Mental Health Q + A with Diabetes Psychologist Mark Heyman


Dr. Mark Heyman is a diabetes psychologist and a certified diabetes educator. founder and director of the Center for Diabetes and Mental Health (CDMH), he is passionate about understanding and supporting the ways diabetes impacts not just the physical but mental health. Mark also lives with type 1 diabetes.

If you have type 1 diabetes or are caring for someone who does, it is likely that you or your loved one might experience any of the following: stressdiabetes distressburnoutdiabulimia and/or depression. We’re here to talk about it. If you have a question you’d like Mark to answer here, e-mail it to with the subject line “Mental Health Q”!

Question: How do you stop a downward spiral when you have a high blood sugar that won’t budge? 

I know that one of the toughest things about living with diabetes is when your blood sugars won’t do what you expect them to do. You take insulin and wait. And your blood sugar doesn’t move. You change your infusion set, or change pens and give yourself more insulin and your blood sugar stays high. You feel angry, frustrated and out of control. Given the situation, these feelings are totally understandable—and normal.

If you have ever been in this situation (and I don’t know anyone with type 1 diabetes who hasn’t) you know how easy it can be for these feelings to spiral and become bigger and more intense. In order to stop this downward spiral, it might help to take a step back take a closer look at these emotions and where they come from.

Imagine for a minute that this happens to you…

You look at your continuous glucose monitor (CGM) and you see a 223mg/dl with double arrows up. You take some insulin and eventually your blood sugar levels off just over 300mg/dl. You take more insulin and two hours later, you’re still riding right around 300mg/dl. You’re feeling irritated, impatient and maybe even a little helpless.

But what’s making you feel this way? The blood sugar that won’t budge pushes you there, but usually that’s not what is causing the emotion. The fact that your blood sugar is high and you can’t bring it down leads to some thoughts, or beliefs about yourself or about your life with diabetes, and it’s these thoughts that make you feel these things and turn these feelings into a downward spiral. For example, you may tell yourself things like ‘my diabetes is out of control’ or ‘diabetes is a never ending hassle.’ When you have these thoughts, it’s natural that you would feel frustrated or helpless.

If you start feeling this way, try taking a step back and ask yourself how accurate is your thought? Does the thought match the reality of the situation? For example, does a having a high that won’t come down really mean that your diabetes is out of control? Or could it mean you are having a frustrating diabetes day? Does it mean that diabetes is a never ending hassle, or could it mean that diabetes is a big hassle today and tomorrow it might be better? My guess is that if you are able to catch your thought (e.g., ‘My diabetes is out of control’ before your emotions start to spiral, and replace it with a thought that is more realistic (e.g., ‘Today my diabetes feels out of control, but hopefully tomorrow will be better—it usually is), your feelings won’t spiral. That’s not to say that you won’t have negative feelings about diabetes sometimes—I would be worried if you didn’t—but this can help keep your emotions from becoming bigger than they need to be.

Question: How can I work on getting over a fear of lows? 

If you are taking insulin and trying to keep your blood sugar close to your target range, you are probably going to have low blood sugars sometimes. With all the symptoms that come with low blood sugars, things like shaking, sweating and confusion, lows can be scary. There are even some people who have a fear of low blood sugar and so they keep their blood sugar high in order to avoid lows. Sometimes people with fear of low blood sugar stay away from doing activities that they think may make their blood sugar go low, like exercise, or where they think that treating a low could be challenging, like driving. Fear of lows can not only keep people’s blood sugar high, making them not feel well and putting them at higher risk for diabetes-related complications, but it can also have an impact on a person’s quality of life.

In my experience, people who have a fear of hypoglycemia fall into a couple of different categories: people who have a fear of hypoglycemia because they have had a really scary low in the past, and people who have never had a scary low.

Let’s start with talking about if you have a fear that started after having a scary low. If this has ever happened to you, it makes total sense that you would have anxiety.  The first thing I would suggest is to look and see if there is a reason why this low happened? Did you take insulin when you started eating dinner and then got distracted and didn’t finish all your food? Or did you go for a long run that day and forgot to set a temp basal later on? Trying to understand why something happened, based on facts can help you in a couple of ways. First, it can help you not do the same thing again. And second, it can help you put your fear in context. Fears tend to generalize, and if you can’t identify which situations that are safe which are not, everything becomes dangerous.

If you have a fear of low blood sugar, but have never had a scary low, you would probably approach your fear in a different way. You may be worried that you won’t be able to handle having a low blood sugar emotionally. You may also be worried that you won’t be able to treat a low if you do have one, either because you won’t have enough low supplies or you won’t be able to think straight. In this situation, I would encourage you to work to bring your blood sugar down in small steps, to show yourself that you can do it. For example, if you are nervous to have a blood sugar below 200mg/dl, try bringing it down to 180mg/dl before treating. A couple days later, try to bring it down to 160mg/dl. And eventually, bring it down, and keep in your target range. This will help you see that you can handle lower blood sugars. And eventually, hopefully you will go low and you’ll be able to pop some glucose tabs and see you’ll come right back up.

If you have a fear of lows that’s really affecting your life, and that you’re having trouble dealing with on your own, that’s when I would encourage you to get help from a mental health professional.

Another Q+A with Mark Heyman about navigating the holidays and lows can be found here.

Explore the full library of mental health resources for people impacted by type 1 diabetes here.

WRITTEN BY Mark Heyman, PhD, CDE, POSTED 10/02/18, UPDATED 10/31/22

Dr. Mark Heyman is a diabetes psychologist and a certified diabetes educator. He is vice president of Clinical Operations and Innovation at One Drop. He is also the founder and director of the Center for Diabetes and Mental Health (CDMH). He is passionate about providing diabetes education and evidence-based mental health treatment to people with diabetes. Mark received his PhD in Clinical Psychology from The George Washington University and completed his psychology internship at the UCSD School of Medicine. He holds an appointment as an assistant clinical professor in the Department of Psychiatry at UCSD. He has been living with type 1 diabetes since 1999. You can follow Mark on Twitter @DiabeticPsych and reach him by email at