Health Topics

Healthy Living

January 2010
Concerns About Insulin Therapy
Rita Saltiel-Berzin
People are often referred to diabetes educators when their doctors want them to start on insulin. They are always upset as nobody looks forward to self-injecting insulin. Some of the common comments and questions I frequently hear are:

I'm going on insulin because I failed, I could not lose weight.
I must be getting sicker if I have to take insulin.
I will never be able to give myself an injection!
This will make my life so complicated…

Most of the comments and questions reflect the fears and anxiety that all people with diabetes (PWD) have. The first order of business is to reduce their anxiety. We discuss that insulin therapy is not related to any failure on their part or because they are getting sicker, but to the natural course of the disease.

Type 2 diabetes is a progressive disease.
Over a period of years, the pancreas will lose the ability to make insulin to meet the needs of the body. The UKPDS (United Kingdom Prospective Diabetes Study) found that once diabetes had developed, there was a 3% decline in insulin output every year. Nine years post diagnosis, most people needed insulin therapy. Most people will have to take insulin, despite carefully following a meal plan and exercising. The need for insulin is physiological and occurs when the pancreas is no longer able to meet the body's need for insulin. In order to control blood glucose levels the missing insulin must be replaced. Once people understand the nature of diabetes, their next concern is their ability to self-inject insulin.

Learning how to give an insulin injection:
I begin by showing the insulin pen or syringe to the PWD, pointing out the size of the needle and syringe. They are always amazed, having visualized a much larger needle. Demonstrating how to prepare an injection either in a syringe or in an insulin pen helps the PWD see that it is a simple process. After I demonstrate how to prepare and give an injection into a pillow or washcloth, the PWD returns the demonstration. At this point, the PWD is more confident in his/her own abilities and self-injects under supervision. The PWD is always amazed at how simple it is and will. often say, "I didn't even feel it." Once the first injection is given, there is an obvious sense of relief within the PWD and a greater confidence in their abilities to manage diabetes.

Alleviating pain and discomfort associated with insulin injections:
For people who are extremely anxious about pain and discomfort, I may perform a short demonstration to illustrate how smooth the needle is as a result of the electro-polishing procedure and needle lubrication that is performed during the manufacturing process that allows the needle to enter the skin easily without friction. I tank an insulin pen or syringe needle and insert the needle into a foam strawberry, then with one hand, I lift the styringe or pen up, and the foam strawberry drops off easily.

Giving that first injection with the proper technique usually goes a long way in showing people that insulin injections can be relatively painless. It is however, an ongoing concern of the PWD. The American Association of Diabetes Educators commissioned a survey of people with diabetes and their health care providers in 2008. The Injection Impact Survey found that, 47 % of PWD said they would be more adherent to their treatment plan if they knew how to ease the pain and discomfort associated with their injections. Pain or discomfort when self-injecting is most likely related to the technique being used. Insulin pens and syringes are easy to use and the needles are very fine and delicate. They are electro-polished for smoothness and lubricated so that they enter the skin easily without trauma. If you are experiencing discomfort when injecting, you should discuss this with your doctor or diabetes educator so that they can re-evaluate your technique and perhaps update you on the latest advances in injection technique.

Balancing diabetes selfmanagement and lifestyle requirements:
The final issue that comes up is, "How do I fit all of this into my lifestyle?" Everyone is busy these days and the PWD is concerned about balancing diabetes self-care activities including insulin therapy with their daily responsibilities and leisure activities. I begin by gewtting a sense of the PWD's daily activities and then scheduling them along with diabetes tasks. For example:

Daily Schedule:  
8:00 AM Check Blood Glucose Give Lispro/ Novolog Injection Breakfast Drive children to school
10:00 AM Go to Market
12:00 Check Blood Glucose Give Lispro/ Novolog Injection Lunch
2:00 PM Pick up children from school Take children to activities
4:00 PM Prepare dinner
6:00 PM Check Blood Glucose
Give Lispro/
Novolog Injection
Eat dinner
Clean up kitchen
Help children with
8:00 PM Begin to put children
in bed
10:00 PM Check blood glucose Take Lantus insulin Make lunches for school tomorrow.
12:00 PM Bedtime!

Successful diabetes self-management requires the PWD and their doctor or diabetes educator to evaluate and discuss their fears and concerns regarding insulin therapy. It is an ongoing process to look at the lifestyle of the PWD and integrate diabetes selfcare behaviors on a daily basis. The result is usually a PWD who feels more energetic, is free of symptoms of both high and low blood glucose and in the process is able to reduce their risk of diabetes complications and live life to the fullest.

About the author: Rita Saltiel-Berzin, RN, MPH, CDE, CHES is a Certified Diabetes Educator. She has worked in diabetes care and education for over 20 years in a variety of clinical and community settings. She is currently employed in the Medical Affairs Department at BD and works with a diabetes team of health care professionals to see patients in a worksite setting.
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