Common patient barriers and perceptions regarding insulin therapy

Common patient barriers and perceptions regarding insulin therapy
and suggestions of how to address:
Common barriers

• Needle phobia

Concern or fear about injecting insulin is common but true needle phobia is rare. Advise
patients that insulin injections are not considered painful and are usually less uncomfortable
than the finger-pricking performed for blood glucose monitoring18.

• Weight gain

This is a common adverse effect of insulin treatment and can increase the person’s body
weight by 2–4 kg. Weight gain can be minimised by appropriate lifestyle and dietary changes
and continuing with metformin (if tolerated)18. A number of studies have shown there is
less weight gain when started on a basal insulin regimen than on a biphasic or basal bolus
regimens19,20.

• Fear of hypoglycaemia

Offer reassurance that most episodes of hypoglycaemia can be self-managed. Additionally
hypoglycaemia is minimised as patients are initiated on a low dose of insulin, with gradual
dose titration. An education package provided to individuals who start insulin may also go
through management and prevention of hypoglycaemia18.

• Driving guidelines

The Driver and Vehicle Licensing Agency (DVLA) highlight the regulations in place for those
people with Type 2 diabetes and who use insulin. Using insulin does not automatically
mean people with Type 2 diabetes won’t be able to drive. A number of factors are taken into
consideration including the type of licence held, frequency and severity of hypoglycaemia
and presence or absence of any eye complications21. The healthcare professional initiating the
insulin will discuss current driving needs and provide individual advice on DVLA requirements.
A guide for healthcare professionals can be downloaded from here.