Introduction: For people with type 1 diabetes, hypoglycaemia is a regular occurrence. Whilst many living with diabetes can accept the presence of low blood glucose levels, others experience an overwhelming sense of dread, resulting in cognitions and behaviours that can have a devastating impact on diabetes management. The origins of fear of hypoglycaemia (FoH) can be many and varied, but the common denominator is fear of the unwanted and difficult experiences associated with somatic symptoms that arise because of sympathetic nervous stimulation. These same symptoms are associated with anxiety-related disorders.

Acceptance and Commitment Therapy (ACT) is one of the suites of mindfulness-based interventions that have been successfully applied to treat a range of psychological disorders including anxiety and depression. In ACT people learn how to be present with their unwanted experiences, bringing curiosity and a non-judgemental awareness moment-to-moment. The application of ACT for people with diabetes, and specifically FoH is not well researched and this presentation highlights the successful use of the approach in clinical practice with a case study.

Method: "Edith", a 52-year old woman with type 1 diabetes presented with an HbA_1c of 12.2% and two decades of behaviours aimed at avoiding low blood glucose levels. Metaphors, ‘willingness to accept’ strategies, values clarification and defusion strategies that were diabetes-specific were applied. Exposure to anxiety-inducing situations was also a key component during therapy.

Results:  After 12 one-hour sessions, Edith was able to tolerate blood glucose levels between 6 - 12mmol/L and her HbA_1c reduced to 9.8%.  Six-months later and after an additional six -sessions of therapy, HbA_1c continued to fall, eventually stabilising at 8.3%.

Conclusion
Fear of Hypoglycaemia can have a major negative impact on diabetes management. Using ACT with Edith who was experiencing the phenomenon produced long-lasting change and reversed the trend towards escalating HbA_1c levels, increased risk of complications, and avoidance strategies that impoverished her life and ‘imprisoned’ her in fear.