Title:Managing Hypoglycemia in Diabetes May Be More Fear Management Than Glucose Management: A Practical Guide for Diabetes Care Providers
Volume: 10
Issue: 6
Author(s): Michael Vallis, Allan Jones and Frans Pouwer
Affiliation:
Keywords:
Ambivalence, cognitive behavior therapy, fear management, fear of hypoglycemia, graduated behavioural exposure,
self-management.
Abstract: Diabetes management is complex and requires significant effort from the person with diabetes to achieve recommended
self-management behaviours. Achieving guideline concordant self-management is made easier when the person
with diabetes is committed to the behaviours. Ambivalence is the psychological state in which a person experiences
inconsistent drives; both toward and away from the recommended behaviour. Ambivalence about achieving recommended
control over blood glucose is expected in situations of hypoglycaemia, due to the associated dangers. In this paper we
demonstrate that hypoglycaemia is a fear event and is likely to elicit strong drives to avoid future hypoglycaemia as a fear
coping strategy. For many, this results in hyperglycaemia. If hyperglycaemia to avoid hypoglycaemia is a fear management
strategy, then hypoglycaemia management should involve fear management. Few diabetes healthcare providers are
trained, skilled and confident in fear management. The purpose of this paper is to review the evidence on the psychological
consequences of hypoglycaemia and to outline fear management strategies that can be implemented by diabetes care
providers. A step-by-step guide is provided to facilitate understanding of the process of the intervention.