What We're Not Talking About When We Talk About Hypos

One thing we need to stop doing, and 3 things to start.

Aug 09, 2022

For me, it’s bread and peanut butter. Maybe it’s a hold over from my childhood of “and make sure you eat something with protein” but the thing I crave the most when I’m having a low blood sugar is bread with at least 5 tablespoons of PB. Maybe 6.

Not that I need bread and peanut butter after chugging my juice box.

But I’m hungry, my brain tells me. I should eat. So I take out the bread and peanut butter and shakily spread a glob and shove it my mouth. If I’m awake and aware, I usually take some insulin for the consumed carbs. The worst was when I would do this in the middle of the night. I would stumble into the kitchen for a juice box at three AM. I would see the bread and peanut butter. Flop back into bed, chewing with my eyes closed. As soon as I feel better, I’ll bolus. I promised myself every time.

Waking up with a blood sugar north of 300mg/dl.

The bolus that never happened.

Eventually I figured out a few things, things that now, as someone who works in the field of behavior change, make even more sense.

What we tend to do.

The first thing is that we rely way too much on trying to talk sense into anxiety. People tell me this all the time about their various anxieties. They want the anxiety to go away because they know they should have anxiety about something and yet still it persists. There are a lot of reasons for this, but mostly it comes down to our discomfort with uncertainty. We try to make uncertainty less scary by either 1) ruminating and preparing the shit out of things or 2) complete avoidance. Can’t worry about the outcome of a low blood sugar if you never go low!

(This is what we call experiential avoidance, and I’ll be talking more about this in an special paid issue later this week).

The second thing I’ve realized is that our approach is all wrong. We try to talk ourselves out of anxiety, which rarely works. And in the case of hypos, we feel like a failure when our attempt at wrangling the Hypo Anxiety Monster doesn’t work.

This happens for two reasons:

Anxiety is pretty normal when you’re hypoglycemia. Your blood sugar is low! That actually is a pretty serious situation. The body is sending off all sorts of alerts to get you moving into action. You want to feel some level of urgency with a low blood sugar and to feel a desire to consume carbohydrates.
Our cognitive abilities are impaired. Hypoglycemia impairs our executive functioning, which means our decision-making skills aren’t super strong. We aren’t just physically weak, we are also a bit mentally weak because of the hypo.

So what’s the problem? As you probably experience yourself, we tend to behave in ways that don’t actually help our diabetes management. What feels like the Most Important Thing Ever ends up doing more harm than good, as it sends us off on a rollercoaster of chasing a high (but how much did I eat? What if I go low again?) followed by an increased likelihood of another low if we then rage bolus from frustration.

What we can do instead.

Rather than relying on mental gymnastics, we can utilize our environment to set up supports for our habits and barriers for unwanted behaviors.

Here are three things you can try if you deal with overtreating low blood sugars because of hypo anxiety.

1. Use measurable and preportioned low treatments. Decide ahead of time how you want to treat your lows before you are low.

This helps limit our reliance on self-control and willpower during a low blood sugar. One study even showed that low blood sugar impacts our self-control. I have always used juice boxes as my preferred low treatment. It’s measurable and pre-portioned, but I don’t like it enough that I’m going to open another juice box if I really don’t need it. Think of a low treatment like medicine, not an invitation to eat something you’ve been depriving yourself of (side note: this is another example of why deprivation is a bad idea in general). Decide in advance the best ways to treat different kinds of low and/or dropping BGs. This keeps me from making decision out of an emotional response or simply an urge.

2. Keep low treatments out of the kitchen.

You don’t need to go into the kitchen to treat a low BG. In fact, in might be safer not to since you probably aren’t always going low in the kitchen. Keep your low stash in places around the house, like your living room, bedroom, or even bathroom. This limits your need to use willpower to not eat additional food during a low.

3. Find other ways to comfort yourself for a set amount of time.

Lows are really uncomfortable and sometimes scary. It is okay to recognize that! It’s also important to recognize that those emotions can contribute to behaviors that aren’t in our overall best interest. If I do go to the kitchen to get a juice box, I try to leave immediately and lay down on the couch. I snuggle with a soft blanket and I take deep breaths to help regulate my nervous system. In addition, it’s helpful to know how long you need to distract yourself for. Many of my clients will set timers so they don’t inadvertently reevaluate too soon.

And finally, I always like to fall back on my old adage:

“I have survived 100% of my low blood sugars.”

Even though there may be a nagging voice telling you to keep eating, there is more evidence to suggest that listening to that voice will do more harm than good. The low blood sugar, and the anxiety that comes with it, will pass and your future self will thank you.

How do you handle low blood sugars? Leave a comment with your tips!

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