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Question #810

Dec 4, 2015

A 51-year-old patient returns to your office for a follow-up visit. She is currently taking metformin and glipizide after being diagnosed with type 2 diabetes eight years ago. She shows you her self-care logs that indicate she has been eating a healthy diet and walking daily. She has been maintaining her weight (BMI 26kg/m2). Despite her excellent efforts, her A1C is 7.8%, above her target of A1C<7.0%. When you start to discuss adding a basal insulin dose to her regimen, she bursts into tears. All of the following are common barriers to insulin therapy initiations EXCEPT (select one answer):  


Answer: A. Fear that hyperglycemia will make her ill

Common patient-identified barriers to initiating insulin therapy are: fear others will see them differently; insulin is not an effective treatment for diabetes; using insulin can lead to complications or death; concern that using insulin will negatively impact their lifestyle; fear of hypoglycemia: fear of weight gain; fear of needles and of injection pain; and insulin cost concerns. Fear of hypoglycemia can be ameliorated with choosing insulin less likely to cause hypoglycemia (newer rapid-acting and longer-acting analogue insulins) as well as patient education on the frequency, avoidance, recognition and treatment of hypoglycemia.

Funnell M. "Overcoming Barriers to the Initiation of Insulin Therapy." Diabetes Care. Jan. 2007; 25:36-38. Available at http://clinical.diabetesjournals.org/content/25/1/36.full. Accessed Oct. 17, 2012 .