Struggles with Panic Attacks

First, I want to address a question that Envoy posted on my blog entry from two weeks ago. Envoy asked if I thought that depression was more common in people who have diabetes. The first answer is that I have always believed it is more common, and research has also indicated that it’s twice as likely to occur in people who have diabetes. That is part of the reason I suggest a yearly mental health checkup in conjunction with your annual physical.


The percentage of people with diabetes who experience depression is quite significant, in the range of 20%. Hopefully, your health-care professional asks you questions about your moods, energy level, activities, sleep, and connections with other people at appointments. An open discussion of this type can give him or her enough information to begin an assessment for depression.

It makes sense that controlling diabetes would be made more difficult if depression is left untreated. However, fewer than 25% of cases of depression in people with diabetes are recognized and treated appropriately. We clearly have a lot of work to do in improving mental health care for people with diabetes.

Another mental health issue that has been shown to interfere with people’s diabetes control is panic disorder. Panic disorder is characterized by unpredictable, excessive fear or terror accompanied by a number of physical symptoms. Symptoms may include pounding heart, palpitations, sweating, difficulty breathing, numbness or tingling sensations, chest pain, dizziness, nausea, trembling or shaking, and chills or hot flashes. Many of these are similar to symptoms of hypoglycemia, or low blood glucose, and they could also resemble a heart attack. Therefore, a person may overreact (by visiting the emergency room, for example) or, thinking that his symptoms are due to low blood glucose, experience great confusion when he checks his blood glucose level, sees that it is fine, but nevertheless continues to experience real and very uncomfortable symptoms.

A recent study showed that people with diabetes who have panic disorder have higher HbA1c levels (a measure of blood glucose control over time) than people who don’t. This indicates that panic attacks may interfere with people’s ability to manage their diabetes. Panic disorder is also underdiagnosed, mostly because people who have it are embarrassed to bring their symptoms up with their doctor.

It is important to understand that panic disorder is a real disease that can be treated effectively if properly diagnosed. As with other mental health conditions, panic attacks are believed to be associated with changes in brain chemistry or abnormal activity in a part of the brain known as the amygdala. If panic disorder is left untreated, it can become complicated by avoidance of activity outside the home that leads to fear of having another panic attack. I worked with a young woman who refused to go to church or any place where she felt she couldn’t just leave at the first sign of an attack. After she was prescribed an antidepressant drug, she no longer had these attacks and was able to return to her normal way of living. She also continues to attend psychotherapy sessions, which also help with this disorder.

If these symptoms seem familiar to you and are not generally related to low blood glucose levels, it may be useful to discuss appropriate treatment with your doctor. At the very least, you can get more information on this issue by looking online at the National Institute of Mental Health’s Web page on panic disorder.

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  • italiangm

    The relationship between anxiety and metabolism is an important one.

    Our bodies are wonderfully adapted to short term stressors. But for each minute that a stressor like anxiety persists past the time it is needed, cortisol keeps suppressing body systems that digest, store energy, and grow/repair/replenish cells — muscle cells, pancreas cells, eye cells, nerve cells, lung cells, heart cells, brain cells, etc.

    Cortisol also reduces the amount and quality of insulin. Without insulin, cells can’t take up nutrients for energy or storage. Do this enough and some cells starve. Remaining cells become less sensitive to insulin. This leaves more glucose in the blood, eventually leading to glucose toxicity, insulin resistance, beta cell death, impaired glucose tolerance (IGT) type 2 diabetes and associated complications.

  • db122

    I had panic attacks for about 1 year before being diagnosed with Type 2 Diabetes. After I learned to control my diet, I only have them when my blood sugar is too high. I thought I was going crazy. Although it is nice to know why I was having the attacks, it is still scary when I have them, particularly since I live alone.

  • anxiety remedy

    Great post. Some natural anxiety remedies to look into are St.John’s Wort, SAMe, L-Theanine, and Tryptophan. There’s also cognitive behavioral therapy (CBT) and programs like Panic Away and The Linden Method, to name a few. Hope this helps!

  • Deven

    I feel that people who are suffering from any type of life suffering disease is more likely to suffer from some form of anxiety…

    Because they are so worried about the disease they are suffering from – they ignite panic attacks..

    Hard thing to deal with for some people -Very common thing!

  • Bob Boise

    What research has been done, if any, to connect hyperinsulinism and metabolic disorder, e.g. endocrine gland function. If insulin has a detrimental affect on the pancreas, wouldn’t it also affect other chemically sensitive glands: adrenal glands which produce epinephrine….I postulate that panic attacks are caused by excess secretion of epinephrine due to morbid insulin interaction. I would suspect there is a genetic component which would cause adrenal hypersensitivity to insulin.

  • dawn

    Bob i agree the adrenals are involved with the insulin levels. i am currently newly diagnosed type 2, also have hashimotos also trying to get my thyroid meds up which along with my bs are spacing me out and giving anxiety and panic; requiring me to need hydrocortisone which calms the panic to some extent (less epinephrine?)
    really need to take more thyroid but cannot. Antidepressants don’t help.
    any advise please?

  • Michal


    Is there any research on the extent to which that panic/stress causes a rise on blood sugar levels?

    I’m asking because I took the glucose challenge test for gestational diabetes and the score came back quite high (160). However, I also suffer from severe blood-injection-injury phobia, including needle phobia. This means that before they drew my blood, I was extremely anxious and when they drew blood, I was panicked and shaking with fear. I can’t help but wonder if this is the real reason for the high score. Especially as I have been monitoring my blood sugar level with a glucometer since and the results have mainly been fine…