Severe hypoglycaemia: how does it impact people with type 2 diabetes?

The centre published the first systematic review on the psychological impact of severe hypoglycaemia in adults with type 2 diabetes

by Dr Shikha Gray

Hypoglycaemia is often believed to be more problematic for people with type 1 diabetes (T1D) than for those with type 2 diabetes (T2D). However, hypoglycaemia is common in T2D, particularly in insulin-treated T2D. As many as 45% of people with T2D have reported self-treated hypoglycaemia and 6% have experienced severe hypoglycaemia (whereby external assistance was required). These statistics underscore the need to examine how hypoglycaemia impacts people living with T2D.

After experiencing severe hypoglycaemia, many people adopt behavioural strategies to reduce their fear and to avoid its repetition. Some of these strategies may be counterproductive. For example, people may excessively reduce their insulin dosage or engage in defensive eating. In the long term, these behaviours may lead to persistent hyperglycaemia and increased risk of developing diabetes-related complications.  Therefore, it is important that we understand the psychological and emotional aftermath of a severe hypoglycaemic episode. Such research can shed light on what motivates people to undertake the above strategies and what can be done to support people to cope with the experience in an adaptive way.

Hence, our team at ACBRD set out to explore how severe hypoglycaemia is linked to psychological well-being and quality of life of people with T2D. We turned to existing literature: through a systemic search, we found 29 studies that were relevant and aggregated the findings. These are summarised below:

  • There is strong evidence that severe hypoglycaemia is associated with greater ‘fear of hypoglycaemia’ and decreased health status; also that these severe episodes could reduce emotional well-being.
  • Studies exploring severity levels of hypoglycaemia (e.g. mild, moderate, severe episodes), showed that ‘fear of hypoglycaemia’ did increase with severity but differences were relatively small. This suggests that the fear may arise from the anticipation of experiencing a future severe event rather than the event per se.
  • The psychological impact of severe hypoglycaemia is not exclusive to those managing their diabetes with insulin; people who take oral medication may also be impacted.

Overall, our findings add to the body of literature on the importance of mental health issues in people with T2D. Particularly, we have shown that severe hypoglycaemia can take an emotional toll on the person.

The take home message for health professionals is that people with T2D should be asked about whether they have experienced hypoglycaemia (whether it be self-treated or requiring help) and, if so, how they were psychologically affected by it. This can open up an opportunity to provide appropriate emotional and behavioural support, which may then help curtail counterproductive coping strategies and promote psychological well-being.

Check out our other blogs on type 2 diabetes, hypoglycaemia and mental health.

Hendrieckx, C., Ivory, N., Singh, H., Frier, B. M., & Speight, J.Impact of severe hypoglycaemia on psychological outcomes in adults with Type 2 diabetes: a systematic review. Diabetic Medicine. 2019;

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