Low Bloodsugar and Anxiety

Hi Everybody!

My name is Jen and I'm 28 yrs old. I recently returned to the University of Arkansas to finish my degree. When I was 24, I withdrew from the end of my sophomore year because I was working full-time and in school full-time. I ended up with keto-acidosis and it was terrible. Anyway, I am back in school and have finally declared a major of social work. My problem is that since I've been back at school, my anxiety level has been off the charts. I'm socially uncomfortable and especially worried about my blood sugar. I test before class but then begin feeling very anxious in class and always wonder whether it's my blood sugar or social anxiety. I'm coming apart at the seams here. Just when I think I've got myself together, I have a new humongous obstacle to face. I'm afraid that I won't be able to finish my degree-which means I'll never get good health care and I can't stand the thought of being a waitress for one more year of my life. I'm desperate for a way to soothe myself-is there any way to know the difference between low blood sugar and an anxiety attack besides testing again?

Thanks for your responses,

Hello Jen,

I think the only way to know for sure is to test. What symptoms do you have when you have lows, are there any that are different than your anxiety attacks? I find that stress and anxiety make me go low, but my bg lows usually have sweating, feeling jittery, numbness and tingling and many other symptoms which anxiety doesn't have for me. I think the more you test the better you will be and you can then begin to distinguish between the two. Maybe you can try talking to someone about the anxiety and this will help too.

Testing is the way to go. If I cannot test, but worry about lows, sometimes i will eat 4 glucose tabs and worry about the result later.

Testing is key, and although I am not always an advocate of this, I would recommend charting your results, your carb intake, exercise etc. By doing this you may be able to see patterns, understand the ups and downs of your glucose levels, etc.

Hopefully, this will help you become less anxious.

Also, I am assuming your are using injections, not a pump. The continuous glucose monitor is another great tool, but you need a pump for that.

Is it possible for you to get a CGM? I'm assuming you're on MDI and not the pump, correct?

I think this kind of anxiety is quite a bit normal for T1s. I've gone through this myself. One thing you can do is simply test in class if you suspect you're going low. If you're self conscious about testing in class, pick a seat that either conveniently allows you to escape class OR one that allows you to discretely test yourself. This is what I always do. I carry a large bag and stash my meter so that I don't have to even pull it out to test. Most of the time, people don't even notice what I'm doing. If you're in a class that's 2 hours long, you very well may have to test in the middle of the class.

Another thing - follow as predictable a schedule as possible when it comes to insulin and food. This has helped me a lot. Find foods that are easy to bolus for (i.e., that don't increase your risk of going low) and pack them each day before you leave the house. Carry plenty of snacks with you.

If you're worried about missing out on class or encountering issues at school because of diabetes, seek out the assistance of your school's guidance counseling center or disability support center. There may not be much they can do, but it's worth checking out.

Anxiety when going back to school after being out for awhile can be quite normal, especially if this is your first semester or two being back. You may be simply worried about your ability to succeed, as you expressed in your original note. This will subside as you get used to the new environment. It may well be this and not your diabetes, in which case visiting the school's counseling center may help.

A CGM would provide confidence that things aren't changing rapidly, but without insurance may be too expensive.

I agree with the other suggestions - do not be shy about testing. After testing a few times in the middle of class, you may build confidence that if you start out with a good BG before class, it will not shift too much in a 50 minute or 1 hour class. In a 2 hour class, as suggested above, it may make sense to test in the middle.

One more thing - how often are you experiencing lows ? And what do you call "low" ?

If you are experiencing too many, it may be that your insulin regimen needs to be adjusted (I:C ratios, or basal insulin) in order to provide a more stable environment. This too would make you worry less. As Spock suggested, logging can help with identifying the patterns needed to make any adjustments you need.

Your university has a counseling and psychological services unit (CAPS) as part of student health services....they may be very helpful in working with you to sort things out. Their services may be included in your tuition or be at a nominal fee. People are sometimes too reluctant to seek out services like this ... it's better to seek help sooner than later.


Hi Jenn, as others have mentioned, a CGM could be a great comfort during class if you have insurance that would make it affordable. I use a Dexcom CGM and leave it on my desk at work so that I can check it periodically. The CGM doesn't mean that I test any less but it gives me a great deal of peace of mind to know which way I'm trending. If I see I'm drifting down, I confirm it with a test and then pop a sweetart to bump it back up. I've pretty much eliminated most of my lows since I got the Dexcom and got comfortable with using it.

Another thought if you're actually having lows in class (that you've confirmed with testing) is that maybe your basal needs to be reduced because your activity level has changed. I'm in Louisiana so have to deal with the heat and humidity like you do in Arkansas. Walking to class across campus could cause your basal needs to be reduced, expecially when it's hot.

You don't say if you're on a pump or MDI, but if you're on a pump, you could just turn down your basal just a notch for the duration of class to give you that peace of mind you're looking for so you can focus on class. I do that sometimes at work if I have a major important project I'm working on.

Good for you for going back to school, Jenn, and for seeking solutions to make it work. You will get lots of good advice and tips here.

A couple suggestions, Jenn, aside from the great Diabetes related suggestions above:

Your school counseling center is a place to start, but if you have problems with anxiety that warrant therapy beyond the scope of their services they will refer you out to a therapist. That might be a good idea to see if you suffer from an anxiety disorder that needs treatment either with meds, therapy, or both. If you can find a therapist that has experience with PWD (people with Diabetes) that would be even better. You might also want to check with your local branch of JDRF to determine that.

Finally, while you work on these issues, you might want to see if your college has any online courses. Online courses are becoming more and more common at colleges and universities, especially in more rural areas, and because students can fit online courses into their busy lives. If your college doesn't have any online courses, you can find another college that does, making sure you can transfer the credits. It would be a way to get some credits and requirements met while you work through these issues and so you'll feel less discouraged. Best of luck to you.