JOIN USDiabetes treatment hit by fear of needles
That India is fast becoming the diabetes capital of the world is now well known. What is not as well known is that 1.4 million Indian are estimated to be taking insulin injections annually. While the figure seems big on a stand-alone basis, it is, in reality, quite small, considering there are over 60 million people living with diabetes in India. The reason: when doctors recommend insulin to patients, almost one-fourth of them refuse it!
The reasons for a patient’s resistance to start insulin therapy, often called Psychological Insulin Resistance (PIR) are many. The patient perceives this to be a personal failure to manage his / her diabetes and fears a life-long dependence on insulin therapy. Another key factor is the fear of needles. In a study “Measuring Psychological Insulin Resistance: Barriers to Insulin Use” published on behalf of the American Association of Diabetes Educators, it was found that of those unwilling to switch to insulin therapy, the fear of injections was found in as many as 67 per cent respondents. The fear arises from lack of awareness about correct insulin injection techniques and the latest needle sizes (one of them is 4mm, less than the size of many people’s eyelashes). This, itself could make this process next to painless.
Allaying fears
There is a mass clinical consensus that health care professionals need to work closely with patients to allay their fears about insulin therapy. They also need to address the personal and social issues that may be leading to the patient’s hesitation to switch from oral medication to insulin therapy. In fact, there are a number of diabetes educators that are now working in the area to hand-hold patients to make the switch and eventually improve the quality of their life.
At the heart of the issue is correct injection technique. A good injection technique is vital in achieving glycemic control and thereby preventing chronic complications. A good injection technique also takes away the fear of needles and helps in maintaining effective insulin compliance, which is critical for management of diabetes.
Another hurdle in adopting good insulin therapy practices is the choice of needle. There is a common misconception that the needle size has to be directly proportional to the body mass index or simply put the obesity levels of the patient. There is no correction between the BMI and the needle size. In fact, small-size (4-6 mm) needles work best as there is almost no patient discomfort and the chances of injecting deeper or in the wrong layer are negligible.
Educating patients
There is also the issue of convincing the patients that the needle should not be used many times over. A needle should be ideally used only once. A needle used multiple times can lead to pain and hence a risk of the patient going off the insulin therapy. Similarly, patients also need to be told about the right way to administer injections and rotate the site.
To maintain compliance with insulin therapy, there are three areas that a patient needs be educated on: the insulin, the device for taking insulin and the technique. While much has been written about insulin, doctors lament that there is comparatively less understanding on the device or the technique to take the insulin therapy. Recently, 13 clinicians from a variety of disciplines came together under the Forum for Injection Technique (FIT), India, to develop the first Indian recommendations on Insulin Injection Techniques, which were further reviewed by 82 clinicians.
These recommendations are expected to go a long way in easing the life of those living with diabetes. If injection devices like needles are used improperly or re-used, it can result in pain with bleeding and bruising and needles breaking off, among other complications. On the other hand, if the right needle size is selected and administered properly, a patient can adopt the therapy with no discomfort at all.
Only with a little more awareness, the life of many people living with diabetes could become easier, better & healthier!
(The writer is chairman, Chronic Care Foundation Research and Ethical Committee)