Struggles with Panic Attacks

By Joe Nelson | November 29, 2006 10:06 am

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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Joe Nelson: Joe is a psychotherapist in private practice in Minnesota, where he specializes in the psychology of chronic disease and sexual problems and works with couples, families, children, and teens. He has been a Licensed Psychologist since 1985 and has earned a master’s degree from St. Mary’s College Winona, a bachelor’s degree in social work from the University of Minnesota, and an associate’s degree in human services from the College of DuPage in Glen Ellyn, Illinois.

Joe has worked with troubled youth in Chicago and Minnesota and on a special project on Turtle Mountain Reservation in North Dakota. He was the first social worker hired by an affiliate of the American Diabetes Association. He worked at the International Diabetes Center for 20 years, directing psychological services there for 12 years. A Certified Sex Therapist, Joe co-developed the Sexual Health Center at Park Nicollet Clinic.

Having practiced meditation for over 30 years, Joe offers instruction in mindfulness-based meditation to patients in groups and as individuals. Joe is married, has a 23-year-old daughter, and enjoys scuba diving, motorcycling, golf, and being outdoors doing almost anything.

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