article from DIabetes In control

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Question: What do you say when a patient says he/she is morbidly afraid

of needles?

You are Correct, The Answer Was D

Answer and Critique

Key Point: Many patients with type 2 diabetes are hesitant to initiate

insulin therapy. Much of this resistance derives from fears or beliefs

about insulin

and its impact on lives.

Although this patient's statement regarding her fear of needles is

important, it is equally important to ascertain the exact nature of her

fear in order

to respond appropriately. Often what patients first identify as their

concern is not the real problem. Therefore, solutions developed to

address the initial

statement will be ineffective because the underlying issue is not

addressed. For example, a morbid fear of needles may refer to injection

pain, a concern

that taking insulin will affect her independence or lifestyle,

misinformation about insulin being a cause of complications, or the fear

of being mistaken

for a drug addict; the strategies to address these specific fears

differ. For example, if her fear is painful injections, showing her the

needle size and/or

asking her to experience an injection may be appropriate. If, on the

other hand, her concern is the need to carry syringes, the impact of

injections on

her lifestyle, or the possibility of being mistaken for a drug user,

showing her an insulin pen may help allay her fear.

A discussion of her fears may lead to a completely different and often

unrelated cause for her hesitation. Patients who have diabetes very

commonly view

the need for insulin as a failure if they have heard statements such as

" You've failed oral agents " or are promised that insulin can be avoided

with weight

loss and exercise. Using the need for insulin as a threat to induce

weight loss and exercise is counterproductive. Presenting insulin as the

next step

in the treatment of a progressive disease early in the type 2 diabetes

care and educational process will help pave the way for initiation of

insulin. This

approach also helps address another common mistaken belief that insulin

is not effective for treating type 2 diabetes. Because type 2 diabetes

is a progressive

disease and this patient already pays attention to her food intake and

exercise, additional weight loss and exercise are highly unlikely to be

effective

at this point. Telling her that the newer needles are less painful than

the older ones or providing information about the safety of insulin may

become

appropriate responses once the basis of her fears is known but are

premature as the initial response. In addition, providing facts often is

of limited

value for alleviating fear.