injectables

Fear of Needles and Diabetes

David Mendosa Health Guide March 22, 2006
  • If you are afraid of needles, you are not alone. More people have what is called needle phobia than have diabetes. At least 10 percent of us have needle phobia, according to Dr. James Hamilton’s ground-breaking article, “Needle Phobia: A Neglected Diagnosis, in the Journal of Family Practice". About 7 percent of Americans have diabetes, according to the U.S. Centers for Disease Control and Prevention’s most recent count.

    If you have type 1 diabetes, you take your insulin injections or else. Almost all type 1s overcome their fear of needles. But, as Dr. Hamilton says, occasionally needle phobia can be fatal.

    If you have type 2 diabetes, you won’t die if you forego injections. But you may well get sicker. While 39 percent of all type 2s older than 18 use insulin, more would benefit from it if they weren’t afraid of the shots. Between needle phobia and the belief that insulin therapy is a last resort when orals fail, many type 2s aren’t getting the control we can and should have.

    Now, in addition to insulin we have two great new drugs that have to be taken by injection. For people with type 2 diabetes Byetta is, I believe, the most important diabetes drug ever. I catalogued my initial experiences with it.

    The other drug, Symlin, can help people with either type 1 or type 2 diabetes. Both drugs come from Amylin Pharmaceuticals. Full disclosure: I own stock in this company.

    More than one person starting out on these drugs has felt like a person who wrote on the Diabetes and Byetta support group. She wrote that she had “weeks of abject fear staring at that pen before I worked up the courage to stick myself with it.”

    I know what she means, even though I am more of a daredevil. Yesterday, as I prepared to take my morning shot of Byetta in my stomach, I reflected on the reluctance I originally had. I know that it was totally irrational, because I had seen my wife shooting up insulin without flinching. I knew too that there are almost no nerve endings in the stomach, so we hardly feel the shot.

    Any reluctance to do fingerstick tests is a lot more rational. That’s one reason why alternative site testing generally makes a lot of sense.

    Needle phobia certainly isn’t rational. It often starts in childhood, when you receive vaccines and other injections with what look like horse needles. Nowadays, the needles that people with diabetes use for their injections of insulin, Byetta, or Symlin are much thinner and shorter.

    Modern 31 gauge needles are so thin, in fact, that I can’t see them without my glasses. They are much shorter too, just 3/16" of an inch long.

    It helps to see someone else inject herself or himself, as I watched my wife. Pricking your finger with a lancet is, of course, much more painful. I would have been much more reluctant to start testing my blood glucose 12 years ago if the pharmacist hadn’t showed me by pricking her own finger.

    Even Exubera, the newly approved inhaled insulin, won’t be a solution for those of us who need insulin. Exubera won’t replace long-acting insulins like Lantus or Levemir.

  • Diabetes UK at "Worried about injecting?" has some useful suggestions. So too does another UK site, the West Suffolk Diabetes Service, with its “Dealing with Needle Phobia” page.

    Strangely, as common as needle phobia is there are few studies of the condition. I searched the professional literature with PubMed using MeSH, the National Library of Medicine’s controlled vocabulary used for indexing articles for MEDLINE/PubMed. The relevant terms are phobic disorders AND needles. There are only 38 citations.

    By comparison, PubMed has 214,594 MeSH citations for diabetes mellitus. I guess that it’s better to have diabetes than to have needle phobia. At least we know a lot more about it. But if you have both conditions, you’ve got a problem. Since there is no cure yet for diabetes, you need to find a cure for your needle phobia.