Hypoglycaemia is inevitable and relatively common in people with diabetes; around 20% of people with type 1 diabetes experience at least one severe hypoglycaemic event over one year, while people with type 2 diabetes who have used insulin for at least five years have similar experience. Despite the increasing availability of modern treatments and technologies, severe hypoglycaemia continues to be the greatest barrier to achieve optimal glycaemic outcomes.
Unsurprisingly, many people with diabetes worry about having hypoglycaemia, as it can lead to losing consciousness in public, having an accident/injury, becoming emotionally upset or uncooperative, embarrassing themselves and, in the worst case, sudden death.Being concerned about hypoglycaemia is rational and adaptive, as it keeps a person with diabetes attentive and responsive to hypoglycaemic symptoms, to enable timely and appropriate treatment.However, this concern can evolve into excessive fear, and seriously impact on quality of life and diabetes management.  This fear of hypoglycaemia is not necessarily proportional to the actual risk, but rather the perceived risk or consequence of having hypoglycaemia in the future.

In response to fear of hypoglycaemia, people with diabetes:
1) may prefer to run their blood glucose levels above the optimal target range by reducing or omitting insulin or by eating more than needed. This can be an effective short-term strategy to reduce fear (and particularly to regain hypoglycaemia awareness) but chronic hyperglycaemia will increase the risk of developing long-term complications.2) may limit their activities to cope with unpredictable hypoglycaemia.  This strategy will seriously impact  on their quality of life, affects interpersonal relationships and can place a significant burden on family members.

Restoring confidence in managing diabetes and regaining a sense of personal control over glucose levels is the primary focus when addressing fear of hypoglycaemia. The best approach will be informed by the underlying reasons for the fear, e.g. impaired awareness of warning symptoms, a traumatic past hypoglycaemic experience, or being generally anxious. Diabetes health professionals are well placed to support people with diabetes in developing personalised strategies to reduce their fear of hypoglycaemia.