One in seven people with diabetes is living with the fear of hypoglycaemia, which has the potential to impact their emotional wellbeing and management of the serious, complex condition.

With mental health care for people with diabetes recognised as a priority area in the Australian National Diabetes Strategy 2016-2020, the National Diabetes Services Scheme (NDSS) recently released a resource to help equip health practitioners, including diabetes educators, nurses, GPs, dietitians and other allied health practitioners, with the strategies and tools to better recognise emotional problems in the 1.7 million Australians living with diabetes.

The Diabetes and Emotional Health handbook and tool kit, a free online resource and the first of its kind in Australia, aims to assist health practitioners to reduce the psychological burden of the condition - in both patients and in their carers.

Dr Christel Hendrieckx, a clinical psychologist with the Australian Centre for Behavioural Research in Diabetes (ACBRD), which developed the resource in conjunction with Diabetes Australia, says health practitioners must talk to patients with diabetes about their hypoglycaemia at every consultation.

Dr Hendrieckx says practitioners should ask patients about their experiences of hypoglycaemia, including frequency and severity, how they manage it, and discuss the patient’s knowledge and feelings about their low blood glucose levels.

“Hypoglycaemia is a well known complication of living with diabetes and more specifically it’s a side effect of the way we are treating diabetes today - it’s a side effect of injecting insulin and some of the medications people are taking,” she says.

“Health professionals know that it’s really a very impacting side effect of living with the condition but the emotional aspect, I think, is less known.”

Dr Hendrieckx says how hypoglycaemia impacts on patients’ lives does not often form a part of their conversation with their health practitioners.

“It’s a delicate conversation to have because it can have an impact on people’s driving or work conditions so it has to be in a very empathetic and non-judgemental way - do you have hypos and do you have symptoms, do you recognise when your blood glucose is going low?

“You need to see whether the person has the understanding or the ability to pick up a hypo in time and to treat it, because if that’s not the case, I think health professionals should talk to the person about - how can we manage your hypos better, so you can avoid very low blood glucose levels.”

Dr Hendrieckx says people with diabetes who fear hypoglycaemia may change the way they manage the condition, impacting on their diabetes and overall health outcomes.

“If someone really is afraid of having a low blood glucose level, they might change the dose of insulin they are talking or they might snack more regularly than they should, just to avoid going low,” she says.

“As a health professional, if you are not aware of these changes that a person is making in their management, it’s harder for you to understand what is going on - why this person is getting these diabetes outcomes?

“We also know, for example, many people with diabetes fear the chronic complications - the impact it can have on their vision or their kidneys, and that’s a very common concern for many people with diabetes.

“If you can talk about these fears you can get a better understanding about how the person is managing their diabetes in their daily life, and it will give you so much valid information on how you can support these people in a more holistic way - not just focusing on the medication or the diet or whether the person is exercising or not.

“The medical part of managing the condition cannot be separated from how people cope, think and live with the condition - it impacts on a lot of aspects of a person’s life.”

The resource comes as a new report, Incidence of Insulin-treated diabetes in Australia, from the Australian Institute of Health and Welfare (AIHW) shows 28,775 Australians - 63 per cent with type 2 diabetes, 26 per cent with gestational diabetes, and nine per cent with type one diabetes - began using insulin to treat their diabetes in 2015.

The report, which uses data from the National (insulin-treated) Diabetes Register, shows 2617 people were diagnosed with type 1 diabetes in 2015 (around one in every 8000 people), the incidence was higher in males than females, while almost two in three of people with type 1 diabetes were under the age of 25.

It reveals 18,142 people began using insulin to manage their type 2 diabetes (about one in every 1400 people), the incidence was almost 1.5 times higher in males than females, and more than 90 per cent of new cases of insulin-treated type 2 diabetes occurred in those aged 40 and over.

The highest rates of insulin-treated gestational diabetes were among pregnant women aged 40-44, with almost one in three women, or 30 per cent, requiring insulin treatment.

Dr Hendrieckx says while many practitioners believe they don’t have the time to discuss emotional wellbeing, it can be easily and quickly incorporated into every consultation.

“It’s all intertwined. If you look at somebody’s blood glucose levels, and you talk about the blood glucose levels, it’s so helpful to understand what do these outcomes mean for this person - are they frustrated or happy about it, do they understand why they are getting these numbers, are they looking for a job and they are stressed about this specific situation?

“That gives you as a health professional a much healthier material to work with and to really support that person in that wholistic approach.

“Then you can work together with that person and say - I understand this, or the challenges with you living with your condition. Let’s talk about how we can make it a bit more easier for you, what are the things we can discuss and agree upon which will become a bit more easier for you to live and manage your condition.

“Give it a try and see how it impacts on the relationship with your patients.”