One in Four Say 'No Way' to Insulin Shots

NEW ORLEANS (Reuters Health) - As many as 25 percent of people with type 2 diabetes say that they would refuse to take insulin injections even if their doctor prescribed them, new study findings suggest.

This presents an uphill battle for doctors trying to help the roughly 17 million Americans with diabetes to have better control over their disease, according to Dr. William Polonsky, who presented the new information here at the American Diabetes Association's 63rd annual meeting.

"More than one quarter of patients with type 2 diabetes not on insulin said there would be no way they would be willing to take insulin if their doctor prescribed it," Polonsky told Reuters Health.

"This is a huge problem," he said. In the study, Polonsky, who is at the University of California at San Diego, and his colleagues interviewed 165 patients who had type 2 diabetes who were not on insulin.

"These findings offer us an opportunity to rethink how we talk about insulin with patients well before they need it," he said.

Addressing patients with type 2 diabetes, Polonsky said, "if you are offered insulin and you don't want to take it, know that you are not alone, there are a lot of people who feel the same way."

But talking with a healthcare provider about the facts can help clear up any fears and misunderstandings, he noted.

"Diabetics also need to understand that they have a progressive disease and over time the pancreas, which manufactures insulin, begins to secrete less and less, regardless of the measures a person takes. So, for some, taking insulin will be inevitable whether or not they do exercise and eat well," said Polonsky.

"Its not because you screwed up or are a bad person ... it's that diabetes is progressing to another level." Polonsky added, "The good news is that we have these wonderful medications to keep glucose in check."

Diabetes is caused by problems with insulin, a hormone produced by the pancreas that helps process blood sugar, or glucose. In type 1 diabetes, insulin production is minimal or nonexistent and a patient must rely on insulin injections for survival. In type 2 diabetes, the body loses its sensitivity to the hormone, but diet and exercise alone can sometimes be enough to control the disease.

However, even for many with type 2 diabetes, if lifestyle changes and oral medications fail to keep glucose levels in check, they have to resort to insulin injections.

"We know that doctors all over the U.S. talk about their patients with type 2 diabetes who refuse to go on insulin," said Polonsky.

Some patients are so adverse to the idea of injecting insulin that they often plead with their doctor for more time to try diet and exercise modifications, or they leave the doctor's practice all together, Polonsky said in an interview with Reuters Health.

In the study, Hispanics were most reluctant to take insulin, with about half saying they would be unwilling to start taking insulin, Polonsky said.

WHY THE AVERSION?

Many people who said they would refuse insulin injections said that they thought once they started taking insulin they would never be able to stop, that the treatment would control their life or that doing so would mean that they had somehow failed to take care of themselves properly, explained Polonsky.

Hispanics were more likely to believe falsely that taking insulin would cause more complications, with 72 percent reporting that they heard that insulin injections, not the diabetes itself, could cause blindness.

"This is an enormous myth," said Polonsky, who pointed out that it is easy to understand how some might make the association.

The problem is that people ignore their illness for decades. Poor glucose control over time has deleterious consequences on the body, especially the tiny blood vessels in the eyes, kidneys, feet and hands.

"It makes sense that people would misconstrue the cause and effect ... since diabetes is an invisible disease, you don't see the effects until late in life," said Polonsky. Once people start treatment, their family members -- who are at increased risk for themselves -- may associate diabetes complications with treatment for the disease, he said.

Hispanics were also more likely to say that taking insulin shots would be painful -- 61 percent compared to 29 percent of non-Hispanic whites.

"We don't have much more data from other ethnic groups and I don't know why Hispanics have these ideas more than other groups," he added.

Reference Source 89

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