A 62-year-old recently retired female school teacher who was diagnosed with Type 2 diabetes 18 years ago comes for a routine evaluation. Her medications include maximum dosages of rosiglitazone, metformin, and repaglinide. She tells you she is very careful about what she eats and walks 30 to 45 minutes 5 or 6 days weekly. She lives with her husband, who is also a retired teacher. Her body mass index is stable at 27, and her hemoglobin A1c value is 9.9%, up from 9.6% 3 months ago. When the physician suggests that insulin is the next step in her treatment program, she reacts very negatively and says, “I have a morbid fear of needles.”

Which of the following is the most appropriate response to this patient?

A. Tell her that the newer needles are less painful than the older ones.

B. Tell her that if her A1c value and body mass index decrease, she will not need insulin. 

C. Provide as much information about the safety of insulin as possible. 

D. Ask her what specifically is frightening to her about needles.