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Insulin Therapy Barriers

Jan 20, 2018

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 8 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:


Correct Answer:  A. Fear that hyperglycemia will make her ill

Educational Critique: 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 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.


Patient. 2014; 7(4): 437–450.  Published online 2014 Jun 24. doi:  10.1007/s40271-014-0068-x

Diabetes Care. 2010 Apr; 33(4): 733–735.  Published online 2010 Jan 19. doi:  10.2337/dc09-1184