Psychological Insulin Resistance Research Articles

What's So Tough About Taking Insulin? Addressing the Problem of Psychological Insulin Resistance in Type 2 Diabetes

P atients with type 2 diabetes are often reluctant to begin insulin and, in many cases, delay the start of insulin therapy for quite lengthy periods of time. Patients may refuse insulin outright (“Look, doc, there is just no way I could take the needle.”), bargain with their health care providers for more time (“Please, I just need a few more months to see if I can drop this weight.”), or even drop out of treatment altogether. Sadly, actions such as these can lead to chronically elevated blood glucose levels, possibly for considerable periods of time, raising the risk for long-term complications. But what do we really know about such cases of “psychological insulin resistance” (PIR)? How often do they occur, why do patients harbor such powerful misgivings, and how can busy clinicians respond most effectively? While clinical lore suggests that PIR is quite common, there has been little formal study in this area. In the United Kingdom Prospective Diabetes Study (UKPDS),1 of those type 2 patients randomized to insulin therapy, 27% initially refused. Early reports from the international Diabetes Attitudes, Wishes, and Needs (DAWN) study2 indicate that the majority (54.9%) of insulin-naive patients worry about the possibility of insulin therapy. Okazaki et al.3 reported that 73% of type 2 patients beginning a diabetes education program where insulin was to be started were reluctant to do so at first. Finally, in a recent survey of insulin-naive type 2 patients,4 24.7% of respondents reported being not willing to take insulin if it was prescribed. Furthermore, the survey showed that Hispanic patients were much more frequently unwilling than non-Hispanic whites (55.6 vs. 21.5%). Qualitative data from Hunt et al.5 also suggest that PIR may be common in the Hispanic population. Overall, these data suggest that PIR may …

Self-management support for insulin therapy in type 2 diabetes.

The purpose of this article is to describe the self-management support that can be provided by diabetes educators for type 2 diabetes patients who are transitioning from therapy with oral hypoglycemic agents to insulin. The role of the diabetes educator in patient education and self-management support during all aspects of insulin therapy is discussed. Phases during which support may be especially important include the decision-making process, initiation, and maintenance. Although some patients make the decision fairly easily, the introduction of insulin therapy is likely to raise many issues and questions for many type 2 diabetes patients. The more reluctant patients may experience psychological insulin resistance, a syndrome where insulin therapy is viewed as a threat or failure, which can affect health professionals as well. The diabetes educator can provide support and approaches to help diminish this resistance and make the transition to insulin therapy easier and more effective for patients with type 2 diabetes. Education and ongoing self-management support are needed for informed decision making and the initiation and maintenance of insulin therapy. Therefore, diabetes educators have a critical role to play during both the decision-making process and the safe transition to insulin therapy.

DAWN sheds new light on psychological insulin resistance

DAWN sheds new light on psychological insulin resistance

When oral agents fail: practical barriers to starting insulin.

Insulin therapy has proven benefits in Type 2 diabetes patients when combination therapy has failed. However, there is some reluctance by both patients and healthcare professionals to initiate insulin therapy. This reluctance has been termed 'psychological insulin resistance'. Barriers to the initiation of insulin therapy include patients' fear of disease progression and needle anxiety; mutual concerns about hypoglycaemia and weight gain; and health professionals' use of insulin as a threat to encourage compliance with earlier therapies. It is essential that these obstacles are identified and investigated as a means of overcoming these impediments to recommended levels of glycaemic control, an initiative being pursued by the DAWN study. Where concerns are tangible, such as fear of hypoglycaemia, therapeutic solutions can be pursued. Overcoming psychological barriers relies more on innovative management techniques. Improving insulin delivery to meet these needs, coupled with enhanced healthcare services, can address psychological insulin resistance and contribute to the maintenance of good metabolic control.