Fear of Hyperglycemia

Many people with diabetes worry about having low blood sugars (hypoglycaemia, or ‘hypo’s’).
To a certain extent, worrying about low blood sugars is a normal and healthy phenomenon in all diabetes patients on insulin (or other blood glucose lowering medication). However, in some people normal and healthy worries develop into hindering anxieties, that influence their blood sugars and quality of life. Often, these anxieties develop after having experienced a serious hypo, needing help from others, and/or being unconscious. But in some people these hindering anxieties might also develop without having experienced a serious hypo.

Many people with fear of hypoglycaemia worry about:

-having a hypo while asleep (or even dying from a hypo in their sleep)
-losing consciousness in public, while driving or being alone at home
-needing help from others, attracting unwanted attention

In some people these anxieties are so intense that they will make sure their blood sugars never drop below a certain level. They might eat some extra carbs before going to bed, before/while driving, or before going out, even when their blood sugars don’t really ‘need’ an extra snack. Or otherwise, people might use less insulin than they should, just to make sure that their blood sugars won’t drop. Some might check their blood sugars excessively, to monitor potential blood sugar drops.
These are all common behavioural reactions to anxiety, and are called ‘’safety behaviours’’. In the short term, these safety behaviours help to prevent/decrease anxiety. However, in the long term, these behaviours make people more insecure about low blood sugars, and help to develop even more anxiety.
That is why it is so important to limit the ‘’safety behaviours’’ to a healthy and rational amount.

If you recognize these anxieties and safety behaviours, there are a few steps to take:

  1. it is good to let others know about it. Best would be to inform your partner/significant other, as well as your diabetes health care professional (s).
  2. make a list of the questions/worries you have about hypo’s. Explain what your fears are about
  3. make a list of the specific safety behaviours that you perform to reduce your anxiety
  4. let a diabetes health care professional educate you about hypogly
  5. let a diabetes health care professional help you in making a stepwise plan on how to limit these safety behaviours

How to enjoy Christmas with Diabetes?

  • Try to fit in some physical activity over the Christmas period –shopping in the sales, a brisk walk with the grandchildren or dancing at a party all count. See also our keeping active guide.
  • Keep healthy snacks around the house so you have something else to snack on instead of chocolates and mince pies.
  • Try to eat fairly healthily on the days between Christmas and New Years to help prevent the pounds piling on too much.
  • Donate unwanted tins of biscuits and boxes of chocolates to your local hospice or care home.

What should I eat when travelling by plane?

Airlines can provide information on the times of most meals so you can plan your insulin. It is best to order the standard meal, though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets. Cabin crew are usually able to provide fruit, crackers or rolls.

On long flights, you may require snacks in between meals and at bedtime to prevent blood glucose levels going too low, so try to carry extra starchy carbohydrate foods, such as biscuits, cereal bars or fruit buns, on board the aircraft. For the journey, some people allow their blood glucose to run slightly higher than usual to avoid the inconvenience of hypos. If you are on insulin, monitor your blood glucose levels frequently and be prepared to make changes to your dosage.

If I have a hypoglycemic event while driving, what should I do?

If you have a hypoglycemic event  whilst driving:

  • Stop the vehicle as soon as possible
  • Switch off the engine, remove the keys from the ignition and move from the driver’s seat
  • Take some fast-acting carbohydrate, such as glucose tablets or sweets, and some form of longer-acting carbohydrate.
  • Do not start driving until 45 minutes after blood glucose has returned normal.

If you have poor warning signs, or have frequent hypos, you should probably not be driving because of the risk to yourself and others. Discuss this with your doctor. If he advises you to notify the DVLA/DVA you must do so. If you fail to do this, your doctor has an obligation to do so on your behalf.

I have to go through an X-ray machine at the airport, is it safe?

The advice given by the Civil Aviation Authority regarding pumps and scanners is as follows:

“There are a number of manufacturers of insulin pumps and unfortunately they do not all give the same advice. This varies from assurance that the pumps can safely go through any screening equipment, including X-ray equipment, to advice that the equipment may be affected by even the low-dose X-ray equipment used in some whole body scanners.”

“If you use an insulin pump, it is therefore important to contact the manufacturer of the particular pump that you use for advice. It is also sensible to contact your airline and the airports you will travel through, to find out their requirements if the manufacturer advises that your pump cannot go through some screening equipment.”

For pumps that are not able to pass through body scanners, the advice is as follows:

 “There are some airports where you will not be allowed to travel if you refuse to be scanned. It is therefore advisable to check with your airline and the airports you will be passing through to see if they do allow an alternative check.”

If your pump cannot pass through a scanner and the refusal to pass through will result in refusal to fly.

How to deal with my Diabetes during and after a pregnancy

During your pregnancy

You will be offered extra monitoring appointments and scans during your pregnancy to help you keep good control of your blood glucose and check your baby’s growth and development. You should have contact with your diabetes team every one or two weeks.

Your doctor will encourage you to do extra blood glucose tests and agree on personal target levels. Generally the aim is for before meal levels of 3.5–5.9mmol/l and less than 7.8mmol/l one hour after meals.

You may find you are more at risk of hypos due to tighter control. You should be given a glucagon kit: ensure that family/friends understand how to use this if you are unable to treat a hypo yourself.

Top tips for a healthy pregnancy

  • Stop smoking
  • Avoid alcohol
  • Eat a healthy balanced diet
  • Keep active


After the birth

Generally, your experience should be the same as anyone’s. But because you have diabetes, doctors will take some extra steps to make sure you and your baby are off to a healthy start.

  • Your baby: All babies’ blood glucose levels drop after separation from the mother. Breastfeeding soon after delivery and at regular intervals usually resolves this.
  • Your baby’s blood glucose will be regularly checked after birth and extra feeds may be given if needed. Your baby should stay with you unless there is a medical reason why he or she needs admitting to a neonatal unit for extra care.
  • After delivery, your insulin needs will significantly drop. You may need an intravenous insulin/glucose drip for a few hours after delivery and your insulin dose will be adjusted as needed.
  • Your blood glucose will be checked regularly, until your levels stabilize. When you resume your normal diet, you should also return to your pre-pregnancy insulin dose. If you were taking insulin for gestational diabetes, the insulin can usually be stopped immediately after delivery.
  • Most women who deliver by Caesarean section are given antibiotics after delivery in order to decrease the risk of infection at the wound site.


Breastfeeding and diabetes

Breast is best, and there’s no reason diabetes will change this. There’s no reason why women with diabetes cannot breastfeed. You may have some early difficulties – for example if your baby needs extra feeds, or if you were initially separated from your baby due to Caesarean section or your baby’s treatment in the neonatal unit – but with patience and practice you and your baby should be able to establish a good breastfeeding pattern.

  • Breastfeeding may lower your insulin needs by up to 25 per cent. Breast milk contains sugar called lactose. Every time you feed your baby, you will lose that sugar and your blood glucose will drop, which may cause a hypo. To help avoid hypos, you may need to eat 40–50g more starchy foods per day while you are breastfeeding.
  • Even though you will be eating more, breastfeeding will not make you gain weight. In fact, it may help you lose weight.
  • If you take Metformin or glibenclamide for Type 2 diabetes, you can usually resume or continue taking these while breastfeeding, if your doctor is in agreement.

Things to check and pack before you travel

  • Carry diabetes ID and a letter from your doctor if you are carrying insulin.
  • Take twice the quantity of medical supplies you would normally use for your diabetes.
  • Flights often cross time zones. If you treat your diabetes with medication or insulin it’s important you check with your diabetes care team. If you need to make any changes to your regimen be mindful that hot or cold climates may affect how your insulin and blood glucose monitor work.
  • Make sure you have the free European Health Insurance Card (EHIC) if you are traveling to a European Union member country – it will ensure that you have easy access to healthcare in that country. Remember it is still advisable to buy travel insurance, as the card doesn’t cover, for example, emergency repatriation.

Packing for your trip:

  • Split your diabetes supplies in separate bags.
  • If flying make sure you have some diabetes supplies in your hand luggage in case your bags get lost.
  • Pack extra snacks in case of delay with your journey
  • Make sure you have all your diabetes medication and equipment packed.
  • If you are carrying syringes and insulin on your flight take a letter from your doctor.

Note: In some countries, blood glucose is measured in milligrams per 100 millilitres (expressed as mg %) and not in millimoles per litre (mmol/l). A blood glucose conversion chart is below.



mg %


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How to drive a car safely

The licensing agencies are trying to ensure you are safe on the road. They will be concerned if you are unable to recognize or self-treat your hypos.

If you are on insulin, check your blood glucose within 2 hours before getting behind the wheel and every two hours whilst driving.

If you hold a Group 2 license and take non-insulin medication which may cause a hypo you should check your levels at least twice per day at times relevant to driving. The results should be recorded on the meter memory.

Safe driving tips

  • Avoid delaying or missing meals and snacks
  • Take breaks on long journeys
  • Always keep hypo treatments to hand in the car
  • Do not drink alcohol and drive
  • Many of the accidents caused by hypoglycemia are because drivers have continued to drive, ignoring their hypo warning signs (e.g., hunger, sweating, feeling faint).

If you have a hypo whilst driving:

  • Stop the vehicle as soon as possible
  • Switch off the engine, remove the keys from the ignition and move from the driver’s seat
  • Take some fast-acting carbohydrate, such as glucose tablets or sweets, and some form of longer-acting carbohydrate.
  • Do not start driving until 45 minutes after blood glucose has returned normal.

If you have poor warning signs, or have frequent hypos, you should probably not be driving because of the risk to yourself and others. Discuss this with your doctor. If he advises you to notify the DVLA/DVA you must do so. If you fail to do this, your doctor has an obligation to do so on your behalf.

Motor Vehicle Insurance

When applying for motor insurance you must declare you have diabetes even if you are not asked about this. You should also inform your insurance company of any changes to your condition or treatment. Failure to do so, or failure to notify DVLA/DVA where required, could mean you are not covered. If you feel your premium is too high it is worth challenging your insurer. Insurers can only refuse cover, or charge more if they have evidence of increased risk.

How to tell your colleagues at work about your diabetes

Some people are ill-informed about diabetes, and they may respond irrationally out of fear or ignorance.  A simple explanation about diabetes is all you need to give. If you do not treat your diabetes as a problem, it is less likely that your colleagues will.

  • Hypos at work: It’s important to tell colleagues how to recognize and treat a hypo (hypoglycemic episode) if you experience these. This will stop them from overreacting at the time and will help to make sure that any hypos you have are treated correctly. Talk to your first aider about your diabetes too and make sure they know what to do in an emergency. If you have had a hypo at work and needed help to treat it, talk to your employer and colleagues afterwards. If possible, explain why the hypo happened to show them that you can normally control the situation and it is unlikely to happen again.
  • Taking time off: Everybody takes time off work for sickness or hospital appointments, whether they have diabetes or not. Diabetes does not necessarily make you more prone to sickness. If possible, try to arrange several clinic appointments for the same morning and give your employer plenty of notice of when and why you will be absent. When you are ill, seek prompt medical attention and keep your employer informed of what is happening.
  • Sources of support and further information: If you feel discriminated against at work, or that you might have been turned down for a job or dismissed because of your diabetes you will probably need specialist advice initially, and in some cases legal advice, if you wish to challenge employment decisions.

I have to go to the hospital, what should I take into consideration when preparing?

You may have a stay in hospital (long or short). This may be for something diabetes related, or not.

Here are some things to think about:

  • The hospital should provide the insulin you normally use – but this may take some time so take some with you to avoid delays.
  • Take your own supplies of diabetes equipment, e.g., blood-testing kit or pump supplies (they probably won’t be able to provide this).
  • Ward staff should be up-to-date with your diabetes care, but do check that they have discussed it with your diabetes team. If they haven’t yet, make sure they do.
  • Don’t assume that everyone treating you will know you have diabetes – it’s always better to be over-cautious and keep mentioning it.
  • While in hospital, your blood glucose levels may be higher or lower than normal. Stress and longer periods of inactivity are just two reasons why. Your blood glucose levels might need to be tested more often and treatment adjusted.

If you want to manage your diabetes care yourself while in hospital you should be supported