Monday , November 20 2017
Home / Resources / Test Your Knowledge / Question #810

Question #810

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):  

Correct

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.

Reference(s):
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 .

Incorrect