety symptoms, and the context of the problem whether other psychological problems are also present, such as diabetes distress or depression
  • your scope of practice, and whether you have the time and resources to offer an appropriate level of support

If you believe referral to another health professional is needed:

  • explain your reasons
  • ask the person how they feel about your suggestion
  • discuss what they want to gain from the referral, as this will influence to whom the referral would be made

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Depression: A Common And Burdensome Complication Of Diabetes That Warrants The Continued Attention Of Clinicians Researchers And Healthcare Policy Makers

Abstract There is ample evidence that depression is a common comorbid health issue in people with type 1 or type 2 diabetes. Reviews have also concluded that depression in diabetes is associated with higher HbA1c levels, less optimal self-care behaviours, lower quality of life, incident vascular complications and higher mortality rates. However, longitudinal studies into the course of depression in people with type 1 diabetes remain scarce. In this issue of Diabetologia, Kampling and colleagues report the 5 year trajectories of depression in adults with newly diagnosed type 1 diabetes . Their baseline results showed that shortly after the diagnosis of type 1 diabetes a major depressive episode was diagnosed in approximately 6% of participants, while 8% suffered from an anxiety disorder. The longitudinal depression data showed that, in a 5 year period, 79% reported no depressive symptoms at any time, while 7% had a high depression score that improved and 14% reported worsening of depressive symptoms. Here, the clinical relevance of these findings is discussed and areas for further research are described. Notes The author declares that there is no duality of interest associated with this manuscript.Continue reading > >

Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Major Importance

Can Stress Cause Type 1 Diabetes
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    Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015 56:34565. This article provides an up to date overview of the worldwide prevalence of mental disorders in youth with estimates of 6.5 % for anxiety, 2.6 % for depression, and 3.4 % for ADHD.

    PubMed Article

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    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association 2014.

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    CAS PubMed Article

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    Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders : a replication study. J Am Acad Child Adolesc Psychiatry. 1999 38:12306.

    CAS PubMed Article

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    Kaufman J, Birmaher B, Brent DA, Ryan ND, Rao U. K-Sads-Pl. J Am Acad Child Adolesc Psychiatry. 2000 3910:1208.

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    Seligman LD, Ollendick TH, Langley AK, Baldacci HB. The utility of measures of child and adolescent anxiety: a meta-analytic review of the revised childrens manifest anxiety scale, the state-trait anxiety inventory for children, and the child behavior checklist. J Clin Child Adolesc Psychol. 2004 33:55765.

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    Bomyea J, Amir N, Lang AJ. The relationship between cognitive control and posttraumatic stress symptoms. J Behav Ther Exp Psychiatry. 2012 43:8448.

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    Fear Diabetes And Anxiety

    Fear is a big part of anxiety and easily a big part of living with diabetes. Anyone with diabetes, at any age, could develop enough fear around a particular aspect of living with diabetes that it becomes a significant struggle to manage their diabetes well, or it begins impacting other aspects of their day-to-day life.

    These diabetes-related fears could include:

    • High blood sugars
    • Insulin pump infusion site application
    • CGM arrows of increasing or decreasing blood sugar levels
    • Carbohydrates or other specific food groups
    • Blood sugar fluctuations at work, school, playground, swimming, etc.
    • Developing a diabetes complication

    One of the most common fears that develop in people with diabetes is a fear of low blood sugars. Lets take a closer look at this.

    Ask Your Primary Care Doctor Or Diabetes Healthcare Team For Help

    Just because youre dealing with anxiety now doesnt mean youll be dealing with forever especially if you get the help you need. Talk to your healthcare team about a referral to a therapist or about starting a medication to help you lessen your anxiety. There are so many options, but they can only help you if you ask for help.

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    Patients With Type 2 Diabetes Exhibit More Signs Of Anxiety Than Those Without

    This 2016 study from North Carolina found that patients with type 2 diabetes exhibited clinical and subclinical symptoms of anxiety more frequently than patients without diabetes.

    Researchers also found that patients with anxiety frequently have more difficulty reaching blood sugar goals and increased incidence of diabetes-related complications.

    Another 2018 study from Bulgaria found that women with metabolic syndrome also have higher rates of anxiety and depression compared to patients without metabolic syndrome.

    Screen For Child Anxiety

    Stress and Diabetes

    The SCARED is a self-report questionnaire with 41 items evaluating different dimensions of anxiety disorders in children – panic disorder or significant somatic symptoms, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and significant school avoidance. The 41-item version of the SCARED was administered among the study population. Adolescents responded to items using a 3-point Likert-type scale that described the degree to which statements were true about them – not true or hardly ever true, somewhat true or sometimes true and very true or often true. The questionnaire shows high levels of internal consistency for the overall score .

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    Diabetes Anxiety Management: A Controversial Technique

    Heymans approach to helping patients overcome their fear of low blood sugars is controversial but a powerfully effective process.

    The overall goal is that we help them bring their numbers down step by step, says Heyman. Tolerating the false symptoms of a low at 150 mg/dL is critical. If you can handle the uncomfortable stage of this for a little while, youll get through it and start to feel normal at normal blood sugar levels.

    Whats so unique about his approach to this process? He will help you purposefully induce an actual low blood sugar while youre right there in the safety of his office, which inevitably helps you rebuild confidence in your ability to treat and manage hypoglycemia.

    I like to send people low in my office in a very safe and controlled way, with lots of glucose on hand, explains Heyman. People struggling with this keep telling themselves, If Im low, Im not going to be able to handle it and treat it. So we give them a safe opportunity to change that belief.

    The result is that patients see real-life proof of their ability to identify and treat a low blood sugar.

    Heyman said he also helps patients develop different habits around diabetes so they feel more empowered on a daily basis where the risk of hypoglycemia is always real:

    Study Design And Setting

    This was a cross-sectional study conducted among 187 T1DM adolescents who had diabetes of more than 1-year duration at the Diabetes Treatment Center, Prince Sultan Military Medical City , Riyadh, Saudi Arabia from June 2013 to February 2014. All adolescents had a diagnosis of type 1 diabetes according to the practice guidelines of the American Diabetes Association . The study was conducted in accordance with the Declaration of Helsinki, and the protocol of the study was approved by the Research Ethics Committee, PSMMC, Riyadh, Saudi Arabia.

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    How Common Are Elevated Symptoms Of Anxiety

    One in six people with Type 1 diabetes are affected by moderate to severe anxiety symptoms. One in five people with Type 2 diabetes who use insulin treatment are affected by moderate to severe anxiety symptoms.
    One in six people with Type 2 diabetes who don’t use insulin treatment are affected by moderate to severe anxiety symptoms.

    How Diabetes Might Cause Or Contribute To Anxiety

    Type 1 Diabetes

    The burden of managing and living with T1D or T2D on a daily basis is the perfect recipe for anxiety. Drossos shared these four common expressions of anxiety in people with diabetes:

    • When I feel anxious and I have no one to turn to.
    • I am constantly afraid of my disease getting worse.
    • I feel that diabetes is preventing me from doing what I want.
    • I am worried about not being able to carry out my family responsibilities in the future.

    A few of the specific aspects of these diseases that can contribute to anxiety include:

    We have seen a rise of anxiety and fear of hypoglycemia in people with continuous glucose monitors, added Drossos, despite the many benefits of using CGMs.

    While many people find CGM technology helpful, using a CGM can also fuel anxiety because of constant alarms, increased attention to blood sugar levels, and the tendency it can create to hyper-focus on creating a perfect graph each day.

    Living with any type of diabetes can impact every single hour of a persons day. Achieving blood sugar targets doesnt actually relieve this pressure, it can actually fuel it and reward it because achieving those targets requires daily persistence in many habits.

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    Mental Health: Living With Type 1

    People with type 1 diabetes are at a heightened risk for mental health issues, including diabetes distress, depression, anxiety, and disordered eating. However, these are all treatable disorders. It is important to pay attention to your feelings about having diabetes or taking care of someone who has diabetes. Talk to your physician, or yourdiabetes educator, or anyone you feel comfortable with on your diabetes care team. They can help you connect to mental health care, whether it is with a counselor, a therapist, a psychiatrist, or a social worker. Having support to live with diabetes is essential. Sometimes talking to a friend with diabetes can also be helpful.

    Do You Feel This Way Because Of Anxiety Or Diabetes

    Some of the symptoms of anxiety are very similar to those of a hypo), such as trembling, sweating, or a fast heart rate. This can make it difficult to know whether you are anxious, having a hypo, or both. If you are not sure, always check your blood glucose, as this will help you to become increasingly aware of your own reliable symptoms of a hypo. You will learn to understand whether you are experiencing feels of anxiety or, in fact, having a hypo.

    Even if anxiety is not related to your diabetes, it can have negative effects on your health, life, and relationships.

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    What Are Causes Of Stress In Diabetes Type 1

    • Loneliness and isolation
    • Counselling for better lifestyle changes
    • Self-care

    Lifestylechanges, irrespective of age, can in help you lift up your spirits. Meditationand yoga have a lot of relaxation techniques that helps to ward off stress. Gethelp from your medical care team who will suggest you to exercise regularly, makechange in your diabetesdiet, medication, and treatment. All these changes can help you copewith depression and anxiety better while dealing with diabetes type I.

    Seeking help in case of psychological issues is very important in type 1 diabetes as neglect of your state of mind can easily lead to neglect in your diabetes treatment.

    The Connection Between Anxiety And Diabetes

    We Can Do This – Diabetes and Anxiety

    According to another study, published in February 2014 in the journal Medical Science Monitor, 42 percent of people with type 2 diabetes also have anxiety and 28 percent have depression.

    Women are also more likely than men to experience anxiety. And according to a study published in November 2015 in the American Journal of Public Health, anxiety might be more common in women during the first two years of the disease.

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    What The Research Says

    40% of people with diabetes. This prevalence is much higher than that in the general U.S. population, where the condition affects 18.1% of people.

    People with diabetes are at risk of developing low blood sugar, or hypoglycemia. Some of the symptoms of hypoglycemia are identical to those of anxiety.

    Additionally, the results of a 2015 animal study suggest that experiencing several episodes of hypoglycemia can increase the likelihood of anxiety. The reason for this may be that hypoglycemic episodes trigger chemical and metabolic changes that physically affect the part of the brain that plays a role in processing anxiety.

    The procedures that healthcare professionals use to diagnose diabetes and anxiety are quite different.

    Gadgets That Make Life With Diabetic Macular Edema Easier

    Interestingly, research suggests anxiety may be tied to type 2 diabetes risk. According to a September 2016 study published in the journal Psychoneuroendocrinology, which measured levels of blood glucose and IL-6, a protein in the body that stimulates immune response and healing, found that people with with low inhibition or attention control were more likely to have type 2 diabetes.

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    What Has Anxiety Got To Do With Diabetes

    Anxiety is the most common mental health issue that Australians experience. Among people with diabetes, some have anxiety before a diagnosis of diabetes, while for others, specific fears associated with managing diabetes may trigger anxiety.

    The link between anxiety and diabetes is not yet fully understood, and research is ongoing.

    What is clear is that anxiety can affect the way people manage their diabetes and, in turn, their physical health. Some examples include:

    • checking blood glucose levels continuously due to intense fears of hypos or developing complications
    • avoiding injecting in public, or not injecting at all, due to worry about what others might think.

    A few years ago I was really anxious, but it wasnt just the diabetes. Diabetes was just one factor, but it was a focal point.

    Louise, 27, person with diabetes

    Depression Anxiety And Eating Disorders Are Common In Teens And Young Adults With Type 1 Diabetes

    Type 1 Diabetes

    Managing type 1 diabetes during the teenage years is challenging. Physical changes, social pressures, and stress can make it harder for teenagers and young adults to control their blood sugar levels. Researchers at Columbia University have found that it is important to watch out for signs of depression, anxiety, and eating disorders that may make it even harder for teens and young adults to keep type 1 diabetes under control.

    The researchers found that 11% of 150 teens and young adults with type 1 diabetes had depression, 21% had anxiety, and 20% had disordered eating. In addition, those teens and young adults with mental health issues were twice as likely to have poor diabetes control, putting them at risk of a number of complications.

    Mental Health ScreeningScreening for these mental health issues in teens should be done at least yearlyand probably also at times when their disease appears to be unexplainably out of control, said a coauthor of the study, Karen Soren, MD, Associate Professor of Pediatrics and Population and Family Health, and Director of Adolescent Medicine at Columbia University Medical Center, in New York, NY.

    Ask for HelpIf you think you or a family member has depression, Ask a provider or parent or a trusted adult for help, advised Margaret Grey, DrPH, RN, Dean & Annie Goodrich Professor, Yale University School of Nursing, New Haven, CT.

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    Taking Care Of Your Mental Health

    Trackingblood glucoselevels, dosing insulins, planning your meals, and taking care of your physical needs are vital. Its a lot of work and it can be emotionally draining. It is normal to be bummed out or tired of managing diabetes. It is a sign of strength to ask for help.

    Maintaining your mental and emotional health is necessary for good diabetes management. Feeling physically good is more than half the battlefeeling good about yourself allows you to take care of yourself.

    Deal with natural emotions like stress, sadness, anger, and denial before they lead to depression.

    • AngerDiabetes is the perfect breeding ground for anger.
    • DenialDenial is that voice inside repeating: “Not me.” Most people go through this when first diagnosed.
    • DepressionStudies show that people with diabetes have a greater risk of depression than people without diabetes.

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