When You're Afraid of Going Low

A severe hypoglycemia episode — a blood sugar low bad enough to frighten you or the people around you — leaves a mark. Many people afterwards begin, quietly, to run their sugar high on purpose.

This is well documented rather than unusual. Research into hypoglycemia avoidance lists the behaviours plainly: deliberately keeping glucose above target, reducing insulin or tablet doses without telling anyone, eating extra carbohydrate as insurance, avoiding driving, exercise, travel or going out alone, and needing someone present before leaving the house.

The fear is rational. The strategy is costly. Running consistently high protects you from the thing you are afraid of tonight, at the price of the complications you are trying to avoid over years. And it tends to grow: the higher your usual level, the earlier you feel "low" symptoms, which confirms the fear.

Rebuilding confidence

• Say it out loud to your care team. Dose reductions made privately out of fear are the single most important thing for them to know, and the least likely to be mentioned.
• Bring the target down gradually, agreed with your doctor, rather than in one jump.
• A CGM with a low alarm is often the thing that restores sleep, because it removes the need to stay high as insurance.
• Know the treatment cold — the 15-15 rule, what to keep by the bed, who to tell.
• Work out why the bad low happened. A hypo with an identified cause is far less frightening than one that seemed random.

See also treating a low: the 15-15 rule.