Supporting clients with type 2 diabetes who are starting insulin

Many people with type 2 diabetes have concerns about starting insulin. These concerns can stem from fear of injections, worries about hypoglycaemia, perceptions of personal failure, or uncertainty about how insulin will affect daily life. Recognising and addressing these concerns can support engagement and reduce anxiety.

The following discussion points may help you navigate common conversations with clients who are transitioning to insulin therapy.

“I’m worried about having a hypo”

Fear of hypoglycaemia is one of the most common concerns raised by clients starting insulin.

When introducing insulin, it can be helpful to explain that treatment typically begins with a low dose that is gradually adjusted based on blood glucose patterns. Reassure clients that their healthcare team will work with them to optimise dosing while minimising the risk of hypoglycaemia.

Key messages:

• Insulin doses are usually increased gradually.
• Regular meals and consistent monitoring can help reduce risk.
• Clients should be educated on recognising and treating hypoglycaemia.
• Changes to eating patterns or physical activity may require dose review.

“I hate needles”

Many clients assume insulin injections will be painful or difficult to administer.

It can be reassuring to explain that modern insulin pens are designed to be simple, convenient, and discreet. Many people find injections less uncomfortable than they initially expected and quickly gain confidence with practice.

Key messages:

• Most insulin is delivered by user-friendly pen devices.
• Needles are very fine and designed for comfort.
• Practical training from a diabetes educator or practice nurse can build confidence.
• Injection anxiety often decreases significantly once clients begin treatment.

“Insulin will disrupt my lifestyle”

Clients may worry that insulin will limit their independence, travel, or daily activities.

It is advisable to acknowledge these concerns while highlighting that insulin delivery devices are portable and designed to fit into everyday life. Improved glucose management may also reduce symptoms such as fatigue and improve quality of life.

Key messages:

• Insulin pens are portable and convenient.
• Clients can travel safely while using insulin.
• Routines and reminders can support regular use.
• Improved glycaemic management may enhance energy levels and wellbeing.

“I did everything right. Why do I need insulin?”

Some clients experience frustration or anger when insulin is recommended, particularly if they have worked hard to manage their diabetes through lifestyle changes.

Acknowledging these emotions is important. Explain that type 2 diabetes can often be a progressive condition and that insulin requirements will often change over time despite a person’s best efforts. Requiring insulin does not mean they have managed their diabetes poorly.

Key messages:

• Anger and frustration are common and understandable responses
• Diabetes progression is influenced by factors beyond lifestyle choices
• Psychological support may be beneficial when insulin initiation is causing significant distress
• Seeking support is a positive step in diabetes self-management.

“I feel like I’ve failed”

Feelings of failure can be a significant barrier to insulin acceptance.

A helpful approach is to reframe insulin as another tool for managing diabetes rather than a last resort. Explaining the decline in pancreatic insulin production can help clients understand why insulin may become necessary over time.

Key messages:

• Starting insulin is not a sign of failure
• Type 2 diabetes often progresses despite good self-management
• Many glucose-lowering medications improve insulin action but do not replace insulin production
• Insulin therapy helps address insulin deficiency when the pancreas can no longer meet the body’s needs.

“Will insulin make me gain weight?”

Weight gain is another frequently raised concern.

A balanced discussion can acknowledge that weight gain may occur in some individuals while emphasising the importance of overall dietary intake, particularly carbohydrate consumption, and appropriate insulin dosing. Referral to an Accredited Practising Dietitian may be valuable where additional support is needed.

Key messages:

• Starting insulin does not automatically result in weight gain.
• Nutrition and physical activity remain important components of management.
• Optimising insulin doses and reducing hypoglycaemia can help prevent unnecessary consumption of additional carbohydrates.
• Dietetic support may assist with weight management goals.

“Does needing insulin mean my diabetes is getting worse?”

Clients often associate insulin with severe diabetes or complications.

It can be helpful to explain that insulin is simply another treatment option used to help achieve glucose targets and reduce the risk of complications. In many cases, commencing insulin may improve outcomes and help clients remain healthier for longer.

Key messages:

• Diabetes should always be taken seriously, regardless of treatment type
• Requiring insulin is common as people age and diabetes progresses
• Insulin can help reduce the risk of diabetes-related complications
• Timely initiation may be more beneficial than delaying treatment

Practice tip

When discussing insulin initiation, you should explore both practical and emotional barriers. Many concerns relate less to insulin itself and more to what insulin represents to the individual. Using empathetic, non-judgemental language and reframing insulin as a proactive treatment option can support acceptance and successful transition to therapy.

By Donna Itzstein, Pharmacist and Credentialled Diabetes Educator