Updated April 26, 2005

Insulin Therapy for Type 2 Diabetes

by Virginia Peragallo-Dittko, R.N., B.C.-A.D.M., M.A., C.D.E.

There’s a lot you can do to control your diabetes. You can make healthy food choices, eat reasonable portions, exercise, lose weight, take your prescribed medicines, manage stress, and visit your health-care team regularly. In combination, these self-management practices can keep your blood glucose level (and blood pressure and cholesterol levels) within target range for a long time. But there are two things that you cannot control: your genes and the beta-cell defect of Type 2 diabetes. The need to make the transition to insulin therapy is not your fault.

Psychological insulin resistance
Insulin resistance is one of the metabolic hallmarks of Type 2 diabetes, but psychological insulin resistance is a horse of a different color. When faced with the need to take injections of insulin, many people resist. They plead, bargain, or never return to the health-care provider’s office. But much of this aversion is caused by fear over misperceptions, because insulin is a highly effective treatment, one that some diabetes experts would one day like to see started sooner rather than later.

Fear of needles. This is one of the most common reasons people avoid insulin therapy and one of the easiest to surmount. Syringe and pen needles are so small and fine that you barely feel them, but don’t take my word for it. Your diabetes educator or the nurse in your doctor’s office can show you the tiny needle and help you to do an injection on yourself. Most people are immediately relieved by the ease of injection and absence of discomfort.

If you can’t bring yourself to insert a needle in your skin, there are gadgets that will do it for you. These devices are designed so that you don’t have to see the needle. With the BD Inject-Ease Automatic Injector and Medicool InstaJect, you just press a button and the needle is inserted under your skin. The Owen Mumford Autoject 2 not only inserts the needle but injects the insulin as well. There are devices to hide needles too, such as the NeedleAid device, which can be used with a syringe or insulin pen, and the PenMate, which conceals the needle on the NovoPen 3. Jet injectors, including Medi-Jector Vision, AdvantaJet, GentleJet, Vitajet 3, and Injex 30, are needle-free. They force a stream of insulin through your skin with pressure, not a needle.

Having a negative experience or association with insulin. When some people are confronted with the need to inject insulin, they immediately think of someone they know who had a bad experience. One woman associated insulin with causing her aunt’s blindness, because soon after her aunt started insulin therapy, she lost her vision. In reality, years of untreated diabetes was responsible for her aunt’s loss of vision, not insulin. The most effective strategy for dealing with these negative experiences or associations is to share them with your health-care team. By learning what is worrying you, they can help you.

Feeling defeated. Some people report a sense of failure when they learn of their need for insulin therapy. They feel that they didn’t take care of themselves, often because of a few pieces of cake they “shouldn’t” have eaten or because of those times they were “too lazy” to exercise. Family members may reinforce these feelings because they don’t understand that Type 2 diabetes is progressive, and they blame the person with diabetes for self-neglect.

If you feel defeated, remember that perfection is not the goal of diabetes self-management. Even if you chose not to make healthy food choices or to exercise in the past, insulin therapy is not a punishment. But it can be an opportunity to reevaluate your choices and get involved in managing your health. Once you know the facts about Type 2 diabetes, you’ll see that you didn’t fail; your pancreas did.

Insulin therapy as threat. For years, your doctor threatened you with insulin therapy if you didn’t stop overeating. Unfortunately, this practice continues. Some well-intentioned health-care providers use insulin injections as a threat to motivate people. However, this only serves to send the message that insulin injections are something to be avoided, not that insulin is one of many effective treatments for diabetes. Health-care providers need to learn other methods for helping people who struggle with managing their diabetes.

Virginia Peragallo-Dittko is a diabetes nurse specialist and Director of the Diabetes Education Center at Winthrop-University Hospital in Mineola, New York.

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