A 58-year-old obese (body mass index of 42) woman was diagnosed with Type 2 diabetes three years ago. She started insulin therapy six months ago because of poor glycemic control on oral triple-agent therapy. Her hemoglobin A1c value before insulin therapy was 9.3%. She was very reluctant to start insulin because of her fear of needles, but she agreed to try insulin if her husband would administer the injections. Her insulin glargine dosage is now 60 U, administered by her husband at 10 PM by using a 1-mL syringe with a 0.5-inch needle in her arm. She continues taking repaglinide before meals.

At her follow-up appointment two months ago, her hemoglobin A1c value was 8.9%. Her blood glucose meter showed that her fasting blood glucose average was 97 mg/dL (5.38 mmol/L) but that her postprandial blood glucose average was still elevated at 241 mg/dL (13.38 mmol/L). After much trepidation, she agreed to start pre-meal insulin injections using insulin lispro, which had to be self-administered because of her husband's work schedule. To help her deal with her fear of needles, she was prescribed an insulin pen with short (8-mm [5/16-inch]) pen needles. She called in weekly for dosage adjustments because, despite increases in her insulin lispro dosage, her postprandial hyperglycemia has persisted.

At a follow-up evaluation today, her A1c value is 8.8%. Her postprandial blood glucose average is 237 mg/dL (13.15 mmol/L). She is frustrated and wants to stop pre-meal insulin because "it doesn't work anyway." Although she never experiences discomfort with insulin glargine injections, she has considerable stinging with the insulin lispro injections. She has also noticed a small, painful bump at the injection sites on her abdomen. Sometimes, a small amount of insulin leaks out when she removes the needle. Physical examination reveals a 5-mm raised, nonerythematous papular lesion at the site of her last injection.

Which of the following changes can be made to decrease this patient's discomfort with the lispro injections? 

A. Self-administration of lispro in the arm instead of the abdomen.

B. Pre-meal injections administered by her husband.

D. Referral to an allergist to rule out insulin allergy.