Fearing the needle

Fearing the needle


Fearing the needle

Even though myriad oral agents are available to control blood glucose levels in diabetics, insulin may be required for treatment eventually. Approximately, 1.4 million Indians are taking insulin injections annually. But it is estimated that one out of every four diabetics worldwide, who are prescribed insulin injections, are reluctant to take them and continue oral medications, which may not control blood glucose effectively. Resistance to insulin therapy is called Psychological Insulin Resistance (PIR), which affects millions of people.

In the study Measuring Psychological Insulin Resistance: Barriers to Insulin Use by American Association of Diabetes Educators, fear of injections was found to be the reason for refusal to take insulin injections in 67 per cent patients. The phobia could partly be due to lack of awareness about correct injection techniques and the availability of new range of shorter and narrower gauge needles.

There is an urgent need to educate patients and doctors about the right injection techniques. A good injection technique is vital in achieving good glycemic control and thereby, preventing chronic complications. Needle length is important to dispel the fear of injections. The shorter the needle, the lesser the psychological barrier! Shorter and thinner needles, widely available now, are safe and avoid injecting into muscle. Insulin injected inadvertently into the muscle may lead to hypoglycemia.

It is also difficult for physicians to convince patients against repeated use of the same needle. A needle should ideally be used only once. If used multiple times, the blunt tip may cause pain, which might lead to discontinuation of the insulin therapy. Appropriate injection technique, including sites of insulin injection and site rotation, should also be made clear.

Several factors, including regular inspection of injection sites, avoiding reuse of needle, regular site rotation, influence the success of insulin injection therapy. If injection devices like needles are used improperly or reused, it can result in bleeding and bruising and needles breaking off, among other complications.

On the other hand, if the right needle size is selected and administered properly, patient can adopt the therapy with no discomfort. A scientific advisory board of endocrinologists and diabetes experts compiled the Forum for Injection Techniques (FIT) India recommendations based on clinical evidence and implications for patient therapy to promote best practices and uniformity in insulin injection technique and reached out to 15,000 healthcare providers and patients in more than 180 hospitals. These recommendations state that correct injection technique can help protect against lipohypertrophy (swelling or lump), unexplained hypoglycemia (low blood glucose) and blood glucose variability (wide swings of high and low blood glucose).

What we need right now is a little more awareness so that we can save many precious lives.

(The author is director-professor and head, department of medicine, MLN Medical College, Allahabad)