<p>The sedentary lifestyle has lead to a spurt in the number of diabetics. There is no denying the fact that a majority of patients suffering from the disease have to undergo insulin therapy – a lifelong process which requires insulin pricks each day. And it isn’t easy for those who are advised to take this therapy. They suffer from Psychological Insulin Resistance (PIR) or resistance to initiating insulin therapy. <br /><br /></p>.<p>“Fear of needles, sense of distress, anxiety and frustration, sense of lifelong dependence on insulin and sense of failure to manage one’s diabetes leads to PIR,” says Dr Nikhil Tandon, Head of Department, Endocrinology, All India Institute of Medical Sciences (AIIMS). He explains, “out of 67 million people suffering with diabetes, only 32 million people are aware of the disease. Out of this, only 16 million patients are taking medication. Now this number is further reduced to 3.2 million patients who continue to take insulin injection.” <br /><br />Tandon adds, “Diabetics, who are advised to take injections, even take one to two years to decide on insulin medication. Fifty per cent people fear Insulin would restrict their lives, while many cited pain as the reason behind their unwillingness. There were some who fear complying with the injection routine.” <br /><br />Ironically, those who are taking insulin fail to administer it properly. Clinical findings suggest nearly two-thirds (64.4 per cent) people injecting insulin have Lipohypertrophy (LH) or swellings at injection sites. Of the patients who correctly rotated sites, only five per cent had these swellings while of the patients with swellings, 98 per cent either did not rotate sites or rotated incorrectly. Also, 39.1 per cent of patients with these swellings had unexplained low blood sugar and 49.1 per cent had varying blood sugar. <br /><br />Dr Ambrish Mittal, Endocrinologist, Medanta Medicity, says, “As insulin treatment is vital for blood glucose control, inappropriate injection skills compromise the dosage accuracy and its effectiveness. The importance of swellings at injection sites is not only cosmetic but also has an impact on insulin absorption, and hence glycemic control. How and where you inject is as important as what you inject. Some people find it convenient to reuse, especially if they are injecting four times a day.” <br /><br />“The success of insulin injection therapy and the adherence to it depends on several factors such as a smooth insulin initiation process with counselling that alleviates the fear of needles; the insulin regime, length of needle and the method of administration. For example, it is always preferable to keep injectable therapy at room temperature, use a new needle for each injection, choose shorter needles with a smaller diameter, and inspect and palpitate the skin prior to each injection to ensure a comfortable injection experience,” says Dr SV Madhu, Head, Department of Endocrinology, GTB Hospital. <br /><br /></p>
<p>The sedentary lifestyle has lead to a spurt in the number of diabetics. There is no denying the fact that a majority of patients suffering from the disease have to undergo insulin therapy – a lifelong process which requires insulin pricks each day. And it isn’t easy for those who are advised to take this therapy. They suffer from Psychological Insulin Resistance (PIR) or resistance to initiating insulin therapy. <br /><br /></p>.<p>“Fear of needles, sense of distress, anxiety and frustration, sense of lifelong dependence on insulin and sense of failure to manage one’s diabetes leads to PIR,” says Dr Nikhil Tandon, Head of Department, Endocrinology, All India Institute of Medical Sciences (AIIMS). He explains, “out of 67 million people suffering with diabetes, only 32 million people are aware of the disease. Out of this, only 16 million patients are taking medication. Now this number is further reduced to 3.2 million patients who continue to take insulin injection.” <br /><br />Tandon adds, “Diabetics, who are advised to take injections, even take one to two years to decide on insulin medication. Fifty per cent people fear Insulin would restrict their lives, while many cited pain as the reason behind their unwillingness. There were some who fear complying with the injection routine.” <br /><br />Ironically, those who are taking insulin fail to administer it properly. Clinical findings suggest nearly two-thirds (64.4 per cent) people injecting insulin have Lipohypertrophy (LH) or swellings at injection sites. Of the patients who correctly rotated sites, only five per cent had these swellings while of the patients with swellings, 98 per cent either did not rotate sites or rotated incorrectly. Also, 39.1 per cent of patients with these swellings had unexplained low blood sugar and 49.1 per cent had varying blood sugar. <br /><br />Dr Ambrish Mittal, Endocrinologist, Medanta Medicity, says, “As insulin treatment is vital for blood glucose control, inappropriate injection skills compromise the dosage accuracy and its effectiveness. The importance of swellings at injection sites is not only cosmetic but also has an impact on insulin absorption, and hence glycemic control. How and where you inject is as important as what you inject. Some people find it convenient to reuse, especially if they are injecting four times a day.” <br /><br />“The success of insulin injection therapy and the adherence to it depends on several factors such as a smooth insulin initiation process with counselling that alleviates the fear of needles; the insulin regime, length of needle and the method of administration. For example, it is always preferable to keep injectable therapy at room temperature, use a new needle for each injection, choose shorter needles with a smaller diameter, and inspect and palpitate the skin prior to each injection to ensure a comfortable injection experience,” says Dr SV Madhu, Head, Department of Endocrinology, GTB Hospital. <br /><br /></p>
