Diabetes and anxiety panic attacks

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The Diabetes-Anxiety Connection: How to Spot the Signs and Find Relief

What Is Anxiety, and How Might It Affect People With Type 2 Diabetes?

Everyone experiences anxiety from time to time, but for someone with an anxiety disorder, feelings of worry and fear are overwhelming or uncontrollable — and they persist and may even worsen over time. People with anxiety may have intrusive thoughts, avoid certain situations that cause distress, and have physical symptoms like high blood pressure. An anxiety disorder is just as much a medical condition as diabetes is.

The difference between everyday anxiety and a clinical diagnosis is how much the anxiety affects your life. “A clinical diagnosis really requires that degree of impairment in your life where you’re not able to fulfill major obligations,” says Nicole Bereolos, PhD, MPH, a clinical psychologist and certified diabetes educator in Dallas.

RELATED: Should You Add a Therapist to Your Diabetes Care Team?

Although people with anxiety can care for their family and perform tasks at their job, anxiety can affect how well someone is able to attend to those obligations, Dr. Bereolos says.

The Connection Between Anxiety and Diabetes

Studies show that people with type 2 diabetes are two to four times more likely to be diagnosed with anxiety and depression.

According to a 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.

RELATED: Is Stress the Source of Your Blood Sugar Swings?

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.

What Causes Anxiety in People With Type 2 Diabetes?

For people with diabetes, the causes of anxiety are multifaceted. For starters, the everyday hassle of testing blood glucose levels, taking medication, and trying to manage diabetes can be stressful. “You can do the same thing every day of the week and have different blood sugar values,” Bereolos says.

People with diabetes may also worry about trying new foods; traveling; diabetes complications; the toll the condition takes on their family; and healthcare costs, which are 2.3 times higher than for someone without diabetes. For Sandi, she worries about the cost of medication and, if her kidneys worsen, the possibility that she’ll have to go on dialysis. “That’s a really scary thought,” she says.

RELATED: How to Help Prevent Kidney Disease When You Have Diabetes

What’s more, according to an October 2017 survey commissioned by John Hancock (an investment, financial services, and life insurance company), nearly half of people with diabetes worry that they won’t qualify for life insurance and 45 percent assume it’s too expensive. “It’s always on your mind, so you can become preoccupied and then overgeneralize your thoughts,” Bereolos says.

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.

According to a study published in August 2014 in Health Technology Assessment, symptoms of anxiety disorder include:

  • Restlessness or feeling on edge
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Problems with sleep
  • Being easily fatigued

RELATED: How to Stabilize Your Blood Sugar

The one exception is panic disorder. Panic attacks are intense and short-lived — they usually last between 15 and 20 minutes — and aren’t triggered by a specific thought or event, but occur seemingly out of the blue. “Usually, people don’t even know where it came from,” Bereolos says.

According to the National Institutes of Health (NIH), symptoms of a panic disorder include:

  • Sensations of shortness of breath, smothering or choking
  • Heart palpitations, a pounding or racing heart
  • Sweating
  • Trembling or shaking
  • Feeling like you’re having a heart attack or dying
  • Feeling of impending doom

How Is Anxiety Diagnosed in People With Type 2 Diabetes?

Because symptoms of blood sugar fluctuations and anxiety can mimic each other, it’s important to speak to your doctor first to rule out a blood sugar issue before turning to a mental health provider for treatment for anxiety, Bereolos says.

If you believe you have an anxiety disorder, your primary care physician or a therapist can make the diagnosis by asking a series of questions or asking you to fill out a questionnaire.

RELATED: 5 Surprising Foods That Have Little Impact on Blood Sugar

How to Cope With Anxiety

When it comes to coping with anxiety, it’s important to find effective ways to deal with stress. For Sandi, a regular meditation practice has helped her manage stress. “My meditation practice allows me to calm my mind,” she says.

Finding ways to better manage your time, practicing good sleep hygiene, eating balanced meals, and exercising are other ways to find relief. “You want to calm the body down so it can better deal with stress day to day,” Bereolos says.

A diabetes or anxiety support group can help you cope with anxiety, especially if you think you’re the only one experiencing it. “It can help to rationalize your thinking, which in essence helps to treat the anxiety and depression going on,” Bereolos says.

How to Treat Anxiety

Although anxiety disorders respond well to treatment, only 36 percent of people are treated, according to the Anxiety and Depression Association of America (ADAA).

If you have anxiety, there’s no reason to suffer in silence. Not only can it prevent you from living a happy, full life, but a study published in January 2017 in the journal Diabetes Care found that people with both anxiety and depression have a higher risk for death.

RELATED: The Truth About How Type 2 Diabetes Affects Your Life Expectancy

Research shows that cognitive behavioral therapy (CBT) combined with medication works best. CBT works by identifying, understanding, and changing thoughts and behaviors, according to the Anxiety and Depression Association of America. As an active participant in your treatment, in CBT you’ll do homework and practice exercises over several weeks or months. “This is a new skill that you’re having to fine-tune and develop over time in order to incorporate it into your day-to-day life,” Bereolos says.

There are several different types of medications you can take to help manage anxiety, and although they are generally compatible with diabetes medications, you should always tell your doctor what you’re taking, to be safe. Like any medication, drugs for anxiety all carry side effects; they may also take up to six weeks to start working.

Your primary care physician can prescribe medication, but if you have a serious mental health diagnosis, are concerned about drug interactions or can’t find a medication that is effective, it’s best to see a psychiatrist.

RELATED: 10 Tips to Help You Take Your Diabetes Medication on Time

How to Help Someone With Anxiety and Diabetes

If you have a family member or a friend with type 2 diabetes and anxiety, be positive, and don’t assign blame, give advice, or try to fix it. People with anxiety, whether they have diabetes or not, simply want to be heard. “The best thing to do is be there as a sounding board,” Bereolos says.

Editor’s Note: We’ve omitted Sandi’s last name to protect her privacy.

For more on the connection between diabetes and mental health disorders, check out Diabetes Daily’s article “Can Hyperglycemia Alter the Brain and Lead to Depression?”!

Could “Relative” Hypoglycemia Be Causing Your Anxiety?

Source: ZeeNBee /

Are you an anxious person? Do you also frequently experience symptoms of hypoglycemia? The two may be closely related.

My first memory of “hypoglycemia” happened when I was in my early thirties, while shopping for groceries. One minute I was fine, and then the next I felt lightheaded, weak, anxious, irritable and tearful. At first, I didn’t know what was wrong. When it dawned on me that I might have low blood sugar, I quickly ate something and felt better. And felt embarrassed about how I had acted! Crying in a grocery store, for no reason at all, isn’t pretty.

After that episode, it happened enough times that I started carrying candies or meal bars in my purse. I couldn’t go for more than a couple of hours without eating, during the day. During times that I felt inexplicably anxious or irritable, a solid healthy meal would typically turn my mood around. Completely. I’d feel calm and normal after, other than feeling embarrassed (yet again!) if I’d been tearful, weirdly anxious or touchy prior to eating.

Over the years, I’ve frequently counseled patients with anxiety to eat regularly and avoid high sugar foods. Best not to let blood sugar get too low, and avoid the dramatic swings in blood sugar that refined carbohydrates trigger, as this would exacerbate (or mimic) their symptoms.

Recently, I came across an explanation of how important it is for people with anxiety or depression to eat a solid meal first thing in the morning. The directive was to eat a breakfast high in fat and protein, as soon as possible after getting up. If an anxious or depressed person were to attempt a demanding task without having a decent breakfast first, they could end up “psychophysiologically unstable” for the rest of the day.

The physiology behind this is that the stress of the complex task (on a fasted body that hasn’t eaten anything yet) causes insulin hypersecretion, which further lowers blood sugar, throwing the body and brain off-kilter and making the person feel physically and emotionally unstable. In a way that’s hard to recover from.

Reading this, I realized that that person was me! I’ve noticed that on Sunday mornings I often feel weirdly irritable or stressed. It’s strange because I’ve normally slept very well and have no reason to be irritable or stressed. Now that I think about it, though, we sleep in on Sunday mornings before heading to church. My breakfast tends to be much later than usual.

There are some fascinating studies in this area. A classic one was published in 1966 by Harry Salzer: Reactive Hypoglycemia and Neuropsychiatric Illness. He described reactive (or “functional”) hypoglycemia as a relative drop in blood sugar that profoundly affected vulnerable individuals, even though their blood sugar never dropped into an officially hypoglycemic range. They would have symptoms of hypoglycemia, without low blood sugar. A relative drop in blood sugar, however, could be observed via a six-hour glucose tolerance test (rather than using the gold standard fasting blood glucose test to test for classic hypoglycemia).

The symptoms of hypoglycemia included depression, anxiety, insomnia, irritability, crying spells, forgetfulness, trembling, racing heart and dizziness (I know these well!). He also observed that the patients suffering from these symptoms were typically eating a diet high in refined carbohydrates and caffeinated drinks.

When he treated them with a high protein, low sugar, caffeine free diet, the “anxiety” symptoms completely resolved in many patients. This was attributed to a smoothing out of blood sugar and insulin levels (both sugars and caffeine can trigger wild swings in blood sugar and insulin secretion).

Another interesting paper was published in the 2016 Case Reports in Psychiatry. A 15-year-old teenager with generalized anxiety disorder and symptoms of hypoglycemia had been eating a diet primarily made up of refined carbohydrates.

They added more protein, fat, and fiber to her diet over a four week period. For example, they traded out her usual breakfast fruit/fruit juice smoothie for one with whole fruit, protein powder, and flax seeds. Her anxiety symptoms decreased dramatically. She also experienced improved energy, less frequent hypoglycemic episodes, and improved concentration and mood.

A few weeks later, she briefly returned to her old way of eating. Her anxiety symptoms returned immediately.

There’s lots of other data out there — for example, a cohort study that showed an association between an increased risk of depression and anxiety and consumption of foods with a high glycemic index.

I worry that today’s near-obsessive emphasis on “time-restricted eating” and fasting (which can have profound benefits in some, to be sure), may cause significant neuropsychiatric mood problems in people vulnerable to anxiety and depression. I’m certainly one of those, which is why I can’t do intermittent fasting on a daily basis. I learned that very quickly, after trying it! I need to eat to stay sane, literally.

In fact, I’m going to start eating breakfast even earlier than I already do. I’ll also make it much more hearty.

Copyright 2018 Dr. Susan Biali Haas

How to Recognize and Treat Hypoglycemia-Related Anxiety

Hypoglycemia and anxiety are conditions that in some cases may be closely related. Hypoglycemia, or low blood sugar, is a condition usually accompanying diabetes. The symptoms of hypoglycemia are similar enough to those of anxiety to make it easy to mistake for hypoglycemia for an anxiety disorder or attack. While hypoglycemia symptoms are a result of the bodily stress it induces, it requires different treatment and preventative techniques than standalone anxiety.

Though anxiety and hypoglycemia are related, an anxiety disorder cannot cause hypoglycemia. Hypoglycemia, however, can cause anxiety. It is important to be able to distinguish anxiety from a hypoglycemia so that your symptoms can be treated in a timely manner.

It’s not uncommon to have health concerns that can be caused by, or related to, anxiety. In some cases, people believe that their anxiety symptoms must be a health problem. In others, a health problem can cause people to be anxious.

Hypoglycemia, whether severe or mild, can result in a variety of symptoms commonly recognized as the result of anxiety. These include:

  • Heart palpitations (rapid or irregular heartbeat)
  • Shaking
  • Sweating
  • Paleness
  • Cold/clammy skin
  • Nausea
  • Seeing flashes of light
  • Dilated pupils (a common fear-response symptom)
  • Moodiness
  • Negative attitude
  • Exaggeration of relatively minor problems

All these symptoms match up to what you would expect to see or experience during an anxiety attack. However, hypoglycemia is also often accompanied by symptoms that do not appear in regular anxiety attacks or conditions, including the following:

  • Hunger
  • Slurred speech similar to drunken slurredness
  • Blank stare/look and “zombie-like” behavior

If you are experiencing any of these in addition to your other anxiety symptoms, you should take the preliminary step of eating something to help regulate your blood sugar. It is recommended that you go see your doctor as soon as possible to be tested for hypoglycemia.

Ruling Out Hypoglycemia

If you are worried that your anxiety symptoms may be caused by hypoglycemia, you should check with your doctor as soon as possible in order to be sure. To officially rule out hypoglycemia, a blood test is required. However, the blood test should NOT be performed immediately after an episode of intense anxiety symptoms. This is because after one of these events, your blood sugar may already be dangerously low, and needs time to recover to prevent further attacks.

A test for hypoglycemia involves a 12-hour fast, after which the doctor can take a sample of your blood and find out whether it has reached dangerously low levels of glucose (the sugar in your blood that provides you with energy). Try to calm yourself during this time – waiting for this type of test can create its own anxiety, and often hunger and thirst contribute to anxiety as well. Try to stay relaxed and busy.

A hypoglycemic attack is no fun, and it is hard to function during it. However, whether you are having a regular anxiety attack or a hypoglycemic attack, it is perfectly safe to eat something to raise your blood sugar levels in either case.

If you find yourself having to do this often (and find that it helps), you probably have hypoglycemia, but it is always best to do to a doctor to be sure (as stress eating can also be an effect of an anxiety disorder and should not be encouraged as it can become an unhealthy coping mechanism).

If you have either type 1 or type 2 diabetes, an excess of insulin (a medication that lowers your blood sugar) may be causing your hypoglycemia. If this is the case, talk to your doctor about adjusting your dosage of insulin.

Otherwise, eating regular, healthy meals is crucial in maintaining the correct levels of blood sugar in your body. Going on a new fad diet, excluding certain food groups from your diet, or starving yourself to lose weight are all common ways for anxiety to sneak into your life when you don’t need it.

When making a dietary change, be sure that you get advice from a professional such as your primary care doctor or a nutritionist.

How to Prevent Anxiety Over Hypoglycemia

Most likely, if you haven’t already been diagnosed with hypoglycemia, you’re simply experiencing anxiety. It’s perfectly normal to feel as though your anxiety symptoms must be the result of a health problem, and not anxiety, since in many cases anxiety mimics serious health concerns.

Anxiety is more common than many of the health disorders it mimics and unfortunately people with anxiety commonly experiencing health anxiety which may cause further concern over the symptoms they experience.

There are some things you know are going to make your anxiety worse: WebMDing your stomach ache, foregoing sleep to list all the ways your work presentation could go wrong, calling your friend who freaks out about everything…But treating yourself to a scoop of Rocky Road or a cupcake from your favorite bakery, that’s going to make you feel better right?

Sometimes, 100 percent yes. But other times, that sweet treat can backfire, sneakily causing all sorts of changes that can lead to the opposite of feeling good: anxiety. Here, health experts break down the relationship between sugar and anxiety, and what you can do to combat it.

How are sugar and anxiety related?

The problem with sugar, says hormone health educator Candace Burch, is that it causes blood sugar spikes and drops, which directly affects mood. “The rush of sugar leads to sugar highs, giving a lot of energy, but then the lows lead to feeling sluggish and down.”

“Sugar can exacerbate your feelings of anxiety because of the way our bodies respond to digesting them,” adds Brigitte Zeitlin, RD, owner of BZ Nutrition, a New York-based nutrition practice. “ cause your blood sugar to spike and then drop faster than they would after eating non-high-sugar-foods. This quick spike and drop causes you to feel uneasy and can even at times mimic a panic attack.” Having low blood sugar levels can actually put the body into a stress response, which, as Zeitlin mentions, can increase anxiety.

Our bodies obviously don’t like being stressed or anxious, says Zeitlin. People combat that in various ways, including reaching for sugary foods. “Foods high in sugar trigger the release of serotonin, which is a feel good hormone,” Zeitlin says. “We are trained to eat sugar and feel good, which makes it understandable why people stress eat, because they just want to feel better when they are feeling stressed and anxious.”

However, when your body is stressed or anxious, you also have higher levels of cortisol (a.k.a. the “stress hormone”). Zeitlin says when this happens, your body suppresses the release of insulin, the hormone that takes up glucose to use for energy. You now have a one-two punch of spiked blood sugar levels (since you’re eating more sugar to combat your stress) and storing excess sugar as fat since you’re not turning it into energy. “So, eating more sugar when you are stressed or anxious just amplifies the amount of sugar your body would naturally have already flowing, and contributes to more severe drops in blood sugar and more drastic drops in your mood,” she says. Enter a cycle of turning to something sweet every time they need another energy and mood boost, and a subsequent rollercoaster of ups and downs which can also contribute to feelings of anxiety.

This sugar-and-anxiety cycle isn’t just relegated to the daytime hours. “High-sugar foods can keep you up because of their energy that prevents your natural stress-booster of sleep from kicking in,” Zeitlin says. “When we don’t get enough sleep we feel even more anxious and stressed because our body missed an opportunity to process it properly.” You’re now going into the next day with less sleep, and thus lower energy levels and higher stress levels. And what do many people reach for to combat stress and anxiety? You guessed it: sugar.

And “high-sugar foods” doesn’t just mean candy, cookies, and cake. “Studies have found that women who eat more refined carbohydrates (baked goods, candy, white breads/rice/cereals, bagels, etc) were more likely to suffer from depression and mood swings because of the drastic peaks and deeps in blood sugar levels,” Zeitlin says.

How to keep sugar from contributing to anxiety

Of course, this isn’t just to freak you out and make you throw out all of the dairy-free ice cream in the fridge. Lots of other things can contribute to anxiety, including stress, coffee, work, and even family relationships—so cutting out Oreos isn’t the magic bullet for reducing anxiety. But the impact of sugar on anxiety levels can affect anyone, says Zeitlin—and if you have an existing anxiety disorder, sugary foods will likely exacerbate your condition, she adds.

One way to combat this is certainly to reduce your sugar intake, including processed foods and breads. It’s also a good idea to load up on foods low in sugar and high in fiber (think veggies, fruit like berries, and whole grains)—Zeitlin says they have a much more even effect on your blood sugar, which can help cut back on feelings of “increased anxiety.” She also recommends stopping eating about two hours before you go to sleep. “This gives your body time to properly digest and process the food—sugary or not—and let that energy subside in time for you to actually fall asleep and stay asleep.”

When you are eating foods higher in sugar, Burch suggests pairing it with foods higher in fiber and healthy fats. “This slows the absorption of sugar, preventing it from spiking blood sugar as much,” she says, and thus making it less likely to put you in an anxiety spiral.

But all this comes with a big caveat: Changing one’s diet shouldn’t be the only thing a person does to fight back against anxiety. “Changing your diet to limit high-sugar foods will not treat or cure your anxiety disorder, but it will help manage it better and optimize the times you are feeling good and less anxious,” says Zeitlin. Psychologist Gail Saltz, PhD, says some ways to reduce anxiety not related to food include deep breathing, working out, and (to bring it all full circle) getting enough sleep. If none of these lifestyle changes are helping, it’s essential to see a professional to help you come up with a treatment plan.

“Sugary foods contribute to mood swings and anxiety. Period,” Zeitlin says. And now that you understand the connection, it’ll be easier to be more mindful when you are consuming foods with sugar in them.

Additional reporting by Jessie Van Amburg.

If you want to cut out sugar completely but don’t know how, here’s some tips. And if your anxiety is worst in the morning, this could be why.

Anxiety + Diabetes

State(s) of Fear

Anxiety has become one of the most commonly diagnosed mental illnesses in the United States. It seems everywhere you turn, someone is talking about it. Whether it’s their child or themselves that are afflicted, everyone and their mother seems to suffer from some level of anxiety. There has been a particular uptick in the level of anxiety reported in children and adolescents. While mental health professionals are trying to put their finger on what exactly is contributing to this – technology, political climate, homework – you don’t have to dig deep to find a reason for increased levels of anxiety in those living with Type 1 diabetes. To begin unpacking this issue, first let’s take a look at what the “A” word actually means.

What is anxiety, exactly?

A certain level of anxiety is healthy – necessary, even. It is what prevents us from engaging in dangerous behaviors, and what keeps us motivated to accomplish the things we need to do. The dictionary definition of anxiety reads as follows: “distress or uneasiness of mind caused by fear of danger or misfortune.”1 When this distress gets too high, or is disproportionate to the situation provoking it, the person tends to suffer from anxiety instead of benefitting from it.

Some of the more common forms of anxiety disorders are:

Generalized Anxiety Disorder (GAD)

A prolonged state of worry or tendency to worry about any and everything. GAD can have physical manifestations, such as GI problems and difficulty sleeping. Someone living with GAD will have a tendency to view everything through a lens of anxiety, and be bombarded with “what-ifs?”

Panic Disorder

Panic disorder can occur after a person experiences one or multiple panic attacks, and is living in constant fear of the next one occurring. Everyone experiences panic attacks in different ways, but the most common symptoms are shortness of breath, feelings of impending doom, de-personalization (that feeling when you are floating outside your body), and heart palpitations, to name a few.

Social Anxiety Disorder

Basically what it sounds like, social anxiety disorder is when people experience extreme discomfort and anxiety around other people. This anxiety is rooted in the fear of what others think of you, or of embarrassing yourself or looking foolish.

Diabetes & Anxiety

T1D and anxiety are made to exacerbate one another. The fears and thought patterns that fuel anxiety are inherent to managing diabetes. On the flip side, struggling with anxiety can wreak havoc on your blood sugars. The more time I’ve spent working with and trying to pick apart anxiety disorders, the more I’ve realized how counterintuitive diabetes management is to anxiety levels.

What ifs

Running through the back of every anxious mind is a pestering whisper of what if? “What if I die?” “What if I embarrass myself?” “What if I fail?” These persistent questions can be crippling. However, when managing diabetes, it is often necessary to ponder what if. For example, I am about to pre-bolus for my dinner on my way home, but what if I get stuck in traffic? I am preparing for a run by adjusting my dosage and snacking, but what if it rains?

At the forefront of diabetes management is planning. Unfortunately, planning often invites what ifs, and what ifs can easily manifest into anxiety. When you are living with anxiety, it is often difficult to differentiate between rational or helpful what ifs and irrational, detrimental ones. Considering the rain or traffic while planning your insulin dosage can be productive, while repetitively pondering the possibility of going low and passing out during your exercise routine is not.

Living in the present

Similarly, planning for diabetes care can interfere with being present in the current moment. In recent years there has been growing evidence of the efficacy of mindfulness-based stress reduction (MBSR) and meditation for treatment of anxiety2. Much of our worry is rooted in what may or may not happen in the future. But it is hard to focus on the present moment and often difficult to be spontaneous when you’ve got insulin on board (IOB), sensors with downward-pointing arrows, and a fixed amount of juice in your handbag. Even the actual practice of meditation can be interrupted by alerting insulin pumps and CGMs. As mentioned above, diabetes management involves a lot of planning. And a lot of planning means a lot of future-oriented thinking.

Checking

Much like planning, with diabetes checking is essential. Checking you blood sugar, checking your IOB, checking your low supplies. But for someone with anxiety, checking can spiral into an obsessive ritual. People suffering from obsessive-compulsive disorder (OCD) have certain rituals they perform to quiet obsessive thoughts that repeatedly run through their mind. Because checking is so essential for diabetes management, it’s easy for someone susceptible to anxiety to fall into a pattern of over-checking. Picture this: you feel anxious about going low, check your sensor data and see no downward arrows. You feel a temporary wave of relief. But moments later, those thoughts recur. They get louder and louder in your head, until you have to check your sensor again – still no downward arrows. You see how this can fall into a negative thought-behavior cycle.

Where do we go from here?

Fortunately, much like type one, anxiety is manageable. But it takes work. If you feel like anxiety is interfering with you or your child’s everyday life, consider seeing a therapist. There are many therapists who have experience working with people with chronic illness. And if they don’t, BT1 has a helpful guide to teach them about type 13.

Where to start: finding a therapist

Your primary care doctor or pediatrician may have some referrals. Or, if you feel comfortable, ask around. It’s more than likely that many people in your life see a therapist and you have no idea. Or, if you have private insurance, you can try calling the “Member Services” number on the back of the insurance card and asking for referrals to local in-network behavioral health providers. There are also many ways to locate a therapist online:

If you have Medicaid (or Medical, or your state’s equivalent), your state’s Division of Mental Health and Addiction Services should have resources for local community mental health centers that accept this insurance. Your therapist or primary care doctor will also be able to suggest if you should consult a psychiatrist. A psychiatrist can prescribe medications for behavioral health concerns.

While diabetes and anxiety may make a great pair, you don’t have to constantly live at their mercy. As you learn to accept and manage your anxiety, you’ll learn how to live well with it. It won’t be easy, and there’s a lot of trial and error. Of course, having type one means you’re used to that! And always remember, you’re not alone in this.

Read more resources on Mental Health.

Kristi Caporoso, MSW, LSW

Kristi Caporoso, MSW, LSW, is a young adult living with type 1 diabetes located in northern New Jersey. She received her master’s in social work at Rutgers University, with a focus on clinical social work in the healthcare field. She is a Licensed Social Worker (LSW) working in a children’s hospital with patients and families coping with a variety of crises and chronic illnesses. Her main interests are reading, writing, running and showing others what living with type 1 really looks like. She has had type 1 for over 25 years. You can find her on Twitter & Instagram: @diabetictruths and her blog: https://diabetic-truths.blogspot.com/

Diabetes and anxiety fact sheet

This fact sheet is available in two formats.

You can download and print out the PDF version.

Or you can read it as a website page below.

Anxiety is often a healthy response to a perceived threat. For most people, anxious feelings go away after the threat has passed. For some people, the fear becomes so intense and long lasting that it starts to affect daily life, including work, school, relationships and diabetes management. If you feel this way, you may have an anxiety disorder, but you are not alone. There are many things you can do to reduce your anxiety.

“There are definite issues that come up, especially around anxiety and low blood sugar. One of the symptoms is anxiety—that fight or flight response—so understanding whether you’re experiencing anxiety for psychological reasons or for physical glucose reasons is quite a difficult thing.”

Andrew, 59, person with diabetes

What is anxiety?

Anxiety is an excessive amount of fear in anticipation of something bad happening. Usually, this is a healthy response to a real threat. For example, certain situations, such as public speaking or having a ‘hypo’ (hypoglycaemia, or low blood glucose), can trigger anxious feelings.

Anxiety becomes a serious problem (a mental health condition, known as an ‘anxiety disorder’) when these feelings last for a long time (i.e., at least two weeks) and affect daily life adversely.

Symptoms of anxiety include:

  • feeling nervous or on edge
  • being unable to stop worrying or control worrying thoughts
  • worrying too much about things
  • having trouble relaxing
  • being so restless that it’s hard to sit still
  • becoming easily annoyed or irritable
  • feeling afraid that something awful might happen.

Anxiety also has physical symptoms, including:

  • muscle tension
  • a racing heart
  • tightness in the chest
  • an upset stomach.

If you have had any of these symptoms for at least two weeks, talk to your general practitioner (GP). They can make an assessment, offer treatment and/or refer you to a mental health professional.

It is important that you seek advice from a health professional.

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 (e.g., hypos, fear of developing complications) 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 wasn’t just the diabetes. Diabetes was just one factor, but it was a focal point.”

Louise, 27, person with diabetes

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.

What you can do

It is important that you seek help from your GP or another qualified health professional. They can help you to identify if you have an anxiety disorder and offer treatment or make a referral to a mental health professional if needed.

If you don’t have an anxiety disorder, your health professional can help you to understand what else might be causing the symptoms.

Whether or not you are experiencing anxiety, it’s important to look after your emotional well-being.

Some of the following strategies may work for you—others may not, and that’s okay. They may give you ideas about other things you could try.

Reach out

Anxiety can make you feel like you are alone and may stop you from going out. If you feel this way, talk to someone you trust. People who care about you will want to support you.

  • Make a point of talking to at least one person every day.
  • If you don’t feel like you have anyone to share your feelings with, call a helpline, talk to your GP, or join a support group or online community. You don’t need to go through this alone.

Move your body

Physical activity has powerful effects on the brain and can improve the way you think and feel about yourself. Try to be active every day.

  • Yoga relaxes and calms both the body and the mind. There are many types of yoga and you don’t have to be a yogi master to feel the benefits.
  • Start small. For example, start with one short walk every second day, then gradually increase the time you spend walking and how often you walk. Or take the stairs, park your car further away, break up work for a stretch.
  • Try to get out and enjoy nature while you move, as this helps to reduce stress.

Get enough sleep

Being tired makes it difficult to feel calm and relaxed. Try to have a sleep routine by going to bed and waking at the same times each day.

The following tips might help:

  • Keep a sleep diary to help you understand some of your patterns.
  • Reduce your caffeine intake: limit your coffee, tea, and soft drinks, and don’t drink them after 4pm.
  • Be active during the day but avoid don’t do strenuous physical activity right just before bedtime.
  • Remember, your bed is for sleeping, so avoid watching TV, checking emails, or using your phone in bed.
  • Make sure the room is quiet and dark.

Don’t try to mask it

It is common for people with anxiety problems to misuse alcohol, prescription medications or illegal drugs. People adopt these behaviours as a way of coping, but they are just a short term fix and don’t resolve the real problem. These ways of coping don’t help in the long term, as people become dependent on them. This increases their anxiety and/or can cause other health or relationship problems.

Don’t try to fight it

When we feel anxious, our initial reaction is often to tell ourselves to ‘stop being ridiculous’ or ‘get over it’. Fighting against anxiety doesn’t work and may actually make it worse. You may have thoughts such as, ‘What is happening to me?’ or ‘I’m having a heart attack … or a hypo!’ These thoughts increase your anxiety.

It’s better to work with the symptoms of anxiety and let them be, rather than working against them. This doesn’t mean you should resign yourself to these symptoms or like them. Acknowledge that they are there and that it is your body’s way of telling you something is wrong. You could try:

  • Observing what it is you are feeling (e.g., fear, fast heart rate).
  • Acknowledging whatever it is that you are feeling by saying aloud or silently to yourself, ‘I’m feeling …’
  • Thanking your body for being such a great protector, and for doing such a thorough job at helping to keep you safe.
  • Telling yourself, ‘This will pass’.

Breathe

Relaxation is a powerful way of reducing anxiety. Try a breathing relaxation exercise (see box Breathing relaxation exercise). Find a quiet room for this activity, and sit in an upright and comfortable position. The more you practice, the better you will become at naturally calming yourself during times of high anxiety. Once you’ve tried it a few times, it may surprise you with how helpful it is for improving your well-being. If this kind of thing isn’t for you, that’s okay, just skip it.

Breathing relaxation exercise

  1. Focus on your breathing. Take a deep breath in through your nose. Hold… then exhale through your mouth, as if you are blowing out a candle. Blow out all the air.
  2. Focus on slowing down your breathing into a calm rhythm. Exhale fully, releasing all the air.
  3. As you continue to breathe slowly and deeply, repeat the following calming messages to yourself silently:
    • I’m feeling anxious right now but I’m okay.
    • I’m safe, even though I feel frightened.
    • This feeling will pass and no harm will come to me.
  4. If you are shaking or trembling, try to physically shake out the tension. Imagine that you are shaking water off your hands to dry them. Now stop and notice how much more relaxed your hands feel.
  5. Now relax the muscles in your body. Let all the muscles go limp. Then tense the muscles in your body—hold on really tight for a minute or so, without causing pain. Then release and let the muscles go limp again. Notice how relaxed your muscles feel.

Talk with a professional

The strategies above may give you some ideas about how to prevent or reduce anxiety, but they can’t replace professional help. It’s always a good idea to talk about your concerns with your GP or another qualified health professional.

Who can help?

Your diabetes health care team

Your diabetes health care team is there to help you with all aspects of your diabetes, including how you feel about it. Share your feelings with them if you feel comfortable to so do—they will give you non-judgemental support and advice. You may want to talk with your:

  • GP
  • endocrinologist
  • diabetes educator
  • nurse practitioner
  • dietitian
  • counsellor or psychologist.

Bring this fact sheet to your appointment to help get the conversation started. You will probably feel relieved after sharing your feelings, and it will help your health professional to understand how you are feeling.

Together, you can make plans to manage your anxiety.

A psychologist or psychiatrist

You might also like to talk with a psychologist or psychiatrist. These professionals are best placed to make a diagnosis and provide treatment for anxiety. Treatment may involve the following:

Ask your diabetes health professional if they know a psychologist or psychiatrist in your area who is familiar with diabetes, or try the following options:

  • Find a psychologist near you by visiting the Australian Psychological Society website at psychology.org.au/FaP.
  • Find a psychiatrist near you by visiting the Royal Australian and New Zealand College of Psychiatrists at yourhealthinmind.org/mental-illnesses-disorders/anxiety-disorders.

You will need a referral from your GP to see a psychiatrist but not to see a psychologist.

Your GP can tell you if you are eligible for a Mental Health Treatment Plan to reduce the costs of seeing a psychologist or psychiatrist.

More information and support

beyondblue

beyondblue.org.au or ph 1300 224 636

Beyondblue provides information and support to people with depression or anxiety, or anyone going through a tough time. Support services are available via telephone, email or live chat, including online forums where you can connect with others.

Lifeline

lifeline.org.au or ph 13 11 14

Lifeline offers 24-hour confidential telephone and online crisis support. People contact Lifeline for a range of reasons, including feelings of depression, stress, anxiety and suicidal thoughts or attempts.

Peer support

ndss.com.au
(search for ‘Publications & Resources’)

To find out about what peer support is and how you can access it in your area, refer to the National Diabetes Services Scheme (NDSS) leaflet, Peer support for diabetes.

Diabetes Australia and the NDSS

diabetesaustralia.com.au
ndss.com.au
NDSS Helpline 1300 136 588

Through the NDSS, you can access a free national NDSS Helpline to obtain information about diabetes and learn about education programs, peer support groups and other events.

The NDSS and you

A wide range of services and support is available through the NDSS to help you manage your diabetes. This includes information on diabetes management through the NDSS Helpline and website. The products, services and education programs available can help you stay on top of your diabetes.

This fact sheet is intended as a guide only. It should not replace individual medical advice and if you have any concerns about your health or further questions, you should contact your health professional.

Version 2 December 2018. First published June 2016.

Panic Attacks Linked To Poor Outcomes For Diabetic Patients, Study Finds

The researchers surveyed patients with diabetes about their symptoms, disability, social and emotional function, and quality of life. They also collected data on the patients’ blood sugar levels, diabetic complications, and other illnesses.

The team had previously reported a strong link between diabetes and depression, which often goes along with panic disorders. They were interested in examining panic independently, however, to see whether patients who have panic without depression would also have poor diabetic outcomes.

“Panic attacks can mimic episodes of hypoglycemia (low blood sugar), so we need a better understanding of how the two conditions are related,” explained Evette Ludman, PhD, lead author of the article and a research associate at Group Health. “We don’t want people adjusting their blood sugar thinking they are having hypoglycemia when their symptoms are actually caused by a panic disorder.”

Of the 4,385 patients surveyed, 193 reported experiencing recent episodes of panic or fear that caused them to change their immediate behavior. After accounting for the effect of depression, panic episodes were associated with higher blood sugar levels, increased diabetic complications and symptoms, greater disability, and lower self-rated health and functioning.

About half of the patients with panic also reported having major depression. By contrast, only 10 percent of patients without panic episodes had major depression.

Panic episodes may be a consequence of the diabetes itself, the researchers explain. Also, panic may interfere with patients’ self-care and ability to follow their treatment plans.

If you have diabetes and you know that anxiety is an issue for you, you should talk to your doctor about possible treatment for your anxiety,” advised Ludman. And doctors should carefully assess their patients with diabetes, looking for signs of depression or panic disorders, she added.

The study was funded by the National Institute of Mental Health.

Founded in 1947, Group Health is Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. The Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. It is funded primarily through government and private research grants.

Anxiety & Type 1 Diabetes: Why It Happens & What to Do About It

Generalized anxiety in people with diabetes is a thing. Here, an expert explains the connection and offers tips to overcome it. Written by Ginger Vieira 20

Some people with type 1 diabetes worry incessantly about all the things that could go wrong with their health. As a result, 20% of people with T1D have generalized anxiety disorder (GAD)—a clinical condition. (Photo:123rf)

Few conditions have a closer connection to anxiety than type 1 diabetes. That’s largely because there are so many “what ifs” triggering the constant worry of managing a 24/7, high-maintenance disease that has a minute-by-minute impact on your immediate and future health.

Type 1 diabetes is the number one ingredient for a daily bout of anxiety, especially the more attention you pay to it.

Not only do we have to worry about what today’s blood sugars will do to our wellbeing 10 or 20 years from now, we also have to worry about how the food we ate just moments ago, or the exercise we’re about to do, or the insulin we took an hour ago is going to impact our blood sugar.

Low blood sugars feel like (and are) immediate danger—it’s as if an internal alarm sounds saying: Feed me! Feed me! Fast! Quickly, before time runs out!

High blood sugars feel like failure, like maple syrup running throughout our bloodstream, rotting us from the inside-out.

Every minute of the day, for the rest of our lives, diabetes demands a necessary degree of worry. In fact, that worry is what helps motivate us to take care of ourselves. If we didn’t care at all about the consequences of neglected blood sugar levels, we’d get sick—fast.

How Daily Worries Trigger Anxiety

But there’s a certain point at which that worry becomes anxiety. Your diabetes-related anxiety may be the result of and about a specific aspect of diabetes, or it may be about the whole big blood sugar fiasco altogether. Regardless, it’s not uncommon, and it’s worth taking a closer look at–especially if it’s impacting your ability to take care of your blood sugars.

“Anxiety is actually really common in people with type 1 diabetes,” explains Mark Heyman, PhD, CDE. Actually, Heyman would know, because not only is his entire career focused on counseling people with diabetes, he was diagnosed with type 1 nearly 20 years ago, in 1999.

“Anxiety really comes down to being worried about things that are going to happen to you in the future” adds Heyman. “And type 1 diabetes encapsulates that perfectly.”

Anyone with type 1 diabetes knows the overwhelming number of tasks that need to be checked off everyday to manage your diabetes. Heyman says, that alone, can easily cause anxiety.

Diabetes creates the potential for worry in nearly every part of our daily lives. There is a constant voice in the back of our heads saying: today’s blood sugars could be hurting your kidneys, your eyes, your fingers, your toes—everything. It’s a non-stop threat that we are always trying to stay on top of.

And it’s a lot of work.

“It is constant mental gymnastics to have to figure out how to do anything around diabetes, and there’s always that worry of ‘what if I do it wrong?’ ” says Heyman.

In fact, Heyman says anxiety is common enough that approximately 20% of all people with type 1 diabetes have generalized anxiety disorder (GAD)—a clinical condition.

“People with type 1 diabetes are definitely more prone to developing GAD—which isn’t about one specific thing, but more a constant worry about the future, whether that’s 5 minutes from now or 15 years from now.”

What Fear Can Do to Your Diabetes

While generalized anxiety implies that a person is experiencing an overall level of emotional stress and worry about many things in life, related specifically to diabetes or not, there is also a unique experience of anxiety specific to people with diabetes would may develop mild-to-moderate anxiety diabetes-related issues such as:

  • Fear of needles and injection pain
  • Fear of CGM sensor or insulin pump infusion site pain
  • Fear of high blood sugars
  • Fear of low blood sugars
  • Fear of certain foods (rice or pizza, for example)
  • Fear of all carbohydrates
  • Fear of CGM arrows (UP, UP, UP…then all of a sudden sideways)
  • Fear of low blood sugars during school
  • Fear of low blood sugars during work
  • Fear of dosing insulin for foods without nutrition labels (like..at parties!)
  • Development of a specific diabetes complication

“Fear is really just another word for anxiety,” explains Heyman. “And trying to avoid that feeling of fear by avoiding that aspect of diabetes management can become a real problem.”

In other words: avoiding it doesn’t help mediate your anxiety, and it certainly doesn’t help you live your life well as a person with diabetes.

When Hypoglycemia—Real or Imagined—Leaves You Traumatized

Easily the most common and most acute focus of anxiety for many with type 1 diabetes is a fear of low blood sugars. Hypoglycemia can be very scary, because even when you’re sitting there with a juice box in your hand and clearly managing the situation, your brain is telling you to be scared, to do everything you can to save yourself.

However, while none of us likes low blood sugars, you know that normal level of fear has become anxiety when you’re either testing your blood sugar constantly, your emotional reactions around low blood sugars are severe and irrational, or you’re purposefully running your blood sugar high all day long to lessen the risk of hypoglycemia.

“There are two categories of folks when it comes to anxiety around low blood sugars,” explains Heyman. “The first group is those who’ve had a severe low blood sugar that led them to needing glucagon or being hospitalized. These patients really do have symptoms of PTSD (post-traumatic stress disorder). They’ve experienced a truly traumatic event.”

We all know what the recovery from an everyday “bad low” feels like when we were able to treat it by merely eating a banana, but waking up after being unconscious from a severe low blood sugar can leave you with a new level of fear that can become incredibly debilitating.

“Of course, you’ll want to do everything you can to avoid letting that ever happen again,” says Heyman. “But I try to help patients step back at really look at the context of what happened in order to regain a sense of confidence in their ability to manage their blood sugars.”

How Can I Become Confident Again?

What caused the severe low blood sugar event? And what can you do in the future to prevent it from happening again—besides, of course, running your blood sugars high all day which is NOT recommended.

“Most of the time, we can find the specific cause and the context of the event so they can see that it wasn’t random,” explains Heyman.

For instance going for a run right after dinner without cutting back on your dinner bolus is a mistake you aren’t likely to repeat.

“The second category of folks with a strong fear of hypoglycemia are those who’ve never had a severe low event, but they’ve read about it, seen it, or heard of what it might be like, and they fear that they won’t be able to handle taking care of themselves if that happens to them,” says Heyman.

Learning to Feel Normal at Normal Blood Sugar Levels Again

In either group, this fear becomes a bigger problem when you begin to run your blood sugars purposefully and daily around at least 200 to 250 mg/dL to serve as a mental safety net.

“This creates another issue because your body gets used to being that high, and then when you do come down to even 150 mg/dL, you’ll feel symptoms of a low blood sugar.”

The physical symptoms are real but there is no actual danger of hypoglycemia at these numbers. Your body is not going to have a seizure of unconsciousness with a stable blood sugar of 150 mg/dL or even 100 mg/dL but when you run your sugars high, your body gets accustomed to that and as a result mistrains your brain to feel symptoms of hypoglycemia when you aren’t actually in real danger.

And then, of course, your brain and body is telling you that you’re low, so you treat the 150 mg/dL with carbohydrates as if it’s truly low, sending you back up over 200 mg/dL. Perpetuating the problem and putting your long-term health at risk.

Controversial Yet Effective

Heyman’s approach to helping patients overcome their ear 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, you’ll get through it and start to feel normal at normal blood sugar levels.”

What’s so unique about his approach to this process? He will help you purposefully induce a low blood sugar while you’re 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 I’m low, I’m 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:

  • Be prepared for lows by putting fast-acting carbohydrate snacks everywhere. Your glove compartment, your office desk, your purse, your nightstand, your bathroom, your spouse’s car, etc. Knowing you’ll have what you need for any low inevitably creates confidence. *Ginger’s Tip: Snack-sized package fruit snacks or jelly beans are great for treating a severe low. They don’t rot, freeze or spill in a purse, and can be easily tucked in every nook and cranny.
  • Ask yourself: What really qualifies as a low blood sugar? Doing this will help you feel empowered—not fearful. And remind yourself regularly of the real, unhealthy long-term consequences of persistently high blood sugars.
  • Learn more about the causes of low blood sugar and how to prevent them. Educate yourself around activities like exercise, and improve how you calculate the amount of insulin you need for your meals. If you’re constantly dropping low during exercise, it’s worth investing in a diabetes coach to learn how to manage your blood sugar around different types of physical activity! (*Check out: Diabetes Strong, Daniele Hargenrader and Fit4D.)

For improving more general anxiety, here are some tips for Heyman:

  • Identify your personal symptoms of anxiety. For some it might be sweaty palms, hyperventilating and crying. For others it might look like anger. Write those symptoms down, and commit to identifying them when they happen. For example, even as you sit there crying during an anxiety attack, tell yourself: I am crying because of anxiety. This is an anxiety attack. And because symptoms like sweating and shaking come with both anxiety and low blood sugar, use your glucose meter to identify what’s really going on.
  • Take a step back to identify the thoughts that are creating or contributing to the anxiety. “A lot of anxiety is simply caused by our thoughts,” explained Heyman. If you keep telling yourself that you’re going to die because your blood sugar is 50 mg/dL, that pattern of thinking is creating your anxiety, and it’s time to change that. Grab the juice box (or other fast-acting carbohydrate) and remind yourself that you can do it. You ARE capable of treating this low blood sugar.
  • Look at your thoughts realistically and consider the logic of your fear. “What’s the evidence for this belief or thought you have, for example, that you’re going to die of diabetes complications next year?” When you are calm, look at this fear and anxiety in an objective, logical way—and perhaps even discuss it with a friend who understands real life with diabetes. It can be helpful to explain it out loud.
  • Slow down and try meditating. Or simply take a deep breath. Calming your mind will reduce the symptoms of your anxiety whether it’s crying or yelling. Become more present by placing both feet on the floor and focus on the moment right now—not the future—not the what-ifs, but just where you are right this second. Forming a habit of working through your anxiety in a calm manner is critical. Just like you have a habit of turning off the kitchen light to save money on your bill when you leave for work, you can create a habit of taking a deep breath, putting both feet firmly on the floor, and taking another deep breath when you feel anxiety creeping in.

When to Seek Professional Help

Experiencing any of the following 5 scenarios indicate you should look into receiving professional help with your anxiety:

  1. If the anxiety is not going away on its own, and what you’ve tried so far to help manage it is not helping or is actually making it worse.
  2. If you find that your anxiety is impacting your ability to function in the world, including at work, at school, in relationships, etc.
  3. If you refuse to go somewhere like school or work unless your blood sugar is over, 250 mg/dL, for example, because that’s the only way you feel protected from hypoglycemia.
  4. If it’s clearly sabotaging your diabetes health. If you A1c keeps going up and up and up, or is sitting consistently well above 8% because your anxiety interferes with your ability to manage your blood sugars in a healthy range, this is a BIG, BIG, BIG sign that it’s time to enlist a therapist.
  5. And lastly, simply put: the more severe the symptoms the more likely it’s time for professional support. A lot of crying? A lot of yelling? A lot of hyperventilating? Get help as soon as possible.

Treating Anxiety with Medication

Heyman adds that pharmaceutical drugs can certainly be helpful for treating and managing anxiety, but if your anxiety is truly related to diabetes, a medication alone isn’t going to help you. You’ll still need to work on thinking about that aspect of diabetes more logically, more confidently in order to gain a more balanced perspective that reduces or prevents anxiety altogether.

In his own life with diabetes, Heyman says he tries look at the positives of having diabetes. “We focus so much on the negatives—and there are a lot of them—but what has diabetes given me that I wouldn’t have at all if I didn’t have diabetes?” he asks himself. “I live a very healthy lifestyle because I feel better and my blood sugars are better. I can’t say I would be as mindful of my health if I didn’t have diabetes. And I’ve met wonderful people and have a great career because of my diabetes. I have gratitude for what diabetes has given me while also recognizing that it’s certainly a huge pain in the a** sometimes, too.”

Updated on: February 7, 2019 Continue Reading Diabetes and Anxiety: 10 Ways to Control the Stress

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