Living with diabetes blog

Psychological insulin resistance stems from fear

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N. January 10, 2012

Insulin dramatically increases the life expectancy of persons with type 1 diabetes. Those with type 2 diabetes have also benefited from modern insulins. However, about a third of those with type 2 diabetes are unwilling to take insulin. Here's a few of the reasons that we hear for "psychological insulin resistance":

  • Guilt — Beginning insulin therapy may make individuals feel that they have failed at managing their diabetes.
  • Needle phobia.
  • Insulin injections would restrict their lifestyle.
  • Insulin causes weight gain.
  • Fear their diabetes is now serious.
  • Fear of getting low blood sugars.
  • In western society, insulin is viewed as a last resort.
  • Association of insulin therapy and complications in close relatives.

Due to the progressive loss of beta cell function in type 2 diabetes, most of those with type 2 will likely require insulin at some point.

Complications of uncontrolled type 2 diabetes are well documented. Type 2 diabetes is falsely perceived as mild.

Beginning insulin therapy indicates to some people that their diabetes is now more serious. People with type 2 diabetes often feel fine and may wonder why they should start insulin. The greatest barrier to starting insulin is the fear of gaining weight, but with lifestyle counseling the weight gain overall is modest.

Healthcare providers are also reluctant to initiate insulin therapy even when a person has a high A1C. The provider's attitude has a significant impact on the patient's attitudes and beliefs regarding insulin. Often, insulin therapy is used as a threat to force people to make lifestyle changes. Or, clinicians can use it as a scare tactic — a threat if the person with diabetes does not comply with prescribed oral agents. Labeling insulin therapy negatively makes people with diabetes feel like they've failed.

Recently, I had a patient tell me she didn't ever want to go on insulin. She wasn't starting on it, but when she repeated the statement I asked her why. She said she didn't want the hassle of having to give herself injections. I mentioned that when a person with type 2 diabetes needs to start insulin, they are often started on a once-daily long acting insulin injection. She was surprised, relieved and said that wouldn't be bad at all.

What are your thoughts?

Peggy

Jan. 10, 2012