A reality of managing type 1 diabetes is that there are needles involved. The needle may be in the form of a lancet for doing fingersticks, a syringe needle, a pen needle or a needle to insert an infusion set for a pump or a sensor for a CGM. It’s probably fair to say that practically no one actually enjoys getting or giving themselves an injection; yet many people do this every day, multiple times a day, often without any grumbling or complaint. On the other end of the spectrum, it’s estimated that up to 10% of the population has a needle phobia, which, according to the International Classification of Diseases, is defined as “the fear of injections and transfusions.”
Needle phobia defined and its implications
Needle phobia can be broken down further into a fear of injections (trypanophobia), a fear of needles and pins (belonephobia) and a fear of sharp, pointed objects (aichmophobia), according to The Encyclopedia of Phobias, Fears, and Anxieties. Someone who has trypanophobia has such an intense fear of injections that he or she may faint or vomit due to the anxiety of having to give or get an injection. With trypanophobia, the nervous system kicks in to cause actual physical symptoms, including feeling clammy, faint, nauseated and/or difficulty breathing. The heightened sensitivity that goes along with bracing yourself to feel pain can actually worsen the pain of an injection.
Not everyone who dislikes (or even hates) injections has a needle phobia. It’s understandable that someone may not look forward to giving themselves an insulin injection. But whether it’s a dislike of injections (or fingersticks) or a phobia, that dislike or phobia can interfere with self-care — meaning, adherence to checking blood sugar regularly or even giving an injection can drop dramatically. And studies show that poor adherence can lead to worsening of glycemic control, a higher risk of diabetes complications, and a decrease in well-being and health status.
Tools that can help
Fortunately, help is available in several forms. First and foremost, if you’re new to having type 1 diabetes and you think you might have a phobia, or you’re just downright worried or scared about giving yourself injections, let your doctor or diabetes educator know. Today’s lancets and needles are a vast improvement when it comes to thickness (gauge) and length compared with lancets and needles of years past. Smaller, thinner lancets and needles mean less pain; less pain can mean less fear
To help make fingersticks less painful, ask your diabetes care team to prescribe a high-gauge lancet, such as a 33-gauge lancet (remember, the higher the gauge, the smaller the needle size). Try BD Ultra-Fine 33-gauge lancets, but make sure it works with the type of meter you use. Also, try setting the depth gauge of your lancet to a lower setting if you find fingersticks to be painful.
Insulin syringes and pen needles have come a long way — today, needles are available that are much thinner and shorter than in years past. You might just be pleasantly surprised at how small needles are and that, in turn, may take some of the fear out of giving yourself an injection. Ask your doctor to write a prescription specifically for the shortest, thinnest needles possible to avoid substitution with another size needle.
If insulin injections are a source of fear, consider using a device such as the Inject-Ease, made by AmbiMedInc. Place your insulin syringe into the Inject-Ease, place the tip of the device against your skin and press the button. The Inject-Ease automatically moves the needle into the skin. You never see the needle, and the tip of this device is designed to reduce the sensation of pain at the injection site. For more information, visit the Inject-Ease website.
This cute little device is aimed at children who are scared of insulin injections, but there’s no reason adults can’t use it, too. Buzzy works by using cold and vibration to block pain signals. Learn more about Buzzy here.
If the thought of giving yourself multiple insulin injections each day breaks you out in a cold sweat, consider using insuflon, which is an indwelling catheter that stays under the skin for up to three days. An adhesive keeps it in place. You then give yourself an injection with a syringe through the little tube that lies against your skin. While this doesn’t eliminate injections altogether, it helps reduce the number that you need to take. Learn more about this device on the insuflon website.
Synera topical patch
Synera is a patch that contains two numbing agents, lidocaine and tetracaine. The patch is placed on the skin 20 to 30 minutes prior to injecting; the patch is then removed and the injection site is numb. For more information, visit the Synera website.
Needle phobia: more help
There are other “tricks of the trade” that can help make insulin injections go a little easier.
If your fear of injections stems from a fear that the injection will hurt, try numbing your injection site with a frozen spoon or an ice cube wrapped in cloth.
Before it’s time for your injection, get in a comfortable position, lower your shoulders, relax your jaw and take some deep breaths.
A lot of people quickly get over their nervousness and even fear about injections by doing some practice sessions with their diabetes educator. One of the first steps an educator might do is show you the syringe or pen needle and even have you touch it. When you feel ready, the educator might give you a practice injection (minus the insulin) — or you might give one yourself! Most people are amazed at how they barely feel the needle.
Inhale your insulin
Ask your doctor or diabetes educator about using an inhalable mealtime insulin. This can cut down on the number of injections that you need, although you’ll still need to inject a longer-acting insulin.
Talk with your diabetes care team about insulin pump therapy and if it’s right for you. You won’t get entirely away from needles when using a pump, but you’ll greatly reduce the number of injections you need to take.
If the above suggestions aren’t helpful to you, consider options that mental health practitioners use to address fears and phobias, such as cognitive behavioral therapy (CBT), systematic desensitization and even hypnotherapy. Ask your doctor for a referral to a qualified professional who can assess your issue and recommend an approach that’s right for you.
For more information about needle phobia, visit the website The Needle Phobia Page.
Want to learn more about getting over a fear of needles? Read “Why Do I Need Insulin Injections: Tips to Get Over Your Fears” and “Injecting Insulin: Tips for Success.”