Dr. Bill Polonsky on Fear of Lows and Rebuilding Confidence

Dr. William Polonsky, clinical psychologist and co-founder of the Behavioral Diabetes Institute, joins host Scott Johnson to explore fear of lows and what it takes to rebuild confidence. Some concern about low blood sugar is understandable. But when fear begins limiting daily life or driving diabetes decisions, it deserves attention and support.

Dr. Polonsky explains the “be safe” and “feel safe” approach he developed with colleagues, including why reducing the risk of lows doesn’t always make the worry go away. Through examples from his work, he shares how practical preparation and gradual, supported steps can help people regain confidence in activities they’ve come to fear.

Scott and Dr. Polonsky also discuss impaired hypoglycemia awareness, feeling caught between lows and highs, and the worry loved ones carry. They explore setting a blood sugar target for when to act on a low, agreeing on when to act on a low, setting expectations around support, and recognizing when mental health care may help. The conversation offers a clear starting point: tell your care team how fear is affecting your life and ask for help with both the risk and the worry.

What You'll Learn:

• How understandable concern about lows can become fear that limits daily life
• Why a frightening low can affect confidence long afterward
• The difference between “be safe” and “feel safe,” and why both matter
• What impaired hypoglycemia awareness can look like beyond familiar warning signs
• How preparation and a “no-delay” glucose number can support timely action
• How gradual steps with professional support can help rebuild confidence
• Why loved ones may carry their own fear, and how agreed-upon support roles can help
• When to seek mental health support and how to start a conversation with your care team

Key Quotes:

• “It took us years to realize what they were telling us is they had lost confidence in their body.” – Dr. Bill Polonsky
• “But one of the things that we learned early on is that you can help people to be safe, but they still may be completely freaked out about hypo fear and don’t feel safe.” – Dr. Bill Polonsky
• “Probably the most important first step is to take a big risk and bring this up with your healthcare provider.” – Dr. Bill Polonsky

Resources & Links:

• Behavioral Diabetes Institute - https://behavioraldiabetes.org/
• The Hypoglycemic Fear Syndrome - https://pmc.ncbi.nlm.nih.gov/articles/PMC10577500/
• ADA Mental Health Professional Directory - https://diabetes.org/tools-resources/mental-health-directory
• TCOYD: 10 Strategies to Overcome Severe Hypoglycemia Fear - https://tcoyd.org/2024/10/10-strategies-to-overcome-severe-hypoglycemia-fear/
• Blue Circle Health (learn more / sign up) - https://bluecirclehealth.org

What is Around the Circle: Living Well with T1D?
The US healthcare system makes it difficult, expensive, and often impossible for people with T1D to access the care, education, and support they need to live. Around the Circle: Living Well with T1D brings together voices from across the type 1 diabetes community to share real stories, expert insight, and practical support for living well with T1D.

Hosted by the team at Blue Circle Health, a U.S.-based program transforming type 1 care, this podcast helps people go from just surviving to truly living well with type 1 diabetes. https://bluecirclehealth.org/.