That India is fast becoming the diabetes capital of the world with an estimated 1.4 million Indians taking insulin injections annually,is a fact that many know. But doctors share that while the figure seems big in itself,it is quite small in comparison to the 60 million-odd people living with diabetes in India because of a refusal to take insulin. The patients resistance to insulin therapy is called Psychological Insulin Resistance (PIR) and the reasons for the same are various say medicos.
One of the factors is that the patient perceives his condition as a personal failure to manage his diabetes and fears lifelong dependence on insulin therapy. Another factor is the fear of needles. In a study called Measuring Psychological Insulin Resistance: Barriers to Insulin Use,published on behalf of the American Association of Diabetes Educators,the fear of needles was dominant in 67 per cent respondents.
Recently,13 clinicians from a variety of disciplines came together under the Forum for Injection Technique (FIT),India,to develop the first Indian recommendations on Insulin Injection Techniques,which were further reviewed by
82 clinicians. They observed that the fear arises from ignorance,since the latest needles are as small as 4mm,which could make the process painless. There is a clinical consensus on healthcare professionals needing to work closely
with patients to dispel their fears. They also need to address the personal and social issues that may be leading to patients hesitation to switch from oral medication to insulin therapy.
Dr Hemraj B Chandalia,director at Diabetes Endocrine Nutrition Management and Research Centre,says,Correct injection technique is the key,which is vital in achieving glycemic control and thereby preventing chronic complications. A good injection technique also takes away the fear of needles and helps in maintaining effective insulin compliance,which is critical for management of diabetes.
Another hurdle in adopting insulin therapy practices is the choice of the needle. There is a misconception that the needle size has to be directly proportional to the obesity level of the patient. Doctors clarify that there is no connection between the body mass index and the needle size.
Similarly,patients need to be told about the right way to administer injections and site rotation. Dr Chandalia says,The recommendations made at the forum are expected to go a long way in easing the life of those living with diabetes. If the right needle size is selected and administered properly,a patient can adopt the therapy with no discomfort at all.