Psychological insulin resistance: Overcoming barriers to starting insulin therapy

Patients with type 2 diabetes and their health care providers may be resistant to the idea of starting insulin therapy. Patients may believe that insulin will adversely affect their quality of life; that they have failed in controlling their diabetes with diet, exercise, and oral agents; or that their disease has become much worse. They may be overwhelmed by the prospect of insulin therapy or have injection-related anxiety. All of these reasons for psychological insulin resistance can be addressed with appropriate diabetes disease management, education, and counseling. From the time of diagnosis, patients must be made to understand that type 2 diabetes is a progressive disease and that it is likely they will eventually need exogenous insulin. Clinicians should present insulin therapy as an effective and flexible way to achieve glycemic control and enlist the help of appropriate resources, such as certified diabetes educators, in the education and counseling of these patients. Eliminating psychological barriers to insulin use may help facilitate earlier introduction of intensive therapy into the diabetes treatment plan and thereby help patients achieve optimal glycemic control.