Anxiety and daily control

[JANETr]

I have suffered from anxiety since early childhood. When I became a Type 1 it took me all my working life to realise that mental stress has a profound effect on my blood sugar control. Anxious? Blood sugar levels become like a fiddler's elbow! Continuous monitoring has allowed me to discover this cause and effect. Imagine an interview with a future employer, or with a mental health counsellor you get to an important question that needs an answer and you are having a hypo! Imagine you need to turn your pump off and find your glucose and your having a hypo! It's almost impossible. My team told me not to " beat myself up over my control"!
How many other diabetics have this problem? I do not think it is a "recognised" or is researched by anyone. Please let me know if I'm incorrect and is there something to help reduce this effect?

 

[Pumper_Sue]

Imagine you need to turn your pump off and find your glucose and your having a hypo!

Why would you turn your pump off? If you are hypo then treat the hypo the hypo was caused by insulin already in the system.

If you know that stress causes you to go low then the simple solution is to cut your basal back if you have a planned stress (to you) situation. 🙂

Welcome to the forum 🙂

 

[everydayupsanddowns]

Which pump do you use @JANETr ?

If I need to stop insulin delivery (eg in advance of exercise) I find it works well to set a 0% Temporary Basal Rate. That way I can define the time (I wouldn’t go more than 2hrs), and I get a beep at the end to remind me to check how things are going.

It’s a manual version of the sorts of basal suspends 2 of my pumps have featured, but I can get it going a bit earlier when I know my BG is likely to drop in the near future.

 

[Lucyr]

I have suffered from anxiety since early childhood. When I became a Type 1 it took me all my working life to realise that mental stress has a profound effect on my blood sugar control. Anxious? Blood sugar levels become like a fiddler's elbow! Continuous monitoring has allowed me to discover this cause and effect. Imagine an interview with a future employer, or with a mental health counsellor you get to an important question that needs an answer and you are having a hypo! Imagine you need to turn your pump off and find your glucose and your having a hypo! It's almost impossible. My team told me not to " beat myself up over my control"!
How many other diabetics have this problem? I do not think it is a "recognised" or is researched by anyone. Please let me know if I'm incorrect and is there something to help reduce this effect?

I also have anxiety and find stress affects my blood sugar but also that the symptoms of hypo and anxiety can be identical so it can be hard to tell which is which. People often tell me I look like I’m having a bad hypo when I’m actually having a panic.

Do you take medication to help your anxiety? I’ve found propanalol helpful at high enough doses.

 

[JANETr]

Why would you turn your pump off? If you are hypo then treat the hypo the hypo was caused by insulin already in the system.

If you know that stress causes you to go low then the simple solution is to cut your basal back if you have a planned stress (to you) situation. 🙂

Welcome to the forum 🙂

Excellent question. Thank you for replying. Hypo caused by excess of insulin for current situation. If pump goes on running it is delivering more insulin to "fuel" my hypo. I found it harder to recover from hypo after taking glucose if pump left running. So now I stop pump and take glucose and take Freestyle libre readings every 10 minutes to monitor treatment progress. I turn pump back on when bloods are above 5. This was recommended to my carer by a paramedic when I had a severe hypo. It seems to work well.

 

[JANETr]

Which pump do you use @JANETr ?

If I need to stop insulin delivery (eg in advance of exercise) I find it works well to set a 0% Temporary Basal Rate. That way I can define the time (I wouldn’t go more than 2hrs), and I get a beep at the end to remind me to check how things are going.

It’s a manual version of the sorts of basal suspends 2 of my pumps have featured, but I can get it going a bit earlier when I know my BG is likely to drop in the near future.

Aaaah, I cycle ( like a lunatic) and don't start until my bloods are above 10. I then run my pump at 40% basal rate for the duration of my ride. Generally my prior bolus is set at 50% for the carb intake of a meal. I have a Medtronic 670G pump. Insulin boluses seem to last about 4 hrs, the length of my rides. I take Freestyle readings every 20-30 minutes during my ride. Cycling, like a lunatic, can lower blood sugars very quickly From 10 to 6 in 30 mins is very easy. Below 7 I take sugar drinks; ten grams glucose per 100ml. Little and often is best as when cycling I do not digest carbs like sweets, buns, cake or even jam sandwiches! The carbs just sit in the stomach until I stop riding and then whoosh up go the blood sugar tests and a bolus to treat the "undigested" carbs is required to restore normality! Why my digestion is so mystifies me. Many years ago, when I raced a bicycle I could consume 125g of glucose in 12.5miles and still have normal urine sugar tests! Those were not "the days"! Thank you for your reply. Your approach is interesting and comforting.

 

[JANETr]

I also have anxiety and find stress affects my blood sugar but also that the symptoms of hypo and anxiety can be identical so it can be hard to tell which is which. People often tell me I look like I’m having a bad hypo when I’m actually having a panic.

Do you take medication to help your anxiety? I’ve found propanalol helpful at high enough doses.

Now Lucyr your reply is what I was hoping for as I was diagnosed with ASD (autism) at the grand age of 65! I'm not sure I like labels, but life WOULD have been easier if I had worn that label as a banner throughout my life! I agree, a hypo and anxiety have exactly the same hallmark symptoms. It has taken me years to realise this. After all, I am "perfectly alright, thank you." Doctor asks "How are you?" Answer given is "I'm fine thank you!" When all the time you have been having hypos at night, before breakfast, at morning tea/coffee, in the middle of a team meeting or a planning meeting for next year's objectives, over the previous week!! I cannot process questions like "How do you feel?" "What do you like?" Would you like jelly, ice cream, fruit or biscuits and cheese?" "All four is not seen as socially acceptable or dietarily desirable." Worse, will what I am about to do/experience turn out to be stressful? How the hell do I know until I am doing it? So, setting a basal rate to take account of potentially stressful situations is kind of a no go area! ""I guess that you, Lucyr, may recognise all of this kind of "stuff". Normal neurotypicals can understand these "foibles" but often dismiss our behaviour as just plain "weird". Hey Ho!
Medication? Now there's an interesting subject! Do you find your response to medicines atypical? The world of medication is unusual since the side-effects of many pharmaceutical compounds are identical to the condition that they are meant to treat! Not sure why this is? Me neither!
A single 20mg capsule of Fluoxetine keeps me less prone to panic attacks. High dose propanolol makes me faint. (I required four catheter ablations to relieve my atrial fibrillation.) A single 20mg tablet of Citalopram takes off all restraints. Two paracetamol tablets are an excellent, fast acting sedative/hypnotic and will put me to sleep. Half a paracetamol tablet reduces anxiety greatly. Half an aspirin is an excellent anti-depressant. I am told that these effects are atypical responses. However, for me, these are real and only recognised after many years yet easily dismissed as the placebo effect.
So diabetic control? Simple; a nightmare. My HbA1c hovers around 7.2-7.4 (in old money) but on a daily basis? May be 10 hypos a week! Thank you for replying. I suspect that many other people with autism have similar diabetes issues. I wonder what the experts know?

 

[helli]

When I cycle (like a lunatic - you are not alone in doing that), I find the best way to manage my levels is to suspend my basal (turn my pump off) from an hour before I start and then resume it an hour before I finish.
I also try not to eat for 3 or 4 hours before exercising To avoid having any bolus on board.
If I suspend the pump when I start, I have too much basal on board when I start so my levels will drop quickly,
i I resume after I finish, I am lacking insulin so my levels will go high.

 

[JANETr]

When I cycle (like a lunatic - you are not alone in doing that), I find the best way to manage my levels is to suspend my basal (turn my pump off) from an hour before I start and then resume it an hour before I finish.
I also try not to eat for 3 or 4 hours before exercising To avoid having any bolus on board.
If I suspend the pump when I start, I have too much basal on board when I start so my levels will drop quickly,
i I resume after I finish, I am lacking insulin so my levels will go high.

I guess we really should stop behaving like lunatics. However, where is the fun in that? I like the way you have tackled the problem. It is interesting that your blood sugar levels rise after the exercise too. You suggest because you lack insulin. Some have suggested to me that adrenaline released during the exercise stimulates glycogen breakdown and therefore raises blood sugar. I'm not sure because I don't store much glycogen as a Type 1 diabetic and endurance events over several days do not suit me, or my metabolism! I may forego my breakfast, like you, and reduce my basal to say 40% to see if that prevents the sharp drop caused by the residual bolus when I have a breakfast. Thank you for sharing your experience. It is very valuable.

 

[Lucyr]

Now Lucyr your reply is what I was hoping for as I was diagnosed with ASD (autism) at the grand age of 65! I'm not sure I like labels, but life WOULD have been easier if I had worn that label as a banner throughout my life! I agree, a hypo and anxiety have exactly the same hallmark symptoms. It has taken me years to realise this. After all, I am "perfectly alright, thank you." Doctor asks "How are you?" Answer given is "I'm fine thank you!" When all the time you have been having hypos at night, before breakfast, at morning tea/coffee, in the middle of a team meeting or a planning meeting for next year's objectives, over the previous week!! I cannot process questions like "How do you feel?" "What do you like?" Would you like jelly, ice cream, fruit or biscuits and cheese?" "All four is not seen as socially acceptable or dietarily desirable." Worse, will what I am about to do/experience turn out to be stressful? How the hell do I know until I am doing it? So, setting a basal rate to take account of potentially stressful situations is kind of a no go area! ""I guess that you, Lucyr, may recognise all of this kind of "stuff". Normal neurotypicals can understand these "foibles" but often dismiss our behaviour as just plain "weird". Hey Ho!
Medication? Now there's an interesting subject! Do you find your response to medicines atypical? The world of medication is unusual since the side-effects of many pharmaceutical compounds are identical to the condition that they are meant to treat! Not sure why this is? Me neither!
A single 20mg capsule of Fluoxetine keeps me less prone to panic attacks. High dose propanolol makes me faint. (I required four catheter ablations to relieve my atrial fibrillation.) A single 20mg tablet of Citalopram takes off all restraints. Two paracetamol tablets are an excellent, fast acting sedative/hypnotic and will put me to sleep. Half a paracetamol tablet reduces anxiety greatly. Half an aspirin is an excellent anti-depressant. I am told that these effects are atypical responses. However, for me, these are real and only recognised after many years yet easily dismissed as the placebo effect.
So diabetic control? Simple; a nightmare. My HbA1c hovers around 7.2-7.4 (in old money) but on a daily basis? May be 10 hypos a week! Thank you for replying. I suspect that many other people with autism have similar diabetes issues. I wonder what the experts know?

All the autism related differences make sense to me, I run an autism support group and I’m not sure there’s much left that I haven’t experienced or heard related to autism difficulties now! Having the formal diagnosis, however late it comes, does help.

I do feel like I have an atypical response to medications. I was diagnosed T2 aged 20, have tried every type of T2 medication out there, multiple different brands or some categories, and none worked, or I got bad side effects with them all. I do often find that digestive system issues are more common in autistics though so perhaps that explains why I’m more sensitive to some medication / diet changes.

Interestingly I’ve also had a catheter ablation, but for SVT. I used to take bisoprolol for it but switched to propanalol as it’s supposed to be better for anxiety. I don’t take it as consistently as it’s prescribed because whilst it helps, I don’t like the feeling of it kicking in and wearing off, and I find that it stops me getting good excitement adrenaline as well as the stressed adrenaline.

Whilst I agree that the level of stress is not predictable, you can predict that some situations have a higher likelihood of being stressful, and you can then look for patterns in what happens to your blood sugar. For example, I know that band practice occasionally has me in a complete out of the blue panic attack, fairly often has me having some level of stress because it’s busy/noisy/nerves, and fairly often is fine. I want to relax and enjoy it so I reduce my insulin with the meal before slightly, have a meal that is easy to count I avoid guessing around stressful situations, I make sure to take my propanolol, and make sure to test my bg more often than usual as it’s unpredictable when stressed.

None of that really causes an issue if it turns to be a non stressed occasion, but helps me keep calm and reduces hypos/anxiety attacks if it is a stressed occasion. But yes I can’t always predict the stress so I only go to that effort for things I know are more likely to be stressful and where bg issues would be too much added stress.